Don’t assume there are no competing interests.
In addition to wanting to help people, people who promote or oppose a health action may have other reasons for doing so. Amongst other things, these reasons may include financial interests, and cultural or religious practices. These are called competing or conflicting interests.
Explanation
Financial conflicts of interest may arise when research is paid for by companies that manufacture medicines or medical equipment. Researchers with financial conflicts of interest are more likely to exaggerate benefits, ignore potential harms, cherry pick which information is used, or make false claims. They may be more likely to selectively report outcomes that favour a new health action and not to publish the results of a comparison if it does not favour the new health action. They also may be more likely to draw conclusions that recommend the new health action. Most health news reports do not consider conflicts of interest, but this does not mean that there were none.
Example
Tamiflu (oseltamivir) is an example of how financial conflicts of interest can result in misleading claims about the effects of a treatment. Tamiflu was approved for seasonal influenza (the flu) by the U.S. Food and Drug Administration in 1999. Several studies and systematic reviews emphasised the benefits and safety of Tamiflu. They claimed that Tamiflu reduces the risk of complications of influenza, such as pneumonia and hospital admission. Most of the studies and systematic reviews were funded by a company called Roche, which also marketed and promoted Tamiflu. In 2005 and 2009, the fear of pandemic flu led to recommendations to stockpile Tamiflu and billions of dollars were spent on this. After battling with the company for over four years, a team of independent review authors finally accessed all the research results held by Roche. After carefully reviewing all the documents, they found no convincing evidence to support the claims that had been used to justify international stockpiling of Tamiflu. Tamiflu was found to slightly reduce the time to improvement of flu symptoms in adults and to slightly reduce the risk of flu symptoms in people exposed to the flu virus. However, it was also found to cause harms that could outweigh the benefits. As a result of biased reporting of the research and misinformed recommendations and decisions, billions of dollars were wasted.
Remember: Ask if people making claims about the effects of a health action have conflicting interests. If they do, be careful not to be misled by their claims.
Primary school
- Lesson 4. Other bad bases for claims about treatments (Part 2). In: The Health Choices Book.
- Animation: More bad bases for claims – The Health Choices Book.
Other
- Book: Who’s Behind the Numbers? In: Know Your Chances.
- Video: Why is conflict of interest a problem for healthcare workers. This is a Health Action International video lasting 3:44 minutes.
- Video: Beware of conflicts of interest. This is TED video lasting 5:35 minutes.
- Video: Do vitamin supplements really work? This is a Reactions video lasting 4:48 minutes.
- Video: Do supplemental vitamins actually work? This is a BrainStuff video lasting 5:16 minutes.
- Video: The disturbing truth about vitamin supplements – sharp science This is a Mashable video lasting 5:11 minutes.
- Video: Doctors, Money, and Conflicts of Interest. This is a Healthcare Triage video lasting 5:55 minutes.
- Blog: Beware of conflicting interests This is a Students 4 Best Evidence blog.