Cochrane Survey: Provide feedback on Cochrane’s Policy on Conflicts of Interest

https://www.cochrane.org/news/cochrane-survey-provide-feedback-cochranes-policy-conflicts-interest

 

https://twitter.com/user/status/1082312708492537861

 

I hope all ME/CFS-patients will fill in the survey to ensure Cochrane will have a stricter COI policy. This is really important.

 

@Jonathan Edwards & indeed any other more knowledgeable members can you please clarify the finer points on this question...?

Its obvious to me that PIs of trials investigating the intervention being reviewd should not be allowed to author reviews as they are essentially marking their own homework...
but this question above is more complicated to me, would appreciate your take on it pls before i make my mind up.

Also this

I'm unsure what they mean by 'commenting'? Does that mean commenting in the media after it's released, or does it mean commenting before the review is finalised?

 

Having made a sound argument founded upon accurate accounts of the evidence is not a COI. But having a history of having misrepresented the evidence is reason for concern.

With something like PACE, I think that it should be seen as a potential COI for people who have been working in the area to have failed to speak out about the problems with this trial.

 

Yes but how does one include that in policy across the board when an evaluation of the evidence in order to determine what 'misrepresenting' it might be, is what Cochrane are supposed to be doing. I'm too foggy to articulate well, but its surely got to be everyone on both sides of an argument that policies apply to & after all PACE supporters would say that it is PACE critics who are misrepresenting the evidence. And lets face it most reviewers who are knowledgeable enough to know the issues with PACE will also likely fulfill the criteria for Q13. So how does one answer the question so that it is fair to everyone & yet still prevents the kind of gross bias thats been happening thus far?

 

It's great to ask people to fill in the survey but not everyone will understand the questions or the implications of them, I think it'd be great if we could release some kind of 'guide', - not telling people what to say but explaining the issues related to each question.
I'm thinking something similar to what Stonewall produced for the recent consultation into the Gender Recognition Act (it's disappeared now the consult's closed) but it was very helpful in understanding the implications of each option so i could make up my own mind.

It was just a few sentences explaining what each Q meant & a couple of real world examples

For example

Some people might think 'well it shouldn't be a barrier because people working in that intervention will be in a better position to assess trials in that area'. We are aware of the problems with that, but many wont be.

I'm afraid i dont have either the strength or the scientific vocab/cognitive sharpness to do it, & completely understand if no one else has either, but i can think of several people who i could ask to complete the survey but who i wouldn't trust to fill it in in a helpful way simply because they dont understand how COIs can impact the situation.

would be happy to proof read/edit anything though.

I'm not nessecarily suggesting an 'S4ME' thing, even just a 'read this before you fill it in' blog type thing from someone, explaining how Cochrane tightening their policy would help us and how the current lax system has harmed us, would be amazing if anyone is up to it.

 

It does not make sense to me to suggest that someone who has previously published an opinion on a treatment then has a COI in relation to a Cochrane review. People with expertise in a field will be xpected to express opinions on a regular basis. This looks like a question drawn up by someone who does not really understand the COI problem.

I do not know what to make of the one about people with declared COI not being able to referee either. In some cases yes, in others no - on a common sense basis.

I suspect that any answers given in yes or no terms will be useless- especially as they cannot be considered representative. The only real value of questions like these is in prompting insightful 'other comments'.

 

Number 8 is interesting because it hints at where the questions may be coming from. There is a stark difference between healthcare professionals whose salary depends on providing a specific mode of treatment (physics ad clinical psychologists) ad those who are there to provide whatever is considered the best treatment (doctors and nurses). The former have a clear COI, the latter do not, unless they are tied to a specific policy - which occurs with alternative practitioners mostly.

 

yes thats a good point. certainly a reason for it not to be an official S4ME thing.

thank you for your insight @Jonathan Edwards

 

I included in some of my comments that I felt a COI was not always cut and dried and would depend on individual circumstances. But that any decisions where a COI was considered non-blocking, then the information should be transparent and open. And that Cochrane themselves should take their own responsibility in such cases, and make that information transparent and open.

Edit: Did this last night, before reading through this thread.

 

Karla Soares-Weiser: Cochrane announces a new, more rigorous “conflict of interest” policy

The BMJ Opinion, 03.12.2019

https://blogs.bmj.com/bmj/2019/12/0...c&utm_medium=twitter&utm_source=socialnetwork

 

The reference given in the last of the above quoted paragraphs is:

Bero LA, Grundy Q. Why having a (non-financial) interest Is not a conflict of interest. PLoS Biol. 2016;14(12):e2001221,
https://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.2001221

 

Great. Another person I thought might be concerned about this bites the dust...

 

It might be better if someone unable to distinguish different types of non-financial interest were otherwise employed.

 

From one of the quotes in post #13 :

I know this is a bit off-topic, sorry, but there is some info I'm missing that I need to make any sense of this thread. What are the rules for positioning in the author list of a paper? I've always assumed that the first person listed is the principal investigator - the person in charge of the whole caboodle for that paper. I don't know if I'm right or wrong on that. But what is the significance of the last named? And do any other rules apply to how and where authors appear in an author list?

 

Could you expand on that @Caroline Struthers ?

Bero raises what I think is a really important issue. Declaration of interest requirements are now confusing 'interest' in the sense relating to 'disinterested' with 'interest' in the sense relating to 'interested'.

The point of enquiring about interests is to identify benefits that might accrue to the author or their associates if they wrote something a certain way. An interest in model railways is not an interest in this sense. The problem with the ambiguity is that interests that do not relate to benefits may be claimed to be interests in the sense relating to benefits in order to disqualify legitimate authors or commentators.

 

For me there is a small point here to be made. It stems from this issue but is a little broader (so includes CoI).

Making new and improved policies around CoI or other important issues in the process of accepting research and clarifying it's potential problems or limits is all fine and well. In the past we have seen that there are many such well made/intentioned policies in place already that get ignored by the people who are meant to uphold them.

It's like the thinking goes that once the policy is there the words on the page have some magical quality to force everything to conform. They are not magic.

Whatever the utility of this particular policy there needs to be the will to intelligently apply it IMO.

 

This.
The problems in the past were of the sort that, as my old boss used to say, even a policeman could recognise.