Michael Sharpe skewered by @JohntheJack on Twitter

Sharpe is only doing what he is obliged to do, and he is correct in that (whether that's acceptable or not is another thing).

As far as he is concerned, he has not been paid to promote a view that he himself does not hold or goes against the general thrust of his research. Given his views, it is therefore not surprising that he would be called upon to give advice to insurance companies and the like. None of this is a conflict as such.

It may conflict with our views, and it may also conflict with science and reality, but that's not what a "conflict of interest" statement is all about.

Also, having a declared conflict of interest does not disqualify him from doing that research. It is merely a statement that enables the reader to assess the context in which the research is done.

 

But if you stand to gain financially, whether indirectly by career advancement or directly via payments, depending on if the result is one or the other, then isn't that a conflict of interest when you are a principal investigator, and essentially calling the shots.

 

Every researcher stands to gain financially from continued employment as a researcher - that's sort of how it works. Grant funding depends on how many papers you publish. Science is a human system with human flaws.

 

Keith Geraghty has a very valid point here. If trial participants sign up on the understanding there are no COI, how can it then be legitimate to take on a COI during the course of that trial? Surely at the very least, participants should be advised of the new COI, and formally asked if they wish to continue participating in the trial or not? Seems like in addition to outcome swapping we maybe have COI swapping (sort of akin to income swapping?).

 

Yes, but there is a difference if you have already nailed your colours to the mast prior to the trial.

It might be how the system works but you didn't explain why that doesn't mean it's a conflict of interest.

I am not talking about publishing a no. of papers per se, I am talking about publishing a result that could destroy everything you've based your career on to date.

 

This all makes me wonder whether there is any management, in a large trial, of questions of COI.

Someone ought to be specifically tasked wth collecting, collating and updating COI information. They should then have to sign off on the declaration for any paper submitted for publication. Just trusting to luck does not seem adequate.

 

Of course it's a conflict. It should obviously be declared so that readers can consider to what degree the research can be trusted. Had it been declared then more people may have scrutinised the trial and noticed all its problems much sooner.

 

Especially as they changed the protocol during the trial after clearly having some insight to how the results were shaping up.

 

True, but I would think that is distinct from the COI issue. Unless, maybe, it could be proven that the COI was undertaken in some obscure response to realising the way the trial was shaping up, or alternatively to how it was known its results would be reported?

 

Yes or visa versa wherby the change in protocol was a response to a required interest. Although, I'm just speculating I haven't looked at timings for any potential COIs or change in desired outcome shenanigans.

 

I'm really not disagreeing with you; I'm trying to understand it from his position, and why he should be so casual about not declaring those things. He simply does not see a conflict. He's already made it clear that he didn't care what the outcome of the trial was - it was "just a trial" - but that makes it worse, because that's clearly not true: why else fiddle with the outcome measures? It's either extraordinary arrogance, or flippancy, or stupidity, or staggering lack of insight. But it is what it is. He clearly doesn't care about the participants, or PwME more widely. He knows he is in a position of power and he is quite happy to taunt us. But that's also precisely why we need to remain calm, and respectful, and try to be understanding, because actually, we know what's going on.

 

They did declare their insurances COIs in the Lancet paper, and there was still very little scrutiny from the academics first looking at the paper.

 

Indeed, but I was really just highlighting why conflict of interests are supposed to be declared. Whether someone does in fact scrutinize the research is really a secondary matter, the primary issue is that these conflicts should be declared so that readers are presented with the relevant facts.

 

Those are some of the best insults I've ever heard!

 

Right. It's ultimately about reducing costs for insurance companies and public health systems by not spending money on exhaustive testing and interventions for people with medically unexplained symptoms. Michael Sharpe has spoken at length on this topic for a long time.

That's why they want to pool all the medically unexplained syndromes together into one basket.

It's also why these guys say they care deeply about people with mental illnesses yet never call out the insurance company discrimination (eg 2 year payout limits or straight up exclusions) against people with mental illnesses etc.

 

It does seem strange. In another discipline every third year undergraduate will learn about subconscious ex post facto reasoning. How can leading researchers be unaware of potential for bias and the consequent need for disclosure?

 

I am unfamiliar with this term, can you explain it further?

 

Decision first. Reasons later.