Media portrayal of conflicts of interest in herbal remedy clinical trials.

• Author: Koper, Megan

Complementary and Alternative Medicine (CAM) encompasses a wide variety of treatments, such as herbal remedies, not currently thought to be part of mainstream medicine. Our study focuses on herbal remedies, as their use is significant and increasing. (1) We ask whether media coverage of conflicts of interest in clinical trials of herbal remedies is of sufficient quality to provide the public with information to make decisions that are rational, well-informed, and low-risk. We know that the vast quantity of information available on CAM through popular media is of varying quality. (2)

In recent years, the scientific community is increasingly interested in studying herbal remedies. (3) As conflict of interest has been an issue in synthetic drug trials, especially those receiving funding from industry, we have reason to believe that this will also be true of clinical trials of herbal remedies, many of which are industry funded.

What is conflict of interest and why are we interested?

In his thoughtful and widely accepted analysis, Thompson defined conflict of interest as "a set of conditions in which professional judgement concerning a primary interest (such as a patient's welfare or validity of research) tends to be unduly influenced by a secondary interest (such as financial gain)." (4) He also noted that, while a secondary interest is usually not illegitimate in itself, its relative weight in professional decision-making is problematic. The goal, therefore, is to prevent secondary interests "from dominating or appearing to dominate the relevant primary interest in the making of professional decisions", rather than to reduce or eliminate them completely. (5)

Conflict of interest rules, those regulating the disclosure and avoidance of these conflicts, generally focus on financial gain because it is relatively objective and easier to regulate by impartial rules. This does not mean, however, that financial gain has a greater potential for harm than other secondary interests. (6)

The subtle distinction between conflict of interest and bias must also be emphasized. A declared conflict should merely be seen as an association creating the potential for bias, rather than an indication of bias itself. (7) It has also been noted that if an association does compromise one's judgment, it is generally a result of unconscious bias rather than outright dishonesty. (8) Because the influence of secondary interests can be extremely subtle, the presence of bias...