Interpreting competing interests

“If I was aware that a lecture on impotence was being given by a urologist whose department was funded by Rhino Horn International my own interpretation of his recommendations would take that into account.” So writes Pawan Randev (p 855) in advocating that people giving lectures or running workshops should declare competing interests in the way that is becoming routine in journals.

Competing interests are there for all to see in this issue of the BMJ. In August last year we took steps to try to increase the number of contributors declaring competing interests. We changed our terminology from “conflict of interest” to “competing interest,” arguing that there is nothing wrong with having a competing interest but that there is with not declaring it. Our change of policy has been accompanied by an increase in the number of disclosures, and we hope—like good postmodernists— that this is increasing readers’ ability to interpret the discourse.

Consider third generation contraceptive pills. Bitter arguments have surrounded their safety relative to second generation pills, with the original studies being “subjected to relentless criticism for being flawed by bias and confounding” (p 795). “In a $3bn world contraceptive market the stakes are high,” observes editorialist Paul O’Brien. He concludes, however, that third generation pills clearly are less safe than second generation pills (p 795). His editorial accompanies a paper showing that hospital admissions for venous thromboembolism have increased 16% since increases in prescriptions for third generation pills (p 820). But Dr O’Brien is a paid consultant to the legal team representing women who may sue the manufacturers of third generation contraceptives. Might this affect his judgment?

Legal battles may also be influencing the study on possible cerebral impairment in people exposed to the drinking water in Camelford, Cornwall, that was contaminated with aluminium (p 807). Previous studies have suggested that normal and benign symptoms have been attributed to the poisoning, but the study we publish today on 55 people taking legal action against the water company finds measurable impairment. Competing interests feature as well in discussions on antivirals in chronic hepatitis (p 799) and antidepressants in older people (p 850).

No doubt competing interests play some part in the worldwide debate over reconfiguring hospital services. As the first article in a seven part series makes clear (p 845), hospitals everywhere are under pressure. An editorial says that there can be no masterplan for reconfiguring hospitals in Britain but that each district will have to trade off access, quality, and cost (p 797).