Monday, March 02, 2009

Journal Asks University to Censure Professor for Alleging an Undisclosed Conflict of Interest

The journal Nicotine and Tobacco Research has written to the University of Alberta, formally requesting that it censure one of its faculty members for publicly alleging that a journal article's author failed to disclose a conflict of interest. The faculty member - Professor Carl Phillips - has published on his blog the letter of complaint sent by the journal as well as the chain of emails in which Dr. Phillips discussed the potential conflict of interest with the journal's editorial board.

Here are the facts of the matter as best as I understand and can present them:

In a 2008 Lancet article which reviewed the literature regarding the relationship between smokeless tobacco use and cancer, a conflict of interest of one of the article's authors was initially not disclosed (see: Boffetta P, Hecht S, Gray N, Gupta P, Straif K. Smokeless tobacco and cancer. Lancet Oncology 2008; 9:667-675). The original article was published in July, 2008. That article stated: "The authors declare no conflicts of interest." After the editor of the journal was notified by Dr. Phillips of a potential conflict of interest of Dr. Stephen Hecht (one of the study authors), an erratum was published in September 2008, which noted: "During the immediate months preceding submission of the review SH was acting in the capacity of an expert witness for the plaintiff in a future court case against a smokeless tobacco company. SH declares his participation in this case in no way influenced his writing or involvement in the review."

More recently, Dr. Phillips made an inquiry to the journal Nicotine and Tobacco Research, in which appeared a December 2008 article co-authored by Dr. Hecht on toxin and carcinogen levels in various brands of smokeless tobacco without any declared conflict of interest. The article stated: "The authors do not have any competing interest pertaining to this work." (see: Stepanov I, Jensen J, Hatsukami D, Hecht SS. New and traditional smokeless tobacco: Comparison of toxicant and carcinogen levels. Nicotine and Tobacco Research 2008; 10:1773-1782).

Initially, the journal responded by stating: "We agree that it might have been more open to disclose Dr. Hecht's involvement in this case. However, he argued that the data presented in this paper represented a scientific report which was in no way influenced by his acting as an expert witness in this case. Indeed, the request to him to act in this way reflected his expertise in the field. My senior editorial board unanimously agreed that there was no intention to deliberately mislead the readers in this instance and, indeed, the need to disclose that an author is serving as an expert witness is a moot point."

A later response from the journal stated: "Before responding to you, I contacted Dr. Hecht again and took the views of my team of Deputy Editors. Our list of potential conflicts of interest includes specifically payments for providing expert opinion in court - one of my Deputy Editors reminded me of that. However, in this case it appears that Dr. Hecht did not receive any payment - he waived the fee. The law firm involved, as I understand it, made an equivalent donation to a U.S. cancer charity. Thus, we accept that there is no conflict of interest to declare."

Dr. Phillips responded to the editorial board, arguing that even if a donation was made to a charity in lieu of direct payment to Dr. Hecht, it would still represent a significant financial interest for Dr. Hecht, and should therefore be disclosed. Since the journal had presumably closed the discussion on the issue (although not without a few rather nasty emails from several editorial board members), Dr. Phillips went ahead and posted the emails on his website, which deals in large part with what he sees as unethical practices in the tobacco control movement.

The journal then wrote an official letter of complaint to the University of Alberta, asking for censure of Dr. Phillips. Interestingly, the letter does not allege any wrongdoing or misconduct by Dr. Phillips. Instead, it appears to want him censured for having challenged the journal's conflict of interest policy and/or its implementation of the policy in this particular matter. The letter does, however, accuse Dr. Phillips of waging this personal attack against the journal and Dr. Hecht in order to weaken Dr. Hecht's testimony in future court cases and in order to promote financial gain for himself by encouraging further support of his work and testimony by smokeless tobacco companies.

Of note, the journal accuses Dr. Phillips of insinuating that Dr. Hecht manipulated data in the article so that it would fit with his testimony as an expert witness: "I believe it extraordinarily insulting to suggest that the data reported in papers published by Dr. Hecht, or any other author in our journal, is manipulated so that it fits with testimony given as an expert witness. All our papers are subject to rigorous review and any conclusions drawn must be justified by the data reported."

Also of note, the letter acknowledges that Dr. Hecht did serve as an expert witness and that the journal is looking to the possibility of publishing an erratum that acknowledges this: "Although we have rejected the main substance of Dr. Phillips' accusation, we are still considering a way of publishing an erratum which indicates that Dr. Hecht has served as an expert witness while making it absolutely clear that he was not paid for his services."

The Rest of the Story

The main story here is that the journal is seeking to have a faculty member censured essentially for expressing his opinion -- reasoned and documented -- concerning the matter of an author's conflict of interest. The letter makes no allegation that Dr. Phillips committed any misconduct or wrongdoing. It does not allege that he disseminated false or even misleading information. It does not accuse him of distorting the facts or the truth in the case. Nor does it accuse him of making a trivial, inane, or insignificant assertion. Instead, the entire case against him appears to be that he has no business challenging the journal's implementation of its conflict of interest policy.

The irony of the whole story is that the journal itself, in the letter of complaint, acknowledges that the author does indeed have an outside interest that is deemed significant enough for the journal to publish an erratum. So apparently, the journal acknowledges that while it disagrees that Dr. Hecht has a formal conflict of interest according to journal policy, Dr. Phillips has highlighted a concern that is significant enough that the central issue should be made known to the journal's readers.

How, then, can the journal expect the University to censure Dr. Phillips for pointing out a matter to the journal that the journal deems relevant enough and of enough interest and importance that it is indeed going to consider publishing an erratum?

It appears to me that the journal is interfering with Dr. Phillips' academic freedom and trying to harm his career rather than responding to any actual (or even alleged) wrongdoing or misconduct on his part.

Ironically, the journal is accusing Dr. Phillips of being the one who is trying to harm someone else's career. Now it appears to be merely a tit-for-tat response.

The most telling point in the whole story is that another journal - Lancet Oncology - published an erratum in which it acknowledged its opinion that Dr. Hecht does in fact have a conflict of interest that should be disclosed in that article and that a mistake was made in failing to disclose it initially. While the issue of whether the same conflict of interest is present in the Nicotine and Tobacco Research article depends largely upon whether or not the subject matter of that paper is closely enough tied to the substance of Dr. Hecht's testimony, the journal is not asserting that the reason why it deems there to be no conflict is that the subject matter of the article and testimony do not coincide.

In other words, it would only be natural for Dr. Phillips or any other observer to question Nicotine and Tobacco Research to see why it did not publish a disclosure for Dr. Hecht similar to the one that appeared in Lancet Oncology. It seems like a perfectly legitimate and relevant question.

Being paid to serve as an expert witness represents a conflict of interest when the research in question is directly related to the testimony to be given. The key question is whether the presence of the financial relationship between the researcher and the attorney/company could be perceived as having influenced the conduct or reporting of the research. If the research is directly related to the expert's testimony, then a reasonable person might question whether the fact of being paid to testify in the trial could have influenced the conduct or reporting of the research.

Since Lancet Oncology acknowledged that Dr. Hecht served as an expert witness, I simply do not see why it is being viewed as somehow inappropriate for Dr. Phillips to be asking this question to another journal. Whether it is a conflict or not rests largely on the overlap between the substance of the paper and the testimony, but it seems perfectly legitimate to put the question forward.

In the journal's response, it did not argue that there was an absence of overlap between the content of the paper and that of the expert witness' testimony. Thus, it was natural and logical for Dr. Phillips to pursue the issue further. In fact, the journal did acknowledge that "it might have been more open to disclose Dr. Hecht's involvement in this case." It also acknowledged that
"our list of potential conflicts of interest includes specifically payments for providing expert opinion in court - one of my Deputy Editors reminded me of that."

So then what exactly did Dr. Phillips do wrong here? The entire issue, in the journal's own words, comes down to whether Dr. Hecht received payment for serving as an expert witness. And in the journal's own words: "in this case it appears that Dr. Hecht did not receive any payment - he waived the fee. The law firm involved, as I understand it, made an equivalent donation to a U.S. cancer charity."

Now if Dr. Hecht decided that instead of keeping the money for himself, he would direct that the money instead be donated to a cancer charity, then Dr. Hecht did indeed receive financial compensation for his work, making it - in the acknowledged opinion of the journal - a significant conflict of interest.

Does making a donation to charity in lieu of accepting payment for serving as an expert witness negate an otherwise relevant conflict of interest? No. The individual is still essentially getting paid for his services. The fact that he chooses to do something with this money other than put it into his personal bank account is his own prerogative, but it does not make the financial interest go away.

Thus, the journal's essential reason for claiming that a conflict of interest does not exist in this case is fallacious. The journal is basically admitting that if Dr. Hecht were being paid for his testimony, a conflict would exist and should be disclosed. However, that is indeed the situation. Whether the money goes into his own bank account or is donated to charity, he is being paid for his testimony. Money is coming out of the law firm that would otherwise not be. And its use is being directed by the expert witness.

So the bottom line is that not only is there an absence of any academic misconduct here, but the position that Dr. Phillips takes is - given the policy as stated by the journal itself - apparently the correct one.

I should also emphasize that the journal's letter appears to be wrong in asserting that Dr. Phillips is alleging that Dr. Hecht manipulated the research findings to aid his testimony. Dr. Phillips is not arguing that there was any impropriety in the research; he is merely arguing that a conflict of interest is present and should be disclosed.

Why is the journal apparently so determined to try to silence Dr. Phillips through university interference in his work? I don't know, but in my experience, the fact that he has received research funding from smokeless tobacco companies is probably a major factor. It automatically makes him an "enemy" of the tobacco control movement, someone who must be attacked and whose character must be questioned, even if the substance of the argument he is making is admittedly meritorious.

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