“Conflicts of interest should always be disclosed.”
This is what I wrote in the ‘RULES’ of this blog when I first started it almost 4 years ago. Sadly, very few people writing comments observe this rule. Perhaps, I just thought, I did not observe it either? So, here are my conflicts of interest: none.
Not true!!! I hear some people say. But it is!
I have no financial interest in any ‘Big Pharma’ or ‘TINY CAM’, and I get not a penny for writing this blog.
How do I pay for my living? Mind your own business… well, on second thought, even that must not be a secret: I get a small pension and have some savings.
Still not convinced?
Perhaps it’s time to define what ‘conflicts of interests’ are. According to Wikipedia, they can be defined as situations in which a person or organization is involved in multiple interests, financial interest, or otherwise, one of which could possibly corrupt the motivation of the individual or organization.
So, not having financial benefits from my current work does not necessarily mean that I have no conflicts of interest. The above definitions vaguely mentions ‘or otherwise’ – and that could be important. What could this mean in the context of this blog?
Well, I might have very strong beliefs, for instance (for instance, very strong beliefs that acupuncture is by definition nonsense [see below]). We all know that strong beliefs can corrupt motivation (and a lot more). And if I ask myself, do you have strong beliefs?, I have to say: Yes, absolutely!
I believe that:
- good evidence is a prerequisite for progress in healthcare,
- good evidence must be established by rigorous research,
- we should not tolerate double standards in healthcare,
- patients deserve to be treated with the best available treatments,
- making therapeutic claims that are not supported by sound evidence is wrong.
These strong beliefs might make me biased in the eyes of many who comment on this blog. In Particular, we recently had a bunch of acupuncturists who went on the rampage attacking me personally the best they could. However, a rational analysis of my beliefs can hardly produce evidence for bias against anything other than the promotion of unproven therapies to the unsuspecting public.
The above mentioned acupuncturists seem to think that I have always been against acupuncture for the sake of being against acupuncture. However, this is not true. The proof for this statement is very simple: I have published quite a bit of articles that concluded positively – even (WOULD YOU BELIEVE IT?) about acupuncture for back pain! A prominently published meta-analysis of 2005 (with me as senior author) concluded: “Acupuncture effectively relieves chronic low back pain.” (This of course was 11 years ago when the evidence was, in fact, positive; today, this seems to have changed – just like the NICE guidelines [probably not a coincidence!])
Conflicts of interest? No, not on my side, I think.
But what about the ‘other side’?
The unruly horde of acupuncturists (no, this is not an ad hominem attack, it’s a fact) who recently made dozens of ad hominem attacks against me, what about them?
- They earn their money with acupuncture.
- They have invested in acupuncture training often for long periods of time.
- They have invested in practice equipment etc.
- Some of them sell books on acupuncture.
- Others run courses.
- And all of them very clearly and demonstrably have strong beliefs about acupuncture.
I think the latter point constitutes by far the most important conflict of interest in this context.
And this is where the somewhat trivial story has an unexpected twist and gets truly bizarre:
I have just leant that the same group of conflicted acupuncturists are now planning to publicly attack the panel of experts responsible for drafting the NICE guidelines. The reason? They feel that this panel had significant conflicts of interest that led them to come out against acupuncture.
Perhaps I should mention that I was not a member of this group, but I suspect that some of its members might have links to the pharmaceutical industry. It is almost impossible to find top experts in any area of medicine who do not have such links. You either gather experts with potential conflicts of interest, or you get non-experts without them. Would that bias them against acupuncture or any other alternative therapy? I very much doubt it.
What I do not doubt for a minute is that conflicts of interest are of major importance in these discussions. And by that I mean the more than obvious (but nevertheless undeclared) conflicts of interest of the acupuncturists. It seems that those with the strongest conflicts of interest shout the loudest about the non-existent or irrelevant conflict of interest of those who do not happen to share their quasi-religious belief in acupuncture.