Thread on financial conflict of interest.
1/My 2018 Dollars for Docs: $0
This was enormously difficult & is not sustainable. Coz if you lead trials some small amount gets invariably reported.
$0 is possible only for people who don't lead therapeutic trials. #MedTwitter
1/My 2018 Dollars for Docs: $0
This was enormously difficult & is not sustainable. Coz if you lead trials some small amount gets invariably reported.
$0 is possible only for people who don't lead therapeutic trials. #MedTwitter
2/ I had to go through all kinds of contortions to get to $0, including taking my name off many papers even though I was an investigator. Ride separately from other investigators to meetings. Avoid drinking even bottled water in long meetings to get zero dollars reported.
3/So we have a problem. If you want experts with zero $ conflicts you will end up with people who don't lead clinical trials.
The $ amounts reported do not mean that investigators are enriching themselves: it can be meetings, being authors on papers. Actual cost to do the trial
The $ amounts reported do not mean that investigators are enriching themselves: it can be meetings, being authors on papers. Actual cost to do the trial
4/ Simply classifying people as financially conflicted vs not is useless without taking into account whether a real conflict exists or is meaningful.
You may end up with "non conflicted" people with $0 against their name who are non experts— knowledge from books, not experience
You may end up with "non conflicted" people with $0 against their name who are non experts— knowledge from books, not experience
5/ After all none of your institutions will let you open a trial without funding. The vast majority of trials, especially in oncology, even many NIH funded ones require support from Pharma.
You also cannot lead a trial and refuse to attend investigator meetings or be an author
You also cannot lead a trial and refuse to attend investigator meetings or be an author
6/ On the other hand we also cannot say everyone gets money, everyone is conflicted, and therefore nothing really matters.
Because there are certain conflicts that do matter. Either based on the type of conflict. Or the $ amount.
We need a balance.
Because there are certain conflicts that do matter. Either based on the type of conflict. Or the $ amount.
We need a balance.
7/ So as hard as it is, look at the details: What kind of conflict. How much.
For reviews, guidelines, editorials you need people without 𝘴𝘪𝘨𝘯𝘪𝘧𝘪𝘤𝘢𝘯𝘵 COI. If you want 𝘻𝘦𝘳𝘰 $ COI as a purity test, you end up with non experts who have never led therapeutic trials.
For reviews, guidelines, editorials you need people without 𝘴𝘪𝘨𝘯𝘪𝘧𝘪𝘤𝘢𝘯𝘵 COI. If you want 𝘻𝘦𝘳𝘰 $ COI as a purity test, you end up with non experts who have never led therapeutic trials.
8/ Don't try to exclude real experts by holding them to impossible standards that you yourself will not meet if you were in their situation running the type of trials they do. Doing so can be a conflict of interest in and of itself.
9/ I had posted this table a while back. The left box is are the most important conflicts. The middle box is just unavoidable for people leading clinical trials and is ok for most activities. The right box is a disclosure like your employment but not a financial COI.
10/ Open payments has errors. It misses some stuff. It includes erroneous stuff. Don't use it as yes/no and write papers that xyz% are conflicted. It gets you a paper. But it's not the truth. It reveals you have probably never led a therapeutic trial, especially in oncology.
11/ I have been worried about conflicts of interest for years. But I'm in a ultra unique position to dictate my terms. Its not possible for most investigators. They are leading trials to help patients. Not for the coffee and breakfast served at investigator meetings.
12/ So I cringe when I see good investigators labeled as conflicted because open payments shows they received some $. Those kind of papers are lazy research. Details matter. Just coz they are hard to get doesn't mean you go for whatever metric you can get easily: McNamara fallacy
13/ I also do not like the move to make people list every irrelevant thing in the name of full disclosure. That just defeats the purpose of disclosure. If everyone is conflicted, then no one is conflicted. Is that the goal? Make it look like everyone has conflicts?
14/ These exhaustive disclosures are like the fine print. Disclaimers. No one reads. Designed to make it look like everyone have something to disclose. Which means patients and physicians are going to think, well it looks like everyone has a conflict so it doesn't matter.
15/ We need to make people disclose as a conflict of interest what's materially relevant, if there is something of that nature to disclose.
16/ In fact if it's left box items, then even disclosure may not be enough for certain activities like reviews, guidelines, editorials etc. If its middle box items then with disclosure most activities would be fine because it is unavoidable for people leading therapeutic trials.
17/ Your can have the right box item in some tiny fine print listed if it makes you happy. But those are not conflicts of interest. It's just disclosures. Just like someone discloses their employment.
And yes. I don't have the time to fight the $168 reported against my name for 2017 for some breakfast I didn't eat.
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