<!DOCTYPE html>

<!--
 * Project   : Research Integrity (RI_INT)
 * Version   : 2.0.0
 * Release   : Fri Apr 24 2020 11:39:36 GMT+0100 (British Summer Time)
 * Copyright : Oxford University Press / Epigeum
-->

<html data-programme="Research Integrity" data-course="Conflicts of Interest">

	<head>
		<title>What can go wrong?</title>
		<meta charset="UTF-8">
		<meta http-equiv="X-UA-Compatible" content="IE=edge">
		<meta name="viewport" content="width=device-width, initial-scale=1">

		<link rel="stylesheet" type="text/css" href="../css/project.min.css">
		<link id="basic-print" rel="stylesheet" type="text/css" href="../css/print.min.css" disabled>
		<link id="summary-print" rel="stylesheet" type="text/css" href="../css/print_interactive.min.css">
	<script type="text/javascript" src="../scripts_scorm_12/SCORM_12_APIWrapper.js"></script>
<script type="text/javascript" src="../scripts_scorm_12/courseFunctions.js"></script>
</head>

	<body onLoad="javascript:Initialize();" onUnload="javascript:Terminate();">
	  
		<div id="app" v-cloak>
			<base-container
				screen-id="coi_1_70"
				current-module = "Conflicts of Interest"
				page-title = "What can go wrong?"
				screen-time = "5"
				screen-time-period = "mins">

				<page-container>
					
					<page-row>

						<page-content-main>
							
							<p>Unfortunately, the effectiveness of the disclosure policies used by universities, journals and professional organisations varies considerably. There is evidence that:</p>

							<ul>
								<li>Significant numbers of researchers do not report conflicts of interest in publications, even when they are required to do so (Klitzman <em>et al.</em>, 2010)</li>
								<li>Journals sometimes do not enforce or even follow their own conflict of interest policies (Goozner, 2004)</li>
								<li>Professional societies have been unable to identify and deal with the conflicts of interest of some of their members and advisors (Risen, 2015).</li>
							</ul>

							<p>For links to the articles cited, see the "Useful links" pod.</p>

						</page-content-main>

						<page-content-sidebar>

							<!-- USEFUL LINKS START -->
							<pod variant="a" has-modal="true">
								<pod-heading>Useful links</pod-heading> <!-- pod title -->
								<pod-content></pod-content>
								<!-- pop-up pod content -->
								<pod-modal-heading>Useful links</pod-modal-heading>
								<pod-modal-content>
									<hosted-link id="RI_INT_coi_1_70_1">
										<p>Klitzman <em>et al.</em>, 2010 &ndash; <a href="https://www.ncbi.nlm.nih.gov/pubmed/20663770" target="_blank">Disclosures of Funding Sources and Conflicts of Interest in Published HIV/AIDS Research Conducted in Developing Countries</a></p>
										<p>Goozner, 2004 &ndash; <a href="http://www.cspinet.org/new/pdf/unrevealed_final.pdf" target="_blank">Unrevealed: Non-Disclosure of Conflicts of Interest In Four Leading Medical and Scientific Journals</a></p>
										<p>Risen, 2015 &ndash; <a href="http://www.nytimes.com/2015/07/11/us/psychologists-shielded-us-torture-program-report-finds.html" target="_blank">Outside Psychologists Shielded U.S. Torture Program, Report Finds</a></p>
									</hosted-link>
								</pod-modal-content>
							</pod>
							<!-- USEFUL LINKS END -->

						</page-content-sidebar>
						
					</page-row>
					
					<page-row>

						<page-content-sidebar>

							<interactive-text>

								<!-- USEFUL LINKS START -->
								<pod variant="a" has-modal="true" class="pod2">
									<pod-heading>Useful links</pod-heading> <!-- pod title -->
									<pod-content></pod-content>
									<!-- pop-up pod content -->
									<pod-modal-heading>Useful links</pod-modal-heading>
									<pod-modal-content>
										<hosted-link id="RI_INT_coi_1_70_2">
											<p><strong>Vaccinations and autism</strong></p>
											<p>DeLong, 2012 &ndash; <a href="https://www.ncbi.nlm.nih.gov/pubmed/22375842" target="_blank">Conflicts of Interest in Vaccine Safety Research</a></p>
											<p>Jones, 2004 &ndash; <a href="http://www.nature.com/news/2004/040223/full/news040223-1.html" target="_blank">Link Between Vaccine and Autism "Entirely Flawed"</a></p>
											<p>Wakefield <em>et al.</em>, 1998 &ndash; <a href="http://www.ncbi.nlm.nih.gov/pubmed/9500320" target="_blank">Ilelal-Lymphoid-Nodular Hyperplasia, Non-Specific Colitis, and Pervasive Developmental Disorder in Children</a></p>
											<p><strong>Lung cancer and tobacco companies</strong></p>
											<p>Harris, 2008 &ndash; <a href="http://www.nytimes.com/2008/03/26/health/research/26lung.html?hp" target="_blank">Cigarette Company Paid for Lung Cancer Study</a></p>
											<p>Henschke <em>et al.</em>, 2006 &ndash; <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa060476" target="_blank">Survival of Patients With Stage I Lung Cancer Detected on CT Screening</a></p>
											<p><strong>The benefits and dangers of GMO foods</strong></p>
											<p>Lipton, 2015 &ndash; <a href="http://www.nytimes.com/2015/09/06/us/food-industry-enlisted-academics-in-gmo-lobbying-war-emails-show.html" target="_blank">Food Industry Enlisted Academics in G.M.O. Lobbying War, Emails Show</a></p>
											<p>Kroll, 2015 &ndash; <a href="http://www.forbes.com/sites/davidkroll/2015/09/10/what-the-new-york-times-missed-on-kevin-folta-and-monsantos-cultivation-of-academic-scientists/" target="_blank">What The New York Times Missed On Kevin Folta And Monsanto's Cultivation Of Academic Scientists</a></p>
											<p><strong>The role of psychologists in interrogation</strong></p>
											<p>Woolf, 2015 &ndash; <a href="http://www.psychologytoday.com/blog/the-fight-against-hate/201507/torture-apa-and-the-hoffman-report-what-now" target="_blank">Torture, APA, and the Hoffman Report: What Now?</a></p>
											<p><strong>Cancer research leader overlooks his reporting responsibilities</strong></p>
											<p>Ornstein and Thomas, 2018a &ndash; <a href="https://www.nytimes.com/2018/09/13/health/jose-baselga-cancer-memorial-sloan-kettering.html" target="_blank">Top Sloan Kettering Cancer Doctor Resigns After Failing to Disclose Industry Ties</a></p>
											<p>Ornstein and Thomas, 2018b &ndash; <a href="https://www.nytimes.com/2018/10/12/health/memorial-sloan-kettering-cancer-disclosure.html" target="_blank">Sloan Kettering Researchers Correct the Record by Revealing Company Ties</a></p>
										</hosted-link>
									</pod-modal-content>
								</pod>
								<!-- USEFUL LINKS END -->

							</interactive-text>

						</page-content-sidebar>

						<page-content-main>
							
							<instructional-text><p>Click on each image for a different example of how issues related to conflicts of interest can have severe consequences. You can find links to the articles cited in the "Useful links" pod.</p></instructional-text>
							<accessible-text><p>Continue on for a different example of how issues related to conflicts of interest can have severe consequences. You can find links to the articles cited in the "Useful links" pod.</p></accessible-text>
							
						</page-content-main>

					</page-row>
					
					<page-row>
						<page-content-wide>
							
							<!-- ACTIVITY START -->
							<opinions>
								<opinion name="Vaccinations and autism" img-src="../images/activity_images/course_specific/coi_1_70_img1.png" img-alt="Alt">
									<p>In 1998, the medical journal <em>The Lancet</em> published an article reporting on a link between autism and the combined measles, mumps and rubella (MMR) vaccine. Further newspaper investigations revealed that the author of the paper, Andrew Wakefield, had significant conflicts of interest that had not been reported to the journal.</p>
									<p>The journal's editor, Richard Horton, later regretted publishing the article, and it was subsequently retracted. Nonetheless, the article received widespread attention and has been linked to a drop in vaccination rates and a rise in outbreaks of some childhood illnesses that had previously been on the decline (DeLong, 2012; Jones, 2004; Wakefield <em>et al.</em>, 1998).</p>
								</opinion>
								<opinion name="Lung cancer and tobacco companies" img-src="../images/activity_images/course_specific/coi_1_70_img2.png" img-alt="Alt">
									<p>In 2006, Weill Cornell Medical College researcher Claudia Henschke reported in the <em>New England Journal of Medicine</em> (<em>NEJM</em>) that 80% of lung cancer deaths could be prevented through the widespread use of CT scans (Harris, 2008). Later investigation raised a number of questions about undisclosed or vaguely reported conflicts of interest. These concerned the following points:</p>
									<ul>
										<li>Most of the funding for the project came from a non-profit foundation that received its funding from tobacco companies</li>
										<li>Members of the Weill Cornell administration served as directors of the foundation</li>
										<li>Dr Henschke held a patent on the software that interpreted the CT technology results.</li>
									</ul>
									<p><em>NEJM</em> subsequently allowed Henschke to publish two corrections, where she provided the source of the funding and patent information (Henschke <em>et al.</em>, 2006). It also strengthened its rules for reporting conflicts of interest. In a follow-up article, Harris reported that further independent research put the prevention rate at 20%.</p>
								</opinion>
								<opinion name="The benefits and dangers of GMO foods" img-src="../images/activity_images/course_specific/coi_1_70_img3.png" img-alt="Alt">
									<p>In September 2015, <em>The New York Times</em> published a story reporting undiscovered financial conflicts of interest by researchers supporting genetically modified organism (GMO) foods. Some of the heaviest criticism was aimed at University of Florida researcher Kevin Folta, who received grants and travel funding from GMO companies and, at times, served as a spokesperson for the industry without fully disclosing the extent of his support (Lipton, 2015). However, it was found that he often disclosed his connections and, according to his university, complied with all conflict of interest policies, leading some to conclude that the harsh criticism he received was not entirely justified (Kroll, 2015).</p>
									<p>This case illustrates why clear and complete disclosure of conflicts of interest is particularly important when there is scientific disagreement that has led to public disagreement about major policy decisions.</p>
								</opinion>
								<opinion name="The role of psychologists in interrogation" img-src="../images/activity_images/course_specific/coi_1_70_img4.png" img-alt="Alt">
									<p>The American Psychological Association (APA) hired an independent investigator to report on the development of APA policy on the role of psychologists in psychological interrogation. On 2 July 2015, the investigator published a scathing report that charged:</p>
									<ul>
										<li>"Members of the APA leadership/staff were indeed collusive with the torture policies of the Bush Administration following the attacks of 9/11 and the resulting wars."</li>
										<li>"Key APA leaders/staff actively endeavored to weaken anti-torture Resolutions/Referendums through a pattern of manipulation, misdirection, and misinformation."</li>
										<li>"Key APA leaders/staff engaged in a pattern of deception to hide their complicity in torture and abusive interrogation practices from other APA leaders, members volunteering in the Association, the broader membership, as well as the wider population." (Woolf, 2015)</li>
									</ul>
									<p>Here, the conflict of interest stemmed from many APA leaders and members relying on government (and often military) funding for their own research or even salaries. When these undisclosed conflicts of interest were brought to light, the APA had to issue new professional guidelines.</p>
								</opinion>
								<opinion name="Cancer research leader overlooks his reporting responsibilities" img-src="../images/activity_images/course_specific/coi_1_70_img5.png" img-alt="Alt">
									<p>In September 2018, ProPublica and <em>The New York Times</em> published a detailed article outlining the unreported financial conflicts of interest of Dr Jos&eacute; Baselga, who was then chief medical officer of the Memorial Sloan Kettering Cancer Center and former president of the American Association for Cancer Research.</p>
									<p>He admitted that there had been inconsistencies in his reporting, but suggested that his lucrative corporate relationships were publicly known (Ornstein and Thomas, 2018a). The fallout was, nonetheless, significant.</p>
									<p>Dr Baselga resigned from his position (Ornstein and Thomas, 2018a) and other Sloan Kettering researchers have since taken steps to correct their conflict of interest statements in previously published articles (Ornstein and Thomas, 2018b). It is clearly difficult to correct the loss of public confidence engendered by major lapses on the part of research leaders and the decisions made based on their compromised advice.</p>
								</opinion>
							</opinions>
							<!-- ACTIVITY END -->
							
						</page-content-wide>
					</page-row>
					
					<page-row>

						<page-content-sidebar>

							<accessible-text>

								<!-- USEFUL LINKS START -->
								<pod variant="a" has-modal="true" class="pod2">
									<pod-heading>Useful links</pod-heading> <!-- pod title -->
									<pod-content></pod-content>
									<!-- pop-up pod content -->
									<pod-modal-heading>Useful links</pod-modal-heading>
									<pod-modal-content>
										<hosted-link id="RI_INT_coi_1_70_2">
											<p><strong>Vaccinations and autism</strong></p>
											<p>DeLong, 2012 &ndash; <a href="https://www.ncbi.nlm.nih.gov/pubmed/22375842" target="_blank">Conflicts of Interest in Vaccine Safety Research</a></p>
											<p>Jones, 2004 &ndash; <a href="http://www.nature.com/news/2004/040223/full/news040223-1.html" target="_blank">Link Between Vaccine and Autism "Entirely Flawed"</a></p>
											<p>Wakefield <em>et al.</em>, 1998 &ndash; <a href="http://www.ncbi.nlm.nih.gov/pubmed/9500320" target="_blank">Ilelal-Lymphoid-Nodular Hyperplasia, Non-Specific Colitis, and Pervasive Developmental Disorder in Children</a></p>
											<p><strong>Lung cancer and tobacco companies</strong></p>
											<p>Harris, 2008 &ndash; <a href="http://www.nytimes.com/2008/03/26/health/research/26lung.html?hp" target="_blank">Cigarette Company Paid for Lung Cancer Study</a></p>
											<p>Henschke <em>et al.</em>, 2006 &ndash; <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa060476" target="_blank">Survival of Patients With Stage I Lung Cancer Detected on CT Screening</a></p>
											<p><strong>The benefits and dangers of GMO foods</strong></p>
											<p>Lipton, 2015 &ndash; <a href="http://www.nytimes.com/2015/09/06/us/food-industry-enlisted-academics-in-gmo-lobbying-war-emails-show.html" target="_blank">Food Industry Enlisted Academics in G.M.O. Lobbying War, Emails Show</a></p>
											<p>Kroll, 2015 &ndash; <a href="http://www.forbes.com/sites/davidkroll/2015/09/10/what-the-new-york-times-missed-on-kevin-folta-and-monsantos-cultivation-of-academic-scientists/" target="_blank">What The New York Times Missed On Kevin Folta And Monsanto's Cultivation Of Academic Scientists</a></p>
											<p><strong>The role of psychologists in interrogation</strong></p>
											<p>Woolf, 2015 &ndash; <a href="http://www.psychologytoday.com/blog/the-fight-against-hate/201507/torture-apa-and-the-hoffman-report-what-now" target="_blank">Torture, APA, and the Hoffman Report: What Now?</a></p>
											<p><strong>Cancer research leader overlooks his reporting responsibilities</strong></p>
											<p>Ornstein and Thomas, 2018a &ndash; <a href="https://www.nytimes.com/2018/09/13/health/jose-baselga-cancer-memorial-sloan-kettering.html" target="_blank">Top Sloan Kettering Cancer Doctor Resigns After Failing to Disclose Industry Ties</a></p>
											<p>Ornstein and Thomas, 2018b &ndash; <a href="https://www.nytimes.com/2018/10/12/health/memorial-sloan-kettering-cancer-disclosure.html" target="_blank">Sloan Kettering Researchers Correct the Record by Revealing Company Ties</a></p>
										</hosted-link>
									</pod-modal-content>
								</pod>
								<!-- USEFUL LINKS END -->

							</accessible-text>

						</page-content-sidebar>

						<page-content-main>
							
							<interactive-text><p>The cases above should suggest that even seemingly insignificant conflicts can have ramifications, and the consequences of non-reporting can be very serious.</p></interactive-text>
							<accessible-text><p>The cases described should suggest that even seemingly insignificant conflicts can have ramifications, and the consequences of non-reporting can be very serious.</p></accessible-text>
							
							<h3>Your experience</h3>
							
							<p>How important and well controlled are conflicts of interest in your field of research?</p>
							
							<instructional-text><p>Indicate whether you agree or disagree with the following statements &ndash; after you have submitted your responses, you will be able to see how your answers compare with those of others taking this course.</p></instructional-text>
							<instructional-text-accessible><p>Consider each statement and reflect on your level of agreement or disagreement.</p></instructional-text-accessible>
							
							<!-- ACTIVITY START -->
							<process show-in-accessible-version="false">
								<process-page>
									<!-- POLL START -->
									<poll poll-id="10488782" noscript-text="Researchers regularly report their conflicts of interest in my field of research."></poll>
									<!-- POLL END -->
								</process-page>
								<process-page>
									<!-- POLL START -->
									<poll poll-id="10488783" noscript-text="My institution's policies covering conflicts of interest are clear and strongly enforced."></poll>
									<!-- POLL END -->
								</process-page>
								<process-page>
									<!-- POLL START -->
									<poll poll-id="10488784" noscript-text="Researchers at my institution receive adequate conflict of interest training."></poll>
									<!-- POLL END -->
								</process-page>
								<process-page>
									<!-- POLL START -->
									<poll poll-id="10488786" noscript-text="My department closely monitors conflicts of interest and discourages conflicts that could compromise research results."></poll>
									<!-- POLL END -->
								</process-page>
							</process>
							<!-- ACCESSIBLE START -->
							<accessible-block>
								<h4>Statement 1 of 4:</h4>
								<p>Researchers regularly report their conflicts of interest in my field of research.</p>
								<h4>Answer options:</h4>
								<ul>
									<li>Strongly agree</li>
									<li>Agree</li>
									<li>Neutral</li>
									<li>Disagree</li>
									<li>Strongly disagree</li>
									<li>Not applicable</li>
								</ul>
								<hr>
								<h4>Statement 2 of 4:</h4>
								<p>My institution's policies covering conflicts of interest are clear and strongly enforced.</p>
								<h4>Answer options:</h4>
								<ul>
									<li>Strongly agree</li>
									<li>Agree</li>
									<li>Neutral</li>
									<li>Disagree</li>
									<li>Strongly disagree</li>
									<li>Not applicable</li>
								</ul>
								<hr>
								<h4>Statement 3 of 4:</h4>
								<p>Researchers at my institution receive adequate conflict of interest training.</p>
								<h4>Answer options:</h4>
								<ul>
									<li>Strongly agree</li>
									<li>Agree</li>
									<li>Neutral</li>
									<li>Disagree</li>
									<li>Strongly disagree</li>
									<li>Not applicable</li>
								</ul>
								<hr>
								<h4>Statement 4 of 4:</h4>
								<p>My department closely monitors conflicts of interest and discourages conflicts that could compromise research results.</p>
								<h4>Answer options:</h4>
								<ul>
									<li>Strongly agree</li>
									<li>Agree</li>
									<li>Neutral</li>
									<li>Disagree</li>
									<li>Strongly disagree</li>
									<li>Not applicable</li>
								</ul>
							</accessible-block>
							<!-- ACCESSIBLE END -->
							<!-- ACTIVITY END -->

							<h3>Summary</h3>
							
							<p>Regardless of how conflicts of interest are managed in your field, at your institution and in your department, your career as a researcher depends on what you do as an individual. Failure to report conflicts of interest can have serious consequences &ndash; particularly if the omission is discovered after the fact and is subsequently reported in a way that is beyond your control.</p>
							
						</page-content-main>
					</page-row>
					
				</page-container>
			</base-container>
		</div> <!-- END content wrapper -->
		
		<!-- scripts -->
		<script src="../js/vendor.min.js"></script>
		<script src="../js/vue-components.min.js"></script>
		<script>
			new Vue({
			  el: "#app",
			  data: {},
			  mounted: function () {
				var core = document.createElement('script');
				core.src = "../js/core.min.js";
				document.getElementsByTagName('head')[0].appendChild(core);

				var project = document.createElement('script');
				project.src = "../js/project.min.js";
				document.getElementsByTagName('head')[0].appendChild(project);
			  }
			});
		</script>

	</body>
</html>