Fair-Balanced Treatment of a Controversial Issue?

Did high-impact journals afford a fair-balanced discussion of a COI? No. A comprehensive review (Lesko et al. 2012) examined research and opinion articles published between the 1980s and 2008 in three high-impact medical journals regarding relationships between companies in the medical product industry and academic physicians. Journals included were Journal of the American Medical Association, The Lancet, and The New England Journal of Medicine.

Of the 108 articles that met the reviewers’ inclusion criteria, only 12 (11%) were neutral or emphasized relationship benefits. All of those mentioned or discussed an opposing point of view. Six attempted to refute the benefit-denying viewpoint. None of the relationship-benefit emphasizing articles drew inferences about patient outcomes. In contrast, 16 of the research papers (15%) emphasized risks associated with industry relationships. None of these mentioned or attempted to refute an alternative viewpoint.

A majority of the articles (80 or 74%) were commentaries emphasizing risks of relationships with companies. 76% drew inferences about patient outcomes. Only 7 (6%) discussed critically and attempted to refute that relationships with industry were beneficial. The study authors concluded that these journals evidenced an antiindustry publication bias and had participated in a conformity cascade—where normative positions do not emerge from objective, balanced weighing of evidence but from social acceptance pressure to conform with the opinions of fellow editors all of whom in effect practice discrimination preferring to accept manuscripts from “COI entrepreneurs” (not the term used by the study authors).

Since the mid-1970s, social psychologists and behavioral economists have shown experimentally the mind’s susceptibility to availability heuristics—they guide the mind, enable substitution of easier for harder problems, and give salience to some features of experience while ignoring others. They over-invest with significance vivid, emotion-laden instances with “representativeness” of social reality.

When a social environment is seeded with a risk heuristic, like COI, and is regularly re-seeded by availability entrepreneurs and media-driven corruption stories, a cascade can become a “moral panic.” A white-glove inspection of the environment finds dirt everywhere (Stossel and Stell 2011): “one sees and hears about it all the time.” Precautionary, preventive measures are enacted. When found wanting, more costly, more stringent measures are proposed. Yet, the social environment is never purged, never is found more ethical, nor are desultory regulations ever repealed, never pronounced an overreaction, a failure.

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