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On Conflicts of Interest

28 Jul, 14 | by Iain Brassington

It’s only a few days since Richie’s paper on providing IVF in the context of global warming was published, but already there’s been a couple of lines of objection to it that have been fairly widespread; I thought it might be worth nodding to one, and perhaps offering an attempt of a defence against the other.

The first objection is that there’s no justification for the claim about same-sex couples in Richie’s paper – that she shouldn’t have treated homosexuality as a lifestyle choice and as “non-biological” infertility.  I think that there’s significant merit to this objection to the paper; and though neither Dominic nor I mentioned the objection explicitly, I think that it’s there between the lines of each of our commentaries.  (It’s certainly an aspect of the paper that’s picked up by the Telegraph‘s coverage of the paper, and it’s been mentioned a couple of times on Twitter and Facebook by people I know and follow.  (I note that the Telegraph also gave a highly bastardised version of my post here.  Ho hum.))  I think that Richie’s argument would have been at least as strong if she’d talked about providing IVF to anyone whatsoever – the qualifications about different “sorts” of infertility and lifestyle, I suspect, weakened the paper, inasmuch as that a paper with unnecessary and argumentatively weak aspects is more vulnerable to objections generally than one in which those aspects have been left out.  So, yeah: I think that that might count as having been – at best – a strategic error on Richie’s part.

Here’s the other claim that I’ve seen a few times about the paper: that it’s weakened by a conflict of interest because of the author’s affiliation.  This isn’t directly a claim about the quality of the argument in the same way that the previous objection is.  Rather, it’s a claim that there’s something unreliable about the very fact of the argument’s having been put.  (I’m not articulating the distinction very well, but I think you can see what I mean.)  In essence, the worry is this: Richie works for a Jesuit Institution; this isn’t clear from her affiliation in the paper; there’s something iffy about this; this iffiness is some form of conflict of interest and her argument is likely to be biased.

I’m not sure what to make of this.  I think that Ritchie may well have an interest, inasmuch as that she has a position on the topic.  But this applies to all of us, writing papers on pretty much any topic.  Does that count as worrisome, or as a source of bias?  Well, I guess that it might in the broadest sense; but while that might seed objections to parts or all of the argument, I’m not sure that that’s necessarily an objection to the paper itself.  I mean, any paper has certain biases inasmuch as that we all have things that we take to be axiomatic and about which we don’t argue; and we’re all likely to stress the strengths of positions with which we agree and downplay the weaknesses.  So, at the most, there’s a tu quoque response available here.

Is there a conflict of interest, though?  Again, I’m tempted to think not.  To see why, start by asking whether it’s possible that Richie’s arguments were made – subconsciously or consciously – because of the nature of her employer.  The answer has to be that it is possible.  Do we have any evidence of this, though, beyond the paper about which we’re talking?  Not really.  So the charge on that front appears to be in danger of collapsing into “This paper can be shown to be dodgy because there’s something dodgy about it”, which is question-begging.

The problem with conflicts of interest, it seems to me, arises when it’s possible that the writer of a paper has misrepresented or withheld certain data, motivated by a tie to some person or institution that may suffer or lose an opportunity should those data be fully visible.  Is that a charge that can be levelled at Richie’s paper?  Again, I think not.  The reason here is that, in common with most ethics papers, there aren’t data to misrepresent in the way that there might be with (say) pharmaceutical research.  Very roughly, a person doing pharmaceutical research funded by a big company has a reason to withhold non-favourable results, and thus readers can get a false impression of just how good a drug is because they’re only aware of the favourable results.  Importantly, there might be nothing in the paper as published that would indicate that there’s more to the story than meets the eye.

Over on the Health Care Ethics and Law FB group, an analogy was drawn with the recent Swiss report into homeopathy, which was fairly favourable, but which was written by homeopaths.  Could Richie’s paper be a bit like this – a paper that was pretty much in tune with Catholic thinking, written by someone at a Jesuit university, being a little too good to be true?  Again, possibly – but not definitively.  I think that the claim that IVF ought to attract more of a particular kind of moral scrutiny doesn’t depend on any particular doctrinal standpoint; the surface detail of the way in which the claims and questions are raised might alter, but the essence of thosee claims and questions doesn’t have to.

Importantly, again, there aren’t any data to misrepresent: Richie wasn’t presenting any claims about the way the world is.  She was talking about how we ought to act given certain facts about the world – facts that are not (I’m assuming) all that contentious.  That’s the difference from the Big Pharma and the homeopathy examples: in both those cases, there’s a reason to worry that the world as it is may not be reflected in the way it’s presented.  I don’t see that here.  What’s on show here is an argument about the way the world ought to be.  The claims therein can be examined without needing any further information – and, as I keep saying, that’s happening already from a number of directions, just as it would with any other paper.

What about the possibility that Ritchie may have felt pressure to withhold counterarguments?  I think that this can be dismissed, too.  One reason for this is that – as I’ve suggested above – it’s possible that the paper would have been stronger if a couple of the details had been left out.  And those counterarguments are already being presented, informally, on Twitter and messageboards.  So even if there was pressure, it’s actually backfired for the person applying it.  Instead of making themselves look better than they are, they’d’ve made their position look worse.

Finally, we can’t say – not plausibly – that it’s up to the author to avoid perceived conflicts of interest, because there’s no accounting for what someone might perceive; to make that stipulation puts authors at the mercy of the most cynical or outright tinfoil-hatted.

So what we’re left with, it seems to me, is a claim that the paper is unreliable because the writer is employed by a certain kind of institution (and may have certain commitments of her own).  And that seems a little ad feminam to me.  A person with different commitments may be less likely to make some of the claims Richie makes; but it doesn’t follow from that that she’s made them because of who pays her wages.  We’d need independent evidence for that, and I don’t see any.

It might be that the paper is, on examination, utter bobbins for one reason or another.  But if it is, then the arguments are already there for the making.  And I don’t think that that’s attributable to facts about who wrote it, or who signs her paycheques.

 

(Incidentally – just on the off-chance that this generates comments, I’m about to go away for a fortnight, and won’t be around much (if at all) to engage with them.  They might be a bit slower to get through moderation, too: it depends on how busy David is.)

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  • David Shaw

    A few points:

    1. Richie has withheld certain data about the world: the fact that her employer and funder is a Catholic institution. This should be declared because her employer might have in interest in the argument being present as it is, just as a pharma company might in something published by an employee. You might think that there’s less evidence in the case of a Catholic Institution than in the case of a pharma company, but that’s neither here nor there.

    2. Most major medical journals require declaration of potential COIs not only for research, but also for comment/opinion pieces. They require disclosure of both financial and “Non-financial associations that may be relevant or seen as relevant to the submitted manuscript”. They seem to manage ok with that system.

    3. Richie should have declared her affiliation more transparently both in the Funding statement (which was missing from the article) and in the CoI declaration.

  • Timothy Murphy

    I agree that there is no meaningful conflict of interest to
    be laid at the feet of Christina Richie’s argument for limiting access to fertility treatment to certainly people only. Brassington says first that he’s tempted to think that there is no conflict of interest. I think the case for exculpating her from a conflict of interest is somewhat stronger than that.

    Brassington says that a conflict of interest might involve influences
    – conscious or not – from the employing Roman Catholic institution. He says there’s no evidence of this. Suppose
    the author of the article in question were a Jesuit priest on the faculty of the same institution. Would that be any more reason to think a conflict of interest was at work, if he wrote an article favorable to the views typically held by Jesuits working at Roman Catholic universities? If there were any basis for thinking this, why wouldn’t we be objecting to any and all analyses offered
    by faculty members of this kind?

    You next indicate that a conflict of interest could involve
    misrepresenting data or withholding data. Maybe that’s one effect of having a conflict of interest, but the better approach to conflicts of interest, it seems to me is to understand them as the exercise of judgment in a way that benefits oneself rather than the object of one’s fiduciary responsibilities. I don’t see that advocating a particular position – Richie does give reasons for her view, whatever you think of them – is open to the charge of conflict of interest in any meaningful way here.

    By the end of your analysis, Brassington has pretty much
    cleared away the arguments that there is a conflict of interest here, so I wonder why he’s only “tempted” to brush aside the charge of conflict of interest?

    There are bigger fish to fry here than conflicts of interest. Richie wants law and policy to obstruct gay men and lesbians as a class from fertility medicine, on the theory that this is the way to a greener planet. Wouldn’t it be nice if – just once – people making judgments against gay and lesbian people this way, asked their permission for the social changes they want to impose? instead of just announcing their exclusion from important social goods from on high? What a different approach would have to be involved if
    Richie had to go to gay men and lesbians and ask them to voluntary withdraw from subsidized fertility medicine, instead of making that decision for them, as if she were fully entitled to do so from on high without any kind of consultation?

  • Timothy Murphy

    I agree that there is no meaningful conflict of interest to
    be laid at the feet of Christina Richie’s argument for limiting access to fertility treatment to certainly people only. Brassington says first that he’s tempted to think that there is no conflict of interest. I think the case for exculpating her from a conflict of interest is somewhat stronger than that.

    Brassington says that a conflict of interest might involve influences
    – conscious or not – from the employing Roman Catholic institution. He says there’s no evidence of this influence. Suppose the author of the article in question were a Jesuit priest on the faculty of the same institution. Would that be any more reason to think a conflict of interest was at work, if he wrote an article favorable to the views typically held by Jesuits working at Roman Catholic universities? If there were any basis for thinking this, why wouldn’t we be objecting to any and all analyses offered by faculty members of this kind?

    You next indicate that a conflict of interest could involve misrepresenting data or withholding data. Maybe that’s one effect of having a conflict of interest, but the better approach to conflicts of interest, it seems to me is to understand them as the exercise of judgment in a way that benefits oneself rather than the object of one’s fiduciary responsibilities. I don’t see that advocating a particular position – Richie does give reasons for her view, whatever you think of them – is open to the charge of conflict of interest in any meaningful way here.

    By the end of your analysis, Brassington has pretty much
    cleared away the arguments that there is a conflict of interest here, so I wonder why he’s only “tempted” to brush aside the charge of conflict of interest?

    There are bigger fish to fry here than conflicts of interest. Richie wants law and policy to obstruct gay men and lesbians as a
    class from fertility medicine, on the theory that this is the way to a greener planet. Wouldn’t it be nice if – just once – people making judgments against gay and lesbian people this way, asked their permission for the social changes they want to impose? instead of just announcing their exclusion from important social goods from on high? What a different approach would have to be involved if
    Richie had to go to gay men and lesbians and ask them to voluntary withdraw from subsidized fertility medicine, instead of making that decision for them, as if she were fully entitled to do so from On High without any kind of consultation? Why not give the most affected parties some say in the matter? Maybe even decision-making power about whether they are willing to make the sacrifice being offered here in the name of an allegedly greener future?

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