Conflicts of Interest,Selective Inertia,and Research Malpractice in Randomized Clinical Trials: An Unholy Trinity

Recently a great deal of attention has been paid to conflicts of interest in medical research, and the Institute of Medicine has called for more research into this important area. One research question that has not received sufficient attention concerns the mechanisms of action by which conflicts of interest can result in biased and/or flawed research. What discretion do conflicted researchers have to sway the results one way or the other? We address this issue from the perspective of selective inertia, or an unnatural selection of research methods based on which are most likely to establish the preferred conclusions, rather than on which are most valid. In many cases it is abundantly clear that a method that is not being used in practice is superior to the one that is being used in practice, at least from the perspective of validity, and that it is only inertia, as opposed to any serious suggestion that the incumbent method is superior (or even comparable), that keeps the inferior procedure in use, to the exclusion of the superior one. By focusing on these flawed research methods we can go beyond statements of potential harm from real conflicts of interest, and can more directly assess actual (not potential) harm.     

Conflict of interest: the importance of potential

The UK Medical Research Council (MRC) takes the issue of conflict of interest very seriously. The overall aim is to preserve a climate in which personal and organisational innovation can flourish while ensuring that potential conflicts are disclosed and identified and conflicts are either avoided or managed with integrity. The approach needs to encompass the MRC’s various responsibilities and the levels at which conflicts might arise: MRC staff (scientists and administrators); the governing Council; research Boards and committees; external peer-reviewers; and applicants for funding. To achieve its goals, the MRC has issued practical guidance on various aspects of conflict of interest. For the future, the MRC has identified the continuing commercialisation of science and the increasing involvement of lay people in scientific decision-making as special challenges in this area. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

Conflicts of interest in science and medicine: the physician's perspective

The various statements and declarations of the World Medical Association that address conflicts of interest on the part of physicians as (1) researchers, and (2) practitioners, are examined, with particular reference to the October 2000 revision of the Declaration of Helsinki. Recent contributions to the literature, notably on conflicts of interest in medical research, are noted. Finally, key provisions of the American Medical Association’s Code of Medical Ethics (2000–2001 Edition) that address the various forms of conflict of interest that can arise in the practice of medicine are outlined. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002. The World Medical Association (WMA) is a global federation of National Medical Associations representing the millions of physicians worldwide. Acting on behalf of patients and physicians, the WMA endeavours to achieve the highest possible standards of medical care, ethics, education and health-related human rights for all people.     

Conflict of interest in Croatia: doctors with dual obligations

There is an emerging awareness of the possibility of conflicts of interest in the practice of medicine in Croatia. The paper examines areas within the medical profession where conflicts of interest can and have occurred, probably not only in Croatia. Particularly addressed are situations when a doctor may have dual obligations and how independent ethics committees can help in decreasing the influence of a conflict of interest. The paper also presents extracts from the Croatian Code of Ethics for the medical profession that address problems of conflict of interest. An earlier version of this paper entitled was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

Military Service and the Life-Course Perspective: A Turning Point for Military Personnel Research

The political and scientific climate is ready for a change in perspective in the field of military personnel psychology. Although more than 200,000 of America's most fit young men and women pass through the military establishment each year, we know very little about the effects of their early military experiences on their life choices or on their subsequent military or civilian careers. Recent interest in these issues shown by Congress, the press, and the Department of Defense (DoD) strongly suggests that psychologists need to address research questions that can evaluate the real lifetime costs and benefits of military service. Current military personnel research approaches are inadequate for this task. Life-course theory is presented as a viable and vigorous conceptual and analytic framework for accomplishing this mission.     

Frequency and Type of Conflicts of Interest in the Peer Review of Basic Biomedical Research Funding Applications: Self-Reporting Versus Manual Detection

Despite the presumed frequency of conflicts of interest in scientific peer review, there is a paucity of data in the literature reporting on the frequency and type of conflicts that occur, particularly with regard to the peer review of basic science applications. To address this gap, the American Institute of Biological Sciences (AIBS) conducted a retrospective analysis of conflict of interest data from the peer review of 282 biomedical research applications via several onsite review panels. The overall conflicted-ness of these panels was significantly lower than that reported for regulatory review. In addition, the majority of identified conflicts were institutional or collaborative in nature. No direct financial conflicts were identified, although this is likely due to the relatively basic science nature of the research. It was also found that 65 % of identified conflicts were manually detected by AIBS staff searching reviewer CVs and application documents, with the remaining 35 % resulting from self-reporting. The lack of self-reporting may be in part attributed to a lack of perceived risk of the conflict. This result indicates that many potential conflicts go unreported in peer review, underscoring the importance of improving detection methods and standardizing the reporting of reviewer and applicant conflict of interest information.     

The resident researcher: An alternative career model centered on community

Considers the potential benefits and costs of an alternative career model for community researchers, one in which professionals specialize in the community where they live. By virtue of their local familiarity, resident researchers can make more informed judgments about research problems and methods. They can employ longitudinal designs to assess change and be available to assist in interpretation and implementation of research. Potential costs include the possibility of provincialism, unintended researcher effects, ethical dilemmas, the need to cultivate community relations, and role conflicts. Interdisciplinary training programs and research field stations can contribute to the development of the resident researcher role. Researchers in the community can help generate grass roots support for social science research. We acknowledge Louise Shedd Barker's helpful comments and suggestions on an earlier version of this article.     

The impact of conflict of interest on trust in science

Conflicts of interest have an erosive effect on trust in science, damaging first the attitude of the public toward scientists and their research, but also weakening the trusting interdependence of scientists. Disclosure is recognized as the key tool for management of conflicts, but rules with sanctions must be improved, new techniques for avoidance of financial conflicts by alternative funding of evaluative research must be sought, and there must be new thinking about institutional conflicts of interest. Our profession is education, and both the public and research professionals of all ages would benefit from greater understanding of how science should and does work. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

Researcher Perspectives on Conflicts of Interest: A Qualitative Analysis of Views from Academia

The increasing interconnectedness of academic research and external industry has left research vulnerable to conflicts of interest. These conflicts have the potential to undermine the integrity of scientific research as well as to threaten public trust in scientific findings. The present effort sought to identify themes in the perspectives of faculty researchers regarding conflicts of interest. Think-aloud interview responses were qualitatively analyzed in an effort to provide insights with regard to appropriate ways to address the threat of conflicts of interest in research. Themes in participant responses included disclosure of conflicts of interest, self-removal from situations where conflict exists, accommodation of conflict, denial of the existence of conflict, and recognition of complexity of situations involving conflicts of interest. Moral disengagement operations are suggested to explain the appearance of each identified theme. In addition, suggestions for best practices regarding addressing conflicts of interest given these themes in faculty perspectives are provided.     

Managing financial conflicts of interest in clinical research

Upholding public trust in clinical research necessitates that human subjects be protected from avoidable harm and that the design, interpretation and reporting of research results be shielded from avoidable bias. On both counts, managing financial conflicts of interest is critically important, especially in the modern era when the opportunities for investigators to benefit personally from the commercialization of their intellectual property are overtly encouraged and rapidly expanding. Efforts are underway in the United States to provide more useful guidance to universities and medical schools for purposes of strengthening the oversight and management of financial conflicts of interest in clinical research. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

Perspectives and the World

In this paper I consider metaphysical positions which I label as ‘perspectival’. A perspectivalist believes that some portion of reality cannot extend beyond what an appropriately characterised investigator or investigators can (in some sense) reveal about it. So a perspectivalist will be drawn to claim that a portion of reality is, in some sense, knowable. Many such positions appear to founder on the paradox of knowability. I aim to offer a solution to that paradox which can be adopted by any perspectivalist, which involves no restriction on the claim of knowability and which allows certain sentences to be unknowable. The solution hinges on recognising that what is meant by ‘knowable’ will vary from one type of proposition to another and thus that characterising the modality involved in the notion in terms of possible worlds will be impossible. I thus offer a subjunctive conditional reading of that modality, a reading which, I claim, has the virtues just recounted.     

Data Trimming, Nuclear Emissions, and Climate Change

Ethics requires good science. Many scientists, government leaders, and industry representatives support tripling of global-nuclear-energy capacity on the grounds that nuclear fission is “carbon free” and “releases no greenhouse gases.” However, such claims are scientifically questionable (and thus likely to lead to ethically questionable energy choices) for at least 3 reasons. (i) They rely on trimming the data on nuclear greenhouse-gas emissions (GHGE), perhaps in part because flawed Kyoto Protocol conventions require no full nuclear-fuel-cycle assessment of carbon content. (ii) They underestimate nuclear-fuel-cycle releases by erroneously assuming that mostly high-grade uranium ore, with much lower emissions, is used. (iii) They inconsistently compare nuclear-related GHGE only to those from fossil fuels, rather than to those from the best GHG-avoiding energy technologies. Once scientists take account of (i)–(iii), it is possible to show that although the nuclear fuel cycle releases (per kWh) much fewer GHG than coal and oil, nevertheless it releases far more GHG than wind and solar-photovoltaic. Although there may be other, ethical, reasons to support nuclear tripling, reducing or avoiding GHG does not appear to be one of them.     

Carbon Sink Conservation and Global Justice: Benefitting,Free Riding and Non-compliance

It is often assumed that in order to avoid the most severe consequences of global anthropogenic climate change we have to preserve our existing carbon sinks, such as for instance tropical forests. Global carbon sink conservation raises a host of normative issues, though, since it is debatable who should pay the costs of carbon sink conservation, who has the duty to protect which sinks, and how far the duty to conserve one’s carbon sinks actually extends, especially if it conflicts with other duties one might have. According to some, forested states like Ecuador have a duty to preserve their tropical forests while the rich states of the global North have a duty of fairness to compensate states like Ecuador for the costs they incur. My aim in this paper is to critically analyse this standard line of argument and to criticise its validity both internally (i.e. with regard to its normative conclusion based on its premises) and externally (i.e. with regard to the argument’s underlying assumptions and its lack of contextualisation). As I will argue, the duty to conserve one’s forests is only a particular instantiation of a wider, more general duty to contribute towards global climate justice for which the context in which one operates (e.g. whether other agents are complying with their duties of global climate justice or not) matters significantly.     

Cultural diversity,migration and education

Migration is not a new phenomenon. However, recent data indicate that unprecedented numbers of people have experienced forced migration around the world with 51% under the age of 18 years. How can educational policies and practices respond sensitively to increasing cultural and migration-based diversity? The purpose of this special section that includes eight studies is to consider these issues more deeply. As a frame for the special section, we address the main question: What are promotive or protective factors for positive development of children and youth attending culturally diverse school contexts? In the collection of papers, these promotive and protective factors range from peers and families, to teachers, to organisational context and climate. With continued disruptions in children's lives due to a pandemic, climate change, war, conflict and poverty, migration will remain a pressing concern and will continue to transform the student populations in our classrooms and schools for the foreseeable future. The need to address how we can best provide students from diverse backgrounds equitable and supportive education, continues.     

Conflict of interest in medical research in Estonia

An area where conflicts of interest can take place in Estonia is in the conduct of clinical trials. The paper lists the main areas where such conflicts of interest can occur. The author also briefly discusses Estonia’s current position with regard to regulating genetic information and the commencement of the Estonian Genome Project. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

Charles Darwin: Continuity,Teleology and Ideology

Climate change has mutated from being a physical phenomenon to be studied to an idea to be contested. The sites of adjudication between competing truth claims have therefore moved from the secluded academy and scientific peer review to the vociferous agora and the extended peer community. This move is illustrated here using the case of the shrinking glaciers of Mt Kilimanjaro. Both the British engineer Guy Callendar, in 1944, and the American campaigner Al Gore, in 2006, claimed that the primary cause of this glacial recession was rising world temperature. Both were passionate believers in the reality of human-induced global warming, but they had very different resources at their disposal to advance these beliefs. While Callendar's claim was revealed only to the editor of the science journal Nature, Gore's claims were visible to millions through his film An Inconvenient Truth. While the force of Callendar's claim was weighed and adjudicated by one peer reviewer, the validity of Gore's claim was tested very publicly in the British courts. Both claims about the cause of Kilimanjaro's retreating glaciers were found wanting. The paper argues that this simple, but powerful, comparison between identical claims-making drawn from two different eras of science, yet with contrasting processes of truth-adjudication, illuminates the different ‘post-normal’ world of science climate change now inhabits. The case study is used to reflect on the role of the extended peer community in establishing and validating scientific knowledge about climate change: who participates, how trust is stabilised and whether science is thereby democratised.     

Visual-spatial working memory, attention, and scene representation: A neuro-cognitive theory

This paper addresses the issue of how visual-spatial working memory, attention, and scene representation are related. The first section introduces a modified two-stage conception of visual-spatial processing. “Stage one” refers to low-level visual-spatial processing and computes in parallel for the currently available retinal information “object candidates,” here called “visual-spatial units.” An attentional process called “unit selection” allows access to stage two for one of these units at a time. Stage two contains high-level visual-spatial information that can be used for goal-directions (e.g., verbal report, grasping). It consists of three parallel processing streams. First, the currently selected unit is recognized; second, a spatial-motor program for the selected unit is computed; and third, an “object file” is set up for the selected unit. An object file contains temporary episodic representations of detailed high-level visual-spatial attributes of an “object” plus an “index.” An index acts as a pointer and is bound via temporary connections to the attributes of the file. Section two of this paper specifies one part of stage two in more detail, namely visual-spatial working memory (VSWM). It can contain up to four object files. A first central claim is that during sensory-based processing for working memory (“access”), one object file is always “on-line,” and up to three other object files are “off-line”. A second central claim is that the process of setting up an object file depends on the number and the activation level of already stored files. Based on the concept of activation-based competition between object files, it is postulated that the more files that are stored and the higher their activation is, the longer it takes for a newly set up object file to reach a sufficient level of activation. Activation-based competition is also used to explain “short-term forgetting” by “interference.” A third central claim about VSWM is that a “refreshment' process exists that increases the activation level of an index of an object file in order to prevent forgetting or in order to bring the file back to the state of controlling the current action. Finally, section three gives a selective look at a number of experimental data such as the attentional blink, backward masking, dwell time effects, transsaccadic memory, and change blindness. New explanations are offered and new predictions made. Received: 16 January 1998 / Accepted: 25 July 1998     

When global problems come home: Engagement with climate change within the intersecting affective spaces of parenting and activism

Emotional engagement with climate change has been identified as an important research agenda. Recent studies have suggested parental worry for children and future generations are motives for climate activism, highlighting both personal and social justice concerns. A global parent-led climate justice movement specifically articulating this has emerged, yet currently remains under-researched. At the same time, social movement research has tended to overlook the social embeddedness of activism. To address these gaps in knowledge, this study used a qualitative mix of diary entries and interviews of UK-based mothers and fathers to investigate the overlapping emotional spaces of climate activism and parenting. It found that a parental lens on climate, informed by dystopian imaginings and processes of responsibilisation amplified fear and risk-related feelings, but were managed by channelling energy into a diverse array of collective action spaces. This led to positive emotions of hope and solidarity which were fostered and circulated within close personal relationships. In addition, the study found times and spaces which put a strain on affective engagement, and on partner relationships. The paper discusses the lack of moral anger in this sample of climate activists compared to previous research, and calls for further enquiry into the movement's development of intergenerational justice grievances.     

Impartial Reasons,Moral Demands

Consequentialism is often charged with demandingness objections which arise in response to the theory’s commitment to impartiality. It might be thought that the only way that consequentialists can avoid such demandingness objections is by dropping their commitment to impartialism. However, I outline and defend a framework within which all reasons for action are impartially grounded, yet which can avoid demandingness objections. I defend this framework against what might appear to be a strong objection, namely the claim that anyone who accepts the theory will be practically irrational.     

The Quantum Structure of Knowledge

This paper analyzes how conflicts of perspective are resolved in the field of the human sciences. Examples of such conflicts are the duality between the actor and spectator standpoints, or the duality of participancy between a form of social life and a socio-anthropological study of it. This type of duality look irreducible, because the conflicting positions express incompatible interests. Yet, the claim of “incommensurability” is excessive. There exists a level of mental activity at which dialogue and resolution are possible. Reaching this level only implies that one comes back to a state of undetermination between situations and interests whose best model is a superposition of states in generalized quantum theory. Some applications of this strategy of going back below the point of “state reduction”, from the psychology of perception to the history of civilization, are presented.