Yesterday 3 colleagues and I submitted a refutation of an article concerned with opioids to a major journal. When it came to the section on stating whether I had a conflict of interest, I realized that I did not have a conflict of interest, it might appear that I did, so what to do?
The facts are this. The article to which we were responding concluded that opioids are no better than nonopijoid treatment in dealing with moderate to severe chronic back pain, osteoarthritis of the knee, or hip pain. This may or may not be true, but the study was methodologically flawed in some very severe ways. Therefore, the conclusion is not warranted from the study.
So, where is the potential conflict? A decade ago, a colleague and I accepted an unrestricted grant from Purdue Pharma (manufacturer of OxyContin and MS-Contin). We were going to (and did) study socio-economic and geographic inequalities in access to prescribed outpatient pain medications in the State of Washington. The only other place where this had been investigated was in New York City, where there were immense inequalities. Would there be in a much different, partly urban and partly rural setting? We did not know. We thought it crucial to know. (the “we” being John Loeser, MD, Neurosurgery and Anesthesia/Pain Medicine, Univ of Washington). Purdue kindly gave us a grant to look at this.
All that Purdue asked was that they receive a copy of the article once it was published (Clinical Journal of Pain) which we provided. There was no other correspondence between us. There were no conditions set for the study.
In other words, there was no conflict of interest. But appearances are sometimes everything. I thought that it would be incorrect to state that I had no conflicts. Yet it was also incorrect to state that I have a conflict of interest. In the end, I thought it better to be safe than sorry and I declared this as a potential conflict. I don’t know whether this was the right thing to do or not, but considering the existing atmosphere, and community standards, I thought it best. Will we be attacked for having a conflict? Maybe. Will the piece not be accepted because of a conflict? Maybe. Would I feel wrong in not declaring a potential conflict? Yes. I would have felt wrong. The optics would be funny.