What is conflict of interest?

posted by Carl V Phillips

A background post today, on the topic of conflict of interest (COI; aka “competing interests”).  This is a critical topic to understanding when identifying and critiquing lies.  It is a favorite topic of some commentators.  But it is also woefully misunderstood, and almost never discussed accurately.

About 90% of the time that someone mentions COI in the context of THR, they really do not care about  COI at all.  It is just one of the anti-THR liars looking for an ad hominem attack on a political opponent because they have no honest arguments and factual lies can only take them so far.  But that is actually just one example of the misuse of the concept that occurs about 99.9% of the time that the term is used in related contexts (and, as far as I can tell, many other contexts).

To understand what COI really means, we need to start with the term itself:  What is conflicting or competing with what?  I suspect that most people who write about COI have never even thought that through.  The interest that most authors, particularly a scientists/researchers, are supposed to be motivated by is communicating the truth.  Any desire to support a particular worldly political goal is another interest that may compete with that.  Researchers who are anti-THR liars are clearly more motivated by their desire to discourage THR than they are by the ethics of doing honest research (and there is no enforcement or system of rewards in this area that compels them to do honest research).

Notice one immediate implication of this:  If it is unambiguous that someone is communicating from an advocacy perspective, then their interest in advocating does not represent a conflict.  When CASAA advocates that people should get honest information and that smoke-free alternative should be available, there cannot be a COI because promoting those are our stated interests.  By contrast, when Christina Gratziou or Stephen Hecht conducts and reports research that is primarily motivated by political (anti-THR) goals, but pretends they are just motivated by scientific truth-seeking, there is a clear COI.  When people like Gratziou or Ellen Hahn produce anti-THR broadsides and statements to the press, they could avoid the COI problem by identifying themselves as being political activists rather than scientists (they would still be liars because their claims are false, but at least they would not be liars with unreported COI).  However, when they pretend to be acting merely as scientific purveyors of information — implying that their primary interest is that of honest researchers or academics — then they create a COI with that lie.

By now you have probably noticed the lack of any mention of funding in all of this.  That is because — contrary to the common naive view — funding is not COI. This is perhaps the most important thing to understand about COI:  It is about preference or belief — and willingness to act on those preferences when it is unethical to do so — not about what motivates someone to those actions.

Receiving funding from an entity with an interest in THR is neither a necessary nor sufficient condition for having a COI.  The relationship of funding to COI is very similar to the relationship between toxicology and real world outcomes that I discussed before:  Funding is one possible explanation for why someone might have a COI, but it is not the COI.  The COI is the motivation to get a particular result from research or to communicate particular claims apart from their truth, no matter what the motive.

Indeed, it is actually quite naive to think that research grants create much COI.  There has been a lot written recently about how Gratziou and Hahn have both been paid by pharmaceutical companies who stand to lose revenue when THR succeeds.  But I really doubt that this funding had much effect on those people’s anti-THR positions.  I have little doubt that their primary motives, like those of most anti-THR liars, are the non-funder-related motives we identified when this blog was started.  It might be that funding has some influence at the margin, but I lived in that world long enough to know that funding generally chases true believers, rather than creating them.

The exception to the “funding is not sufficient to cause COI” observation is when someone is employed by an organization with a position on the matter at hand (THR or whatever) or the rarer case when someone owns intellectual property or other substantial assets that will dramatically change in value based on research results.  Someone who invented a product obviously should not be the one we trust to do the research on whether it works.  Employees of anti-THR organizations like, say, the American Cancer Society or most units of the US government, would probably suffer serious consequences if they told the truth about THR.  Such individuals have such extreme COI that if they wanted to try to be honest scientists, they would need to go to great lengths — making sure their work was extremely transparent, thoroughly reviewed by anyone who wants to review it, etc.

For an example of that, consider the scientific research that comes out of BAT.  The researchers there know that they have a clear COI because of their employment status, but are intent on doing honest research that contributes to our understanding of the health impacts of tobacco products (THR and otherwise), and having it taken seriously.  (I can testify to these motives based on extensive communication with many of them; this contrasts with those who casually make declarations about people’s motives with neither material evidence nor any familiarity with the people in question.)  Knowing that they have to deal with that COI, the researchers openly share their research to the extent possible and are very conservative in their conclusions.  Contrast that with most research from anti-THR organizations and individuals that is secretive, never seriously reviewed, and overstated.

Notice also that I mentioned the US government.  As noted in yesterday’s post, and as will become further apparent from future posts, the US government is and has been the most aggressive anti-THR liar in the world.  The EU government and the UN are similarly anti-THR and similarly dishonest.  So if funding were tantamount to COI, then anyone receiving funds from the US government or most other large governments or quasi-governments would have a COI.  Indeed, it is rather more likely that a government would cut off someone’s funding for taking the “wrong” position than would a pharmaceutical or tobacco company.  Governments and their puppets and puppet masters are all about politics, after all, while manufacturers have a real stake in good science, and are generally capable of distinguishing between someone’s scientific contribution and their political views.

You might notice that the only people who could be seen as being without sin — those who never take any money to work on THR (pro or con) and do not anticipate that their work on the subject will affect their income in any way — do not seem to make a big deal about COI.  The only people who come to mind are Bill Godshall and most of the CASAA board of directors.  Pretty much every complaint about funding in this arena comes from people who are lavishly funded by someone with an interest in the outcome, and who are trying to keep it that way.

Still not convinced?  How about a personal example.  A plurality of my recent income has come from the pharmaceutical industry, as has a solid majority of my family’s income.  Over the course of my life, weighted by how much value the marginal income had to me, I have gotten more from pharma than any other industry (not counting universities themselves as an industry).  So that explains why I am so biased in favor of pharma when I write about THR, huh?  Um, yeah, right.  Also solidly in the top few industries for providing my lifetime income is the energy industry, and those who are familiar with some of my other work will notice that I am oh so positive about them.  [These last few sentences were all sarcasm, in case it was not obvious.]  The key is that, in contrast with government grants and hiring which are almost always heavily motivated by politics, it is my experience (and the reported experience of everyone I know who has worked in all of these realms) that most corporations — pharma, tobacco, or otherwise — are interested in the learned input of anyone who is honest and productive, even if they are often on the wrong “side”.

To summarize:  COI is not about funding, it is about interests, and it is much more common than generally perceived.  Lying by an ostensible scientist or expert is definitive evidence that she has a COI, whereas having a COI certainly does not mean that someone is lying.  Moreover, if you do decided to look at funding sources for clues about who might have a COI and thus be lying, you should be somewhat less concerned about corporate funding than the usual rhetoric implies, and way more concerned about government and advocacy group funding and employment.