Saturday, 4 October 2014

What's a conflict of Interest


What's a conflict of Interest

A conflict of interest (COI) is a situation occurring when an individual or organization is involved in multiple interests, one of which could possibly corrupt the motivation.

The presence of a conflict of interest is independent of the occurrence of impropriety. Therefore, a conflict of interest can be discovered and voluntarily defused before any corruption occurs. A widely used definition is: "A conflict of interest is a set of circumstances that creates a risk that professional judgement or actions regarding a primary interest will be unduly influenced by a secondary interest." Primary interest refers to the principal goals of the profession or activity, such as the protection of clients, the health of patients, the integrity of research, and the duties of public office. Secondary interest includes not only financial gain but also such motives as the desire for professional advancement and the wish to do favours for family and friends, but conflict of interest rules usually focus on financial relationships because they are relatively more objective, fungible, and quantifiable. The secondary interests are not treated as wrong in themselves, but become objectionable when they are believed to have greater weight than the primary interests. The conflict in a conflict of interest exists whether or not a particular individual is actually influenced by the secondary interest. It exists if the circumstances are reasonably believed (on the basis of past experience and objective evidence) to create a risk that decisions may be unduly influenced by secondary interests.

These days when a Neuro talks they have to declare their conflicts of interests....because they can be perceived to influence the listeners treatment practises. 

So if Dr X is getting a reward e.g. a consultancy for their time from company Y and the talk is about company Y's drug then it is declared and you can choose to believe the data or not. However as you know there is a "mafia" of neuros others call this opinion leaders, including ProfG who seem to be on every trial. These guys have CoI statements longer than their talks.

However, the CoI's are now shown as an info blip during a talk. They are impossible to read at the lightening pace... as fast as a slide of Dr. ***** ********'s unpublished data :-) that they are shown. Therefore they are essentially useless. But is does not need a brain surgeon to link the speaker to the company supporting the meeting event.

Scientists seldom declare anything...They are usually not on the receiving end of financial reward. However, they could file a patent on their work and this could have financial reward sometime in the future.I questioned a senior Scientist on this they thought it was not a conflict...in their head it wasn't but it is the perception that you deal with.

I filed one patent on using anti-TNF to treat MS with the guy who filed the first patent on anti-TNF for arthritis. Needless to say it was duff in MS but has sold billions in arthritis. Guess who has the massive house in a nice part of town.

However if a scientist gets a few papers in Cell/Nature/Science they may get a job offer with a bigger salary. So do they declare the  paper a conflict of interest. No.... common sense prevails...Shame it doesn't always

37 comments:

  1. I'd like to make the following points:

    (i) MS research seems to be a nice little gravy train where, in addition to public servants (which, for example Profs G and M are - NHS or University or both) getting paid their salaries, they can make quite a bit extra doing work for the companies which sell drugs to the NHS). This situation would never be tolerated in the civil service e.g. a civil servant working for the MoD with responsibility for letting contracts for military equipment with the defence industry would not be allowed to do work on the side or taking consultancy fees from a defence contractor - it's classified as corruption.

    (ii) There's an issue of principle about motivation. I would hope that researchers into this dreadful disease and the MS neurologists would be motivated by the desire to improve the lives of MSers. I find it pretty distasteful if one of the motivators was to make quite a bit of dosh on the side.
    (iii) how much money are we talking about? Prof G's slides list a huge number of COIs i.e. companies he had done work for. There is no indication of the scale of the money involved for me to assess whether there is a real conflict. Prof G says that he follows the advice of a mentor who told him to work for everyone so there could be no allegation of bias for one company. My interpretation is 'fill your boots'.
    (iv) work life balance. Prof G moans that he is overloaded but he opts to do the work for companies on top of his NHS and university work.


    The system won't change as too many people are doing very well out of it. As a public servant myself, I could work in the private sector for more money, but wanted to do something for the public good (which I get a salary for). I'm glad my public body forbids me from undertaking work for private companies. That's the best way to avoid COIs.

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    1. Whilst I perhaps should not have posted this comment...but these arrive because ProfG is putting his head about the parapet and allowing you a view on his life. I will comment on some of the issues when I have time later today.

      Delete
    2. I worked for years in the private sector and worked really hard because I loved my job. Sometimes we were offered gifts or hospitality in appreciation of our commitment. this all had to be declared. Prof G has declared his conflicts and we are all free to make up our own minds. I'm a DMT sceptic, but that doesn't mean I'm not interested and believe that patients have the right to try them. MPs are still able to make money, outside of parliamentary duties. I don't mean expenses. Have we heard them declare their conflicts? No. Outsourcing of NHS to private healthcare providers and shares in pharmaceutical companies spring to mind.

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    3. Public servants can’t make extra money...well let’s look...Prince Charles public servant..gets the Duchy of Cornwall making $28,000,000..what he does with this is his business...What ProfG does with any pharma money is his business also.

      Members of Parliament...they don’t have second jobs do they?...Wrong.

      NHS doctors..oh private practise at a few hundred quid an hour.

      Does ProfG do private practise...no....oh well yes actually because the government are now making consultants private practioners as they have created a two tier system of haves and have nots. Access to drugs or not access to drugs. Does he get paid for this private practise...no. Is Prof G full time in the NHS..no...we have been through this before.

      Do Universities allow private consultancy work for personal gain...yes they do. Do they want us to interact with Pharma yes they do.

      Why because they usually are the ultimate beneficary, pharma money comes into the University and primarily not in our Pocket. But is a pharma grant a reportable COI..yes it is.

      Just got a contract from pharma...money in my pocket £0. Money in University Pocket lots...but this is how they pay their staff, which keeps the machinery working that allows the lecturers to teach your kids.

      Grant giving agenices are running out of cash because they get less donations. Universities are not funding infrastructure for running labs, the NHS is struggling finacially.....you have to think how you support secretarial work; lab managers; researchers; nurses, vets; etc, etc. You have to be innovative. Without infracture you cannot develop drugs or treatments.

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    4. Anon 8:31 how do you explain the Westland helicopter scandals? is political gain not corruption of some sort?

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    5. So now to point (i) We do work with companies that sell drugs to the NHS....Agreed.
      we do not work for these companies

      However your arms sales analogy goes astray as we have no control of the NHS buying the drugs. This is an independent body e.g. and as Prof G has declared his interests then the NHS side would not ask him to be on their side. So no corruption here.

      Likewise you are making the mistake of assuming money is always changing hands

      If ProfG were paying the NHS to buy a useless drug that would be correct. However, members of TeamG can be on both sides of fence working or NICE DoH and pharma but not at the same time. This nearly happened once by chance I found two neuros were attending the same EMA meeting but because we under stand what conflicts are one side withdrew.

      Therefore this comment is irrelevant I believe

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    6. (iii) Motivation if you think you are in this game to get rich think again...if you want to make a difference the only way is pharma....ProfG spends lots of time trying to convince pharma A or Pharma B to do studies that will help to get drugs to people with MS. Some of this is successful some not.

      Motivation The only way is pharma! To think otherwise is delusion.

      I you read version one I apologise

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    7. (iii) how much money are we talking about? Prof G's slides list a huge number of COIs

      None of your or my business. The taxman is interested. As i said CO is not necessarily fill your boots

      Delete
    8. Anonymous 8.31
      I'm afraid your civil service as a model of propriety does not stand up. HMRC for example regularly employ tax consultants from the big accountancy firms to advise hMRC on tax policy, they then go back armed with the knowledge on how to evade the new rules. Massive conflict of interest!

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    9. Someone posted this
      Marcus Aurelius said "everything we see is a perspective, it is not the truth", he also said "if you are distressed by anything external, it is not due to the thing itself but your judgement of it ...'

      So take a chill pill and maybe I will

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    10. Lol, I totally recommend Marcus Aurelius (not the film version) and stoicism (not the version most thought of as stoicism), along with meditation (in my case Zen) to keep one 'chilled'. Well, it works for me (for over 25 years).

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  2. How many MS drugs have MS pharma delivered to people with MS....SO FAR ABOUT TEN

    How many MS drugs have academics delivered to people with MS......ZERO

    Therefore, if you want to develop a drug for someone with MS, you need to engage with Pharma. It is simple as that..no engagement with pharma and you will have no progress. Any engamenet and this is percieved as a COI even if it in't an actual CoI

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    1. Well said MouseDoctor. I don't think you need to justify any of this, but if it stops the 'black or white' simplistic comments, great. Watch those stress levels :)

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    2. "How many MS drugs have MS pharma delivered to people with MS....SO FAR ABOUT TEN

      How many MS drugs have academics delivered to people with MS......ZERO"

      No drugs that can be patented, but academics are working on therapies such as HSCT which is likely to be approved in the near future for those who fail 1st line treatments.

      These are the real hero's in MS research. I can understand Team G's dissaproval for this therapy as it will kill the cash cow.

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    3. MD, please don't waste your time on the likes of Anonymous 7.03

      And those who think Team G is in this for the money: don't waste your time on this blog

      Delete
  3. If you work as a civil servant during the day...could you work as a shopkeeper in the night? I think you could.

    If you want to build a house, would you design it yourself? or who you get someone with the expertise to design it for you? Would you expect to pay the architect for this service?...I would, wouldn’t you?

    Would you question what the architect does with that income?...I wouldn’t... it’s their business.

    If pharma requests a service, where they don’t have the correct expertise in house, would you expect that they pay for this service? I think that you would expect that they would have to pay for this service. Therefore, if I was going to give a seminar at a drug company they usually have to compensate you for the time taken in preparation of the service.

    Do we always charge pharma for this service...No, because it is about helping them to help them get treatments to you.

    Currently I am helping an Asian Pharma get their MS models going we have asked for nothing; I know ProfG is helping a company deliver a drug to people with MS; he has asked for nothing, even when he could. In contrast to Jesse J is is not all about the money, money , money

    I am contracted for the typical 40h week and work around 70-90h. Think, how much time doing this blog alone takes. Do the University want this type of activity, well they believe public engagement in science is part of our function.

    Can we do pharma work, well we can do it within our university role and we inform our line-managers. We can do it in our personal time also. Can we get paid for this work, would you work for free or would you prefer to be paid for what you do? What do you do with the money, we can either pay tax on it or put it into accounts in the university to pay for things that the university do not pay for, fund a research project, fund a research day..they don’t grow on trees, etc.

    I was asked to do a PhD by another university (i.e. not my employer) recently this takes a day to do and if you do the viva another day and another few hours doing paper work. They have to pay for this service. You get £150, less tax, so is this below minimum wage?

    In another instance, I have just donated my fee from an Australian University to the Australian MS Society it is my choice. Could and would I keep the money.....it is likewise my choice.

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  4. Thanks for publishing a defence, MD. Why are people so cynical about the good intentions of TeamG? I find it really puzzling and quite sad - imagine having that outlook on life! It is obvious to me that members of the team do what they do for a few reasons - obviously to be paid for their expertise, but also to conduct research which adds to the body of knowledge about MS and hopefully lead to effective therapies. Thanks for the work you do, it is much appreciated.

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  5. It is an important discussion and I am glad MouseDoctor took the time to reflect on many aspects of interactions between pharma - hospital doctors/opinion leaders. It is impossible to do a phase III study without many hospital centers involved ( how would pharma recruit patients in the trials and who would do all the clinical work? It takes many hours of work per patient enrolled in the study and I am very glad pharma is paying for it and very glad that some patients are willing to participate - there would be no progress and no new drugs otherwise. )
    And that the "opinion leaders" are paid generously for the lectures? well, they are. It takes many years of hard work to aquire the knowledge needed to be considered an "opinion leader" :-). It takes a lot of time to prepare a lecture, pack your bags and then travel to the other end of the world ... every other week. I am surprised there are people who want to do it, even for the $$$ they get ;-)
    J

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    1. Thanks I agree but some of the "opinion leaders" hang onto other's shirt tails:=)

      Delete
  6. A feature article in BMJ this week: Should patient groups be more transparent about their funding?

    http://www.bmj.com/content/349/bmj.g5892

    MS charity funding was discussed.



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    1. Interesting, yes MS charities will gladly accept cash from many sources including pharma.

      However a worse example, I believe a company set up a charity to fund work what was in the companies interest. The charity spent its time getting other people to pay for the work...business genius or scumbags?

      Likewise what happens when a company supports people power behind the scenes

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  7. (iv) work life balance. Prof G moans that he is overloaded but he opts to do the work for companies on top of his NHS and university work.

    You have no idea of what profG will do, how can you? I am not sure, however some of you are pissing and moaning, why? Prof G can do this or that and to some people it will
    not be good enough.

    He wants to take a sabbatical and is he the anti-christ?

    Academics can take a sabbatical. It is part of their job description. Some people go away for a year or son. Do they sit on their a** and do nothing. Ask Prof G down under.... on sabbatical from Oz...I think he is doing the charcot project so it is not lazy ass?

    Some people are pissing and moaning about prof G taking a 6 months break...What is going to be done during this time..maybe getting treatment to MSers. I didnt hear you complaining as Dr C from Cambridge taking a 12 month sabbatical. Yet this happened.

    Think before you spout.

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    1. Dr C from Cambridge helped get a highly effective drug to market - fantastic work. He's just about to start a trial of a remyelinating drug. He certainly deserved a sabbatical. Sorry, i didn't catch the name of the highly effective or neuroprotective or remyelination drug which was developed and got to market by Team G.

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    2. Well done to the Team C for their role in CAMPATH development and lets hope that Dr C has success with the remyelinating trial, but as we know a trial is not a drug to market. But lets not forget the other scientists who came up with the idea.

      However I think you will find that ProfG and TeamG has been involved in a significant number of compounds that have come to market and in many ways that we do not and cannot talk about. A scientist cannot lead trials and this needs a consultant neurologist so even if I invent the cure someone else will take the credit.

      As to doing trials, I think we are probably doing five to ten at any one time as it gives our patients options, it is they who are the heros because without people willing to take a risk there would be nothing.

      Name a drug that members of the team were involved in, would being inventor of beta interferon be a drug that came to market I wonder?

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    3. Professor Yuti Chernajovsky comes to mind?

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    4. Really scraping the bottom of the barrel if interferon is the best you can do. I'm just after one drug which in the last ten years was identified by Team G (over the last ten years) and I can now benefit from.

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    5. Well we were instrumental in cannabis being taken seriously as a symptom relief agent for MS. I did a fair bit of work back in the day on agents that reduced lymphocyte migration into the brain which paved the way for the development of Tysabri. Prof G has been involved in pretty much all the clinical trials for the current medications approved for MS plus many in development.
      Also we have got trials for neuroprotective agents for MS underway building on our now extensive experimental data plus the anti-retroviral Charcot study.
      We're proud of our achievements but there is still much to do.

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    6. Me and MD have also over the last 10 years been developing a new class of anti-spastic agent which has none of the side-effects of conventional anti-spastic medications such as Baclofen etc, which we are hopeful will improve the lot of MSers in the future.
      No hanging of heads in shame here.

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    7. MD2 - thanks. But in reality there is nothing that has so far benefited me or any others users of this blog. I really hope that will change with neuroprotective drugs and / or a drug from the Charcot project. I don't doubt the effort, but if you tot up all the research papers, attendances at conferences and seminars, something on the shelf of a pharmacy is still lacking. This situation is similar to lots of other research teams.

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  8. I can see that from one side you can see this or that...but at the end of the day its not about filling pockets it is for more about trying to get useful treatments available. You do profG an TeamG an amazing dis-service by suggesting otherwise.

    We take a lot of flack about being idle so and soes. However we do not need to hang our heads in shame in contrast to what some of your say. We are trying to get treatments available.

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  9. The original poster made some interesting points. The biggest scandal is that for the last 20 years the ms pharma companies made tens of billions of dollars sellng us drugs with limited efficacy. Perhaps an even worse scandal is that ms research has been funded for 60 years yet no cure has been delivered nor the basiv questions about the disease answered. On the issue of Team G, i have yet to see any major breakthroughs. Perhaps 2015 will be different.

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    1. Sellng us drugs with limited efficacy......They do what was said on the tin.

      Pharma companies making millions.......They are a business often with shareholders, however they need to defend themselves.
      No cure has been delivered.......Who delivers....pharma.....they prefer to manage.....but maybe the 50% of people who don't need more treatment on Alemtuzumab may beg to disagree.

      TeamG-Look abit harder and you will find but what are your expectations of breakthroughs.....your level of research is rubbish!
      I won't ask where you think breakthroughs have been made and why.

      2015-Hopefully for more progress.

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    2. When those drugs with "limited efficacy" came out they were the only drugs for MS. Take it or leave it. Something or nothing.
      And biological systems are extraordinarily complex, autoimmune diseases have many things going wrong at the same time and we have no "cure" for any of them as far as I know.
      MS research is not slow compared to research in other autoimmune diseases. Take SLE... one new approved treatment for SLE since the 50s?
      But if it was up to me I would put more money into research labs and less into non-productive epidemiological rambles. ( which are great for increasing the number of publications and PhDs, but little otherwise :-).
      J

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    3. noboby puts money into epidemiology and this is why we get the rambles:-)

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