The fallacy of competing interest statements: no shortcut to rigour in research

Abstract

We recently noted your editorial by Richard Smith et al. concerning author conflict of interest statements.1 We are concerned that it could be taken to imply that we failed to declare appropriately ‘competing interests’ that might have influenced our views in a recent PLOS Medicine debate on the role of the private sector.2 We refute this suggestion and believe that it is essential to distinguish competing interests from the broad range of factors that influence and shape judgements about evidence – such as personal values and beliefs, professional and disciplinary training, et cetera. We do not claim to be lacking in self-interest – that would run counter to most bodies of economic thought – but it is incorrect to suggest that our views were influenced by competing interests as usually defined: ‘… anything that interferes with, or could reasonably be perceived as interfering with, the full and objective presentation, review, or publication of research findings …’.3 The authors of the editorial do not argue that we received any direct financial benefits from our contribution. However, they imply that a range of potential institutional linkages may have affected our position on the appropriate role for the private sector – our employer (the London School of Hygiene and Tropical Medicine), the World Health Organization and the other ‘governments, foundations, NGOs and UN agencies’ with which we have all collaborated or received funding from in the past. There are two issues here. The first is that none of these organizations could be said to have a single and unitary view on the private sector – they are all institutions within which a range of positions and perspectives thrive. Second, it is difficult to see how we would stand to benefit, jointly or individually, from presenting any particular perspective. Neither our reputation, nor our incomes, nor those of our employer, depend on taking a particular side in this debate. Indeed, given the current wave of interest in the private sector we might argue the opposite – that taking a more positive line on the private sector might attract greater income for our activities! The suggestion that any ‘culture’ within LSHTM could influence our position is particularly troubling: the procedures and processes for academic promotion, for example, involve extensive external scrutiny and review. Finally, we disagree with Smith et al.'s implication that simply declaring a long list of potential influences is the sufficient and appropriate step in protecting rigorous research judgements. It is of even greater importance to ensure that we present our arguments explicitly, use evidence appropriately, be reflective about the bases on which we reach our judgements, and allow readers to determine whether our arguments are credible, persuasive and trustworthy. This is precisely what we aimed to achieve in our contribution to the PLoS Medicine debate. Contrary to Smith et al.'s claim that we argued against a greater role for the private sector, we actually proposed a balanced assessment of public and private roles based on a rigorous assessment of existing evidence. Indeed, among the four of us are authors who have frequently promoted the idea of greater private sector involvement in healthcare delivery.4,5 Misrepresentation of all influences on such complex health policy questions as ‘competing interests’ is a distraction to broader debates about the appropriate and rigorous conduct of such research.6