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How does bias arise?

Jordan Cohen, the president of the Association of American Medical Colleges, stated recently that "a conflict of interest exists when the prospect of some personal advantage is strong enough to pose a realistic possibility that [it] might compromise the researcher’s primary obligation to adhere to sound scientific procedures in an unbiased search for the truth." In other words, money can make people bend the truth.

Identification of a conflict of interest means only that the possibility of wrongdoing exists, not that wrongdoing has been committed. For most scientists the strongest conflict of interest is personal. Basic science brings few financial advantages, so success (and the associated notoriety) is a far stronger motivating force. It has prompted more than a few researchers to commit research fraud.

But monetary conflicts of interest are more easily quantified, and are therefore the ones subject to regulation and scrutiny. These conflicts range from company funding of an academic’s research, to companies paying the academic for speaking engagements, consulting sessions, and involvement on an advisory board. Increasingly, academics also own equity in companies that are exploiting their basic research.

Most people, and perhaps particularly scientists given their commitment to the truth, think they will not be influenced by such temptations. "Everybody has in their own mind that they understand the situation better than everyone else," says Scott. "But the reality is there is subtle bias in everything we do."

That bias showed up in studies of the cost-effectiveness of six anti-cancer drugs. Charles Bennett of Northwestern University in Chicago, Illinois, analyzed the results of these studies, and reported in the October 1999 JAMA that company-sponsored trials were one-eighth as likely to reach a negative conclusion about the cost-effectiveness of these drugs when compared to trials sponsored by non-profits.

A similar situation arose when the safety of a class of drugs called calcium-channel antagonists was called into question. Multiple articles were written both supporting and opposing the use of these drugs. Of the supportive authors, 96% had ties to a company making calcium channel antagonists, whereas only 37% of the critical authors had such ties.

Clearly there is widespread conflict of interest, and at least some of that conflict leads to bias. So what can we do about it?

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