by Justin B. Moore, PhD, MS, FACSM
The Scholarship of Public Health addresses topics relevant to scientific publishing, dissemination of evidence and best practices, and the education of current and future professionals. Typically, this column presents some considerations and best practices for finding time to produce scholarship in the form of a manuscript or presentation. This post looks at the varying ways that conflicts can manifest themselves in research.
“Hell isn’t merely paved with good intentions; it’s walled and roofed with them. Yes, and furnished too.” ~ Aldous Huxley
Several years ago, a New York Times blog described a conflict of interest in which three prominent scientists received an unrestricted grant[a] from the Coca-Cola Company to conduct research and convene an international consortium of scientists to address issues of “energy-balance.” The scientific publications of the group were clearly identified with the source of funding; less alarm was raised about that component since industry funding is not unusual in obesity research. What caused the most alarm was the lack of funding disclosure on the Global Energy Balance Network website and invitations to join the network. This omission was compounded by controversial statements by one of the three researchers under scrutiny, statements that appear to support the position of the soda industry and advance the notion that sugar-sweetened beverages are not to be avoided as long as one exercises enough to bring oneself into energy balance. Considering previous investments by Coke to manage the messages about their products, one can hardly be blamed for becoming alarmed by this lack of disclosure or the comments supportive of an industry that many view as evil. Clearly, the Times author found a witch, and we all know what we do with witches. The resulting backlash was not pretty, to say the least.
However, while this unfortunate example was relatively straightforward (the scientists in question experienced formal repercussions, some severe), similar arrangements may not be as clear-cut as some would have you believe. Biasing influences are everywhere, and some are not as obvious as others. A multi-million dollar grant to promote energy balance from an industry with a clear connection to obesity (and unethical marketing practices to boot) certainly represents a conflict of interest. However, I would argue that there are other equally incentivizing sources of bias, both financial and philosophical in nature. For example, many researchers are directly compensated by industry to serve in an advisory capacity or to make public appearances and give lectures. Other scientists may file patents or create businesses based upon their research. Still more use their expertise in the field to write books for public consumption, and receive royalties from the publisher to the extent that the book sells, driven by a compelling presentation of the current science. In the latter example, a considerable monetary incentive exists to confirm the science supporting the positions presented in a book, since the market for books wherein authors contradict their own research is probably small. Finally, we all have personal biases that are a product of our experience and expertise but also a driving force in the questions we form and which we decide to investigate. For example, I find it very unlikely that a proponent of a meat-centric diet will write a grant proposal to test the benefits of a plant-based diet (or vice versa). While these internal biases seem more benign, they are influential just the same, perhaps “justifying’” a few more post-hoc analyses to identify beneficial (or harmful) effects of the nutrient or behavior under study. Again, a witch may be afoot.
Since the scientific community is clearly infested with witches, the question is how we purge ourselves of their influence. Taking a primary prevention approach, we could simply ban all industry funding at academic and nonprofit research institutions. This ban would also need to include honoraria from industry, profits from side businesses, or royalties from publishing companies since these could be equally influential on our scientific output. However, as one with an interest in implementation, I concede that this approach is not very feasible, especially given the current funding climate.
Taking a secondary prevention approach, we could put additional policies in place to protect against the source of funding influencing the findings of the research, since any influence of industry funding on discoveries would hypothetically be mediated by poor methodology or willful manipulation of data. With a secondary prevention approach, it would be imperative to create ad-hoc independent panels (comprised perhaps of a methodologist, a statistician, and a content expert) who would review all manuscripts from industry-funded authors (broadly defined) prior to submission to scientific journals. This would not be without expense, but this could be passed to the funding organizations. Scientific journals themselves could increase scrutiny of industry-supported manuscripts, subjecting all manuscripts with industry funding, honoraria, or royalties to additional statistical and methodological review. While this may seem unnecessary to some of my colleagues who deem some industries more trustworthy than others, this prevents the challenging task of judging the motivations of the corporation and/or the health benefits of their product lineup.
Taking a tertiary prevention approach, we could simply wait for evidence (any evidence) that someone has received funding/honoraria/royalties from an industry, make a subjective judgment regarding the health benefits of their product and/or ethics of their business practices, and celebrate/ignore/vilify the scientist at our discretion. Admittedly, this is the most personally fulfilling since most of us feel confident to do so,1,2 and social media has given us access to instant social reinforcement from our peers and admirers. However, this approach, by its nature, does nothing to prevent the publication of willfully or subconsciously misleading evidence, thereby fueling a growing public mistrust of the scientific community. Clearly, this is the least appealing of the three prevention options from a public health perspective, but it is also the de facto choice we’ve made.
Ultimately, the public health community must identify a witch-control strategy that can be implemented and disseminated in a manner to maximize effectiveness. As with many prior epidemics, primary prevention efforts may produce unintended consequences, and tertiary prevention efforts will prove to be ineffective, costly, and counterproductive. Secondary prevention clearly holds the most promise but is not without costs. These costs may be financial in nature or take the form of reductions in academic freedom that the most virtuous (and unscrupulous) of us enjoy. However, only a systematic approach that treats known and unknown threats alike will be effective in preventing both conscious and subconscious bias from obstructing the creation of an optimal public health agenda. Good intentions are not enough to protect us from our biases, just like industry funding cannot be expected to corrupt by mere presence. Only a systematic approach that treats all money equally in its power to corrupt (regardless of source) can protect us from ourselves and allow sound science to evolve.
- Dunning D, Johnson K, Ehrlinger J, Kruger J. Why people fail to recognize their own incompetence. Current Directions in Psychological Science. 2003;12(3):83-87.
- Kruger J, Dunning D. Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated self-assessments. Journal of Personality and Social Psychology. 1999;77(6):1121-1134.
[a] Unrestricted grants provide funds to the university that can be freely used by the principal investigator to support their general research interests. By definition, they have no formal requirements for consulting with or reporting to the sponsor before disseminating the results of the supported activities.
Justin B. Moore, PhD, MS, FACSM, is the Associate Editor of the Journal of Public Health Management and Practice and an Associate Professor in the Department of Implementation Science of the Wake Forest School of Medicine at the Wake Forest Baptist Medical Center in Winston-Salem, NC, USA. Follow him at Twitter and Instagram. [Full Bio]
Read previous posts by this author:
- Writing the Methods Section of Your Manuscript for the Journal of Public Health Management and Practice
- Teaching Public Health Practice For Non-Practitioners
- Writing a Cover Letter to a Journal
- Writing the Results Section of Your Manuscript for the Journal of Public Health Management and Practice
- A Few Tips on Avoiding Burnout in Academic Public Health
- Writing the Discussion Section of Your Manuscript for the Journal of Public Health Management and Practice
- Impact Factor: The Metric You Love to Hate
- Finding Time for Scholarly Writing, Part II
- Finding Time for Scholarly Writing, Part I
- Who Is a Scientist, Anyway?
- Letting Journal Editors Do (Some of) Your Work for You
- Selecting the “Best” Journal as an Outlet for Your Work
- How Can Public Health Students Make Themselves Competitive for Employment?
- Writing an Abstract for Publication
- When Is Public Health Coming to Students of Public Health?
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