by Carl V Phillips
Chris Snowdon understands what constitutes true conflict of interest, and provides us with two critical observations about it relating to THR. I point out that he understands it because most people who invoke the concept, especially those who make it a centerpiece of their rhetoric, clearly do not have a clue about what it means.
Conflict of interest occurs, to put it clearly enough that even those who harp on the concept might understand, when there is an interest someone is supposed to be serving (perhaps due to their job description, but possibly just because of how they are representing themselves), but there is something about that individual that might cause them to favor some other interest that is conflict with the one they are supposed to be serving. Notice that this is not remotely similar to the usual naive misunderstanding of the concept, that COI exists iff and only if someone has received funding from industry. Indeed, notice the funding is not only not sufficient for COI to exist, but it is not necessary.
For example, when Stanton Glantz humorously tried to take on Igor Burstyn’s science, he had a severe conflict of interest: He was pretending to offer a scientific analysis, and thus was obliged to fulfill the interest of being an honest scientific analyst, but because Glantz is really motivated entirely by personal politics when he is pretending to be a scientist, there is a conflict of interest. By contrast, if Glantz has published his screed and had made clear his real goal — “here are some talking points that those of you who wish to deny what this study demonstrated can use” — then there would have been no COI. This is because his personal politics would be perfectly aligned with the interest he claimed to be serving, so there could be no conflict. Whether some interest creates a conflict obviously depends on what interest you are claiming to serve. That should seem rather obvious, but again seems completely over the head of almost everyone who presumes to make a big deal about COI.
In this brief but completely damning post, which he quite rightly describes as the “conflict of interest of the week”, Snowdon reports on a director at a smoking cessation clinic complaining about the success of e-cigarettes in taking away his clients. The director includes an attack on vaping as part of that. So, what interest is a government-funded smoking cessation employee suppose to be pursuing? Smoking cessation, of course. If he is objecting to successful smoking cessation it must be because he is more interested in serving some other interest, say, keeping his job.
In this much longer post, Snowdon explores how COI seems to being the defining factor in government decision-making about e-cigarettes. The interest of a government official is supposed to be the interests of her constituents or the people. Snowdon recounts a recent story that, by itself, is the typical naive COI story: The expert panel that advised the UK MHRA on e-cigarettes included people who had gotten grants and contracts from pharma companies. Left by itself, that is a major *yawn* — everyone with any skills in health research has gotten grants/contracts from pharma companies. But treating that as if it were somehow noteworthy in isolation is exactly what most commentators did. Would the influence from such funding alone cause someone to lie? Doubtful.
But contrast, Snowdon goes on to put this in the context of the outright bribery that seems to dominate EU parliament votes related to tobacco and THR. Of course, the EU is pretty much purpose-built for COI. The representatives are so incredibly far from their constituents, and barely monitored by them or the press, and live in a disconnected world that is all about power and connections and prestige (and thus the handing out of material benefits). Europe still loves monarchy (though if you have real monarchy there is no COI because there is no obligation to the people — l’etat c’est moi).
Snowdon leaves it to us to connect the dots, but I think he is pointing out that perhaps we should be rather more wary about observations that might suggest there might be a hidden COI (even though they do not themselves represent a real COI) among decision makers. A history of a few grants and contracts means nothing, unless it is a corner of a serious COI scandal. It is as if we were considering tobacco industry behavior and we were still living in 1975 (which, apparently, most of tobacco control thinks is the case) and there were subtle hints of tobacco company influence over decision makers. That would be in the context of definitive evidence of improper influence elsewhere, and would suggest extra scrutiny. Except in this century, of course, it is everyone other than the tobacco industry that seems to warrant the extra scrutiny.
Finally, it is worth noting that while the prospects of personal financial gain might explain the behavior of the MEPs, I actually think it is way down the list of important COIs that caused people to lie about e-cigarettes in the other cases. Tobacco control and smoking cessation people are probably much more conflicted by the desire to personally be responsible for health benefits, a self-centered but not precisely selfish motive. That is, they are desperately afraid that the goal will be achieved in spite of them rather than instead of them. This interest conflict severely with the goal itself when the world moves on and the goal is better served by what others are doing.