BIAS

“opinion or feeling that strongly favours one side in an argument or one item in a group or series”

ACADEMIC BIAS

“The pre-med syndrome”

Extraordinary size of science(difficult supervision of young researchers)

Professional and economic competition

Fertile soil for fraud

CONFLICT OF INTEREST (COI)

Conflict of interest exists when a participant in the publication process (author, peer reviewer or editor) has a competing interest that could unduly influence (or be reasonably seen to do so) his or her responsibilities in the publication process (submission of manuscripts, peer review, editorial decisions, and communication between authors, reviewers and editors).

CONFLICT OF INTEREST

COI exists when an author, reviewer, or editor has financial or personal relationships that inappropriately influence (bias) his or her actions

http://www.icmje.org/ethical_4conflicts.html

Financial relationship – the most easily identifiable• Employment• Consultacies• Honoraria• ...

COI – OTHER REASONS

• Possible source of bias

• Rarely appears in COI statement

• More subtile

• Lack of uniformity among journal editors

• Academic competititon/commitments

• Intellectual passion

• Desire for fame

• Personal relationship

• Political or religious beliefs, developing country bias

• Gender bias

• Institutional affiliations

COI – OTHER REASONS

COI – ACADEMIC COMMITMENTS

• “Intellectual passion”

• Hard to challenge conventional wisdom

• Needs extra effort to be published

COI – PERSONAL RELATIONSHIP

• Family, friends, enemies, competitors or colleagues...

• Difficulty to be unbiased

POLITICAL AND RELIGIOUS BIAS DEVELOPING COUNTRY BIAS

• Commitment to political/religious views may pose COI

• Studies coming from low and high income countries

Yousefi-Nooraie R, et al. BMC Med Res Methodol 2006;6:37.

Enhancement of exclusive and biased use of critical appraisal checklists by editors of western medical journals

presuption that editors and reviewers are biased against their nationality

POLITICAL AND RELIGIOUS BIAS DEVELOPING COUNTRY BIAS

Developing world authors• selective reporting of larger studies • with less serious limitations • with positive and significant results

Yousefi-Nooraie R, et al. BMC Med Res Methodol 2006;6:37.

COI – GENDER BIAS

A study of postdoctoral fellowship awarded by the Medical Research Council in Sweden

Women are often disadvantaged

women needed more publications(+3 papers in Nature or Science)(+20 papers in specialty journals)

Wenneras C, Wold A. Nepotism and sexism in peer-review. Nature 1997;387:341-3.

COI – INSTITUTIONAL AFFILIATIONS

• Not just for pharma industry

• Manufactures of medical devices

• Academic institutions which has patents

• Civic organisations (patients organisations)-special interests or advocacy positions

WHO CAN BE BIASED?

• Authors

• Editors

• Reviewers

• Journal staff

WHAT KIND OF BIAS?

• Reporting bias

• Publication bias

BIAS FROM RESEARCHERS/AUTHORS

Promotion and funding of physicians – closely linked to the number of their publications

• Trivial studies leading to rapid results

• Reporting a study more than once

• “Salami-slicing” publication

Selective reporting• Ignoring certain data (i.e., instances of drug side effects)• Submission of positive results only • Inclusion of results that agree with the reviewers or editors

BIAS FROM RESEARCHERS/AUTHORS

False authorship – “ghost” authors and “honorary authors”

Rejecting papers that do not accord with their own beliefs

BIAS FROM REVIEWERS

Accepting papers without critical judgement that support their previous findings, or one that cites them extensively

Some journals reject most papers without independent review

BIAS FROM EDITORS

More likely to send papers to reviewers if they have met or know the authors

Possibility to choose the reviewers

COI – IS IT WRONGDOING?

• Conflict of interest – ubiquitous

• Can’t be eliminated – sholud be managed constructively

• Problem – when COI influences publication process

• Dangerous – not immediately apparent

• Suspicious COI can errode trust and journal reputation

• Authors can suggest persons they feel should not be reviewers

• Reviewers must clearly disclose possible COI and refuse to review the manuscripts

• Reviewers must not use knowledge of the work before publication

COI – REVIEWERS

COI – EDITORS

• Avoid reviewers with obvious COI

• No personal, professional or financial involvement

• Editorial staff must provide clear disclosure of COI

• Publish regular disclosure about potential COI

• Determine whether COI can impair an individual’s objectivity such that the article should not be published

Thank you for your attention!