HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

Correspondence to:

SPECIAL ARTICLE: R. G. Holloway, C. J. Mooney, T.S.D. Getchius, W. S. Edlund, and J. O. Miyasaki Invited Article: Conflicts of interest for authors of American Academy of Neurology clinical practice guidelines Neurology 2008; 71: 57-63 [Abstract] [Full text] [PDF]

Correspondence: Submit a response to this article

Correspondence published:

Invited Article: Conflicts of interest for authors of American Academy of Neurology clinical

Kimford J. Meador   (10 September 2008)

Reply from the authors

Robert G. Holloway, Chris J. Mooney, Thomas S.D. Getchius, Wendy S. Edlund, and Janis O. Miyasaki   (10 September 2008)

Invited Article: Conflicts of interest for authors of American Academy of Neurology clinical 10 September 2008
Kimford J. Meador, Woodruff Research Building, Emory University 101 Woodruff Circle, Suite 6000, Atlanta, GA 30322 Send Correspondence to journal: Re: Invited Article: Conflicts of interest for authors of American Academy of Neurology clinical kimford.meador{at}emory.edu Kimford J. Meador	Holloway et al. provided an excellent description of conflicts of interest (COI) as they relate to AAN clinical practice guidelines. [1] Their thoughtful discussion addressed complicated issues surrounding COI and identified areas for improvement. Both research and clinical practice were more common COI than personal income from industry. This finding occurred despite the fact that the AAN requires reporting of all industry-related COI, but leaves the reporting of non-industry related COI to the opinion of the individual as to whether it constitutes a COI. This dichotomy is surprising given that there are psychological barriers to recognizing one’s own COI, which as the authors point out has been termed “COI anosognosia.” Holloway et al. also noted that the approach to COI is evolving. As a result, there is a hodgepodge of reporting requirements across academic societies, journals and universities. The variance creates extra work tracking COI under different definitions (e.g., type, duration, magnitude) and presents an uneven picture of the scope of COI for an individual. Many of these reporting requirements have been solely focused on industry-related COI, or as in this case, use different criteria for industry-related COI. Is this because there is COI anosognosia for research and clinical practice? Even those activities which are pivotal to our professional role and academic pursuits may create bias (e.g., nonfinancial bias toward academic career advancement). Bias, not COI, is the real enemy from a scientific perspective. [2] The tendency of the lay press and others to demonize COI risks is superficial since it overlooks the real problem of bias. [2] Nevertheless, this atmosphere creates a concern about appearance, which likely contributes to the focus on industry-related COI. However, all industry-related activities are not orthogonal to our academic role. Some research activities involving industry (e.g., consultant research design) are critical to translation of scientific discoveries into practical applications. Holloway et al. point out that “there is an urgent need to better identify and quantify the types of conflicts and their potential biasing effects.” Without such data, the most reasonable approach is to have full disclosure of all potential COI. References 1. Holloway RG, Mooney CJ, Getchius TS, Edlund WS, Miyasaki JO. Invited Article: Conflicts of interest for authors of American Academy of Neurology clinical practice guidelines. Neurology 2008;71:57-63. 2. Schwid SR, Gross RA. Bias, not conflict of interest, is the enemy. Neurology 2005;64:1830-1831. Disclosures: Dr. Meador reports receiving research support from NIH grants 2RO1-NS38455, R01-NSO31966-11A2, and N01-NS-5-2364, McKnight Brain Institute, MCG Foundation, Glaxo SmithKline, EISAI Medical Research, Myriad Pharmaceuticals, Marinus Pharmaceuticals, NeuroPace, SAM Technology, and UCB Pharma; and also serves on the Professional Advisory Board for the Epilepsy Foundation.
Reply from the authors 10 September 2008
Robert G. Holloway, University of Rochester Medical Center 601 Elmwood Avenue, Neurology, Box 673; Rochester, NY 14642, Chris J. Mooney, Thomas S.D. Getchius, Wendy S. Edlund, and Janis O. Miyasaki Send Correspondence to journal: Re: Reply from the authors robert_holloway{at}urmc.rochester.edu Robert G. Holloway, et al.	We appreciate Dr. Meador’s interest in our article and agree with most of his comments. [1] We emphasize that the updated and current AAN clinical practice guideline conflict of interest policy is for authors to report all interests and that these interests be disclosed to reviewers during peer review and to readers when published. [3] We are not as convinced as Dr. Meador, however, that the real enemy is bias and not conflicts of interest (COI). Too much emphasis on the consequence (bias) might detract from the needed motivation and individual commitment to disinterestedness as an important norm for maintaining objectivity in the guideline development process even if COI self-awareness is at times difficult. It also presupposes that the current mechanisms in place to control biasing effects (e.g., explicit procedures, peer review, public access of data) are capable of maintaining this objectivity even in the face of progressive commercialization. We are not so sanguine. In addition to better understanding the biasing effects of different types of conflicts, a continued commitment to the ideals of impartiality will also optimize the chances of properly exercising judgment when grading evidence and formulating recommendations. Reference 3. AAN Conflicts of Interest Policy for Clinical Practice Guidelines. Available at: http://www.aan.com/go/practice/guidelines/development . Accessed August 5, 2008. Disclosures: Dr. Holloway has received income from NINDS (Chair, Data Safety Monitoring Committee); Maximus, Inc. (adjudicating insurance claims); and Milliman Robertson, Inc. (reviewing neurology guidelines), and has received research support from NIH, Veterans Administration, and National Multiple Sclerosis Society. Mr. Mooney has received research support from the state of New York and the American College of Physicians. Ms. Edlund and Mr. Getchius are employees of the American Academy of Neurology. Dr. Miyasaki has received income from NIH (Independent Medical Monitor), Boehringer Ingelheim (consulting), Teva (advisory board, speaking), and Amarin Corporation (Safety Monitoring Committee) and has received research support from Allergan, Solstice, Teva, NIH, National Parkinson Foundation, and Parkinson Society Canada.