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The commentary by Hirsch1 was enlightening and provided insight into the issues surrounding COIs regarding medical journals. However, the issues he raised simply support the concerns that health information consumers, like me, have with industry-based research being published in peer-reviewed journals. Even 3 years after his employment with Merck, Hirsch still has the need to support his former employer's actions. Such loyalty is to be expected but confirms why industry-based research reports should be held suspect of reporting bias. Savvy health information consumers cannot turn a blind eye to who is sponsoring the research.
Affiliations and funding sources are important to report, and I appreciate that peer-reviewed journals expect such disclosure because these factors do play an important role in how the results and conclusions are weighed in the reader's mind. Why do pharmaceutical companies not produce their own publications to report the research they are performing?
I do not agree with Hirsch's contention that just because an article passed peer review it should be accepted. First, if a student passes an examination and is later found to have cheated, should the student not be punished for cheating? Second, I do not agree that authorship is an art. Those who did the work should be acknowledged as the authors. If a student hands in a paper that was written by someone else, should the student not be punished for cheating?
I doubt that tobacco and chemical companies will ever report that smoking and/or exposure to chemicals causes cancer. Similarly, we cannot expect that pharmaceutical companies will ever publish research showing their products to be ineffective; however, this has not stopped them from publishing research that supports their assertion that their product is no less than or just as effective as their competitor's products.
I understand Hirsch's point that professionals working in industry-based research may be held back in their professional careers, but that is the price one pays for higher salaries vs what academics give up for academic freedom. Of course, the blurring of the distinction among collaborating disciplines due to economic necessities raises issues that need to be resolved when such mixing results in ethical gray areas.
For example, I am concerned that many respected medical experts in their specialty areas who readily accept consulting positions with pharmaceutical companies do not think this would compromise their ability to be impartial in determining the optimal treatment if treatment involves their company's product. Additionally, I am troubled when I hear at medical conferences, even if spoken in jest, that statins should be added to drinking water because that would be easier than trying to convince people to eat healthier.
With the national hypertension and cholesterol guidelines in need of updating, I question whether there will be enough untainted experts to sit on the committees to update these guidelines. Just because the practice of pharmaceutical consulting is pervasive, it does not necessarily indicate that such practices are professionally ethical. I suggest at least a 10-year moratorium for any expert who would sit on these committees and severing all financial ties at least 2 years before volunteering for these committees through 5 years after the guidelines have been implemented.
Finally, many ethically compromising practices, such as guest and ghost authorships, should not be tolerated by the professions that value scientific research for what it should provide toward the advancement of medical knowledge—that the optimal treatment has been discovered through unbiased research.