Healthy Skepticism Library item: 7054

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Publication type: Journal Article

Andersen NV.
Dispute over conflicts of interests leads to changes for medical society.
BMJ 2006 Dec 16; 333:(7581):1240
http://www.bmj.com/cgi/content/full/333/7581/1240

Abstract:

After a year of controversy over the influence of drug industry money, conflicts of interests and lack of transparency, members of the International Continence Society (ICS) last week decided to postpone an election for a new general secretary and to review and possibly rewrite the constitution of the society and its ethical guidelines.

“In three days we’ve made five years’ worth of progress. We have managed to re-establish trust between the involved parties, and this should go a long way towards resolving our problems. We all agreed that the wellbeing of the society should be our highest priority,” said Hans Peter Dietz, associate professor in obstetrics and gynaecology at Sydney University, a vocal critic of industry influence.

The review comes as a result of a dispute within the society stemming from growing unease that industry money is influencing scientific discourse in the medical society.

Overactive bladder syndrome and its treatment, for example, has been fiercely debated. The syndrome covers everything from having an unusually strong and sudden urge to urinate-maybe combined with frequent urination in the day or night-to incontinence.

There are currently a handful of medicines used to treat overactive bladder syndrome, but, according to a review by the Cochrane Collaboration, their efficacy is questionable (BMJ 2003;326:841-4). The review concluded, “Although statistically significant, the differences between anticholinergic drugs and placebo were small, apart from the increased rate of dry mouth in patients receiving active treatment. For many of the outcomes studied, the observed difference between anticholinergics and placebo may be of questionable clinical significance. None of these studies provided data on long term outcome.” Up to nine out of 10 patients stop the drugs within a year.

The altercations in the society began last year with the election of a new editor in chief of the society’s journal Neurourology and Urodynamics. The selection process was thought by some members of the editorial board to be so obscure that they resigned.

When, subsequently, certain members of the society asked that full disclosure be given by some of the society’s office holders of any relevant conflict of interest, their request was denied. Instead an internal discussion document was prepared proposing that the society’s advisory board be given a new, far reaching power to expel any member “if, in the opinion of the Board, he has acted or has threatened to act in a manner which is contrary to the interests of the Society as a whole or if his conduct … is likely to bring the Society, or any or all of its Directors or members into disrepute.”

The proposal was never presented to the society’s members and abandoned, but then an alternative was put forward: no member should be able to view or discuss the disclosure of another member’s conflicts of interests unless the society’s executive committee and the member permit it.

The rule said that every member would have to fill in a form showing their conflicts of interests annually, which would be held at the society’s office.

“Any member wishing to view other members’ disclosure forms must:

a) Complete and submit a form themselves

b) Put their request in writing indicating the reason for their request

c) Make a written commitment not to discuss or disclose any information contained in the disclosure form to a third party without prior consent of both the form’s author and the ICS Executive Committee

The ICS Executive Committee will review and approve requests accordingly. Failure to adhere to this policy is likely to result in expulsion from the Society.”

More recently, the society’s executive has proposed another rule change, the effect of which, according to some members of the society, would be to remove the limit on the period of time trustees are entitled to hold office. This proposal has further aggravated the internal opposition.

At the annual meeting of the society last week in Christchurch, New Zealand, Professor Peter Dietz together with Danish professor Gunnar Lose, and Werner Schäfer, a biomedical engineer and director of the Continence Research Unit at Pittsburg University, led a push for transparency, new ethical guidelines, and a totally different structure of governance within the society.

A compromise solution was reached and a constitutional committee was established to review and, where appropriate, to rewrite the rules. All the matters will be voted on by the membership next year.