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Subject:
From:
Elizabeth Brooks <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 28 Nov 2012 11:54:15 -0500
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Yes, Judy -- it *is* a complicated world, esp. when you venture into the
confusing and scary-sounding realm of conflicts-of-interest (COI).

Karleen's research for the Int'l Code Documentation Centre is related to a
political issue, with COI implications: Whether associations of healthcare
professionals (HCPs) and/or BFg counselors, who serve mothers-and-babies,
are demonstrating tangible support for the [WHO] International Code by
refusing to accept sponsor or advertising dollars from entities who are not
meeting their obligations under the Intl Code.  As the Int'l Code itself
would expect; see Article 7.  All it takes is a quick flip through any of
the major journals for physicians, IBCLCs, nurses, dietitians and
childbirth educators to see the different kinds of **ads** that are deemed
acceptable in each ... many of them from Code violators.

It is well-documented that commercial interests and healthcare interests Do
Not Mix.  It puts HCPs -- and by extension, their member assns --  in a
professional conflict of interest to accept funding or barter from
pharmaceutical and medical device manufacturers. Healthcare providers
market good health ... companies market products/services.

My two favorite books on the subject are Jerome Kassirer's "On the Take,"
and Carol Elliott's "White Coat Black Hat."  You can also freely access my
favorite chapter in the treatise by Lo & Field, on commercial influences on
HCP education, at http://www.ncbi.nlm.nih.gov/books/NBK22945/

Note that most of the scholarly writing on this topic goes to
*pharmaceutical and medical device* manufacturers.  I maintain that there
is also plenty of conflict-of-interest to be found when IBCLCs are given
financial inducements from book publishers, stool makers, bra designers,
pillow stuffers, herbal tincture makers, phone app writers, etc.

The rules for accepting **advertising** revenue, by a professional assn
journal's publisher, are different from the rules for evaluating **research
abstracts and articles** that are submitted to the same peer-reviewed
journals (in hopes of publication).  All journals with any degree of
respectability require authors to **disclose** any relationship that might
be deemed to have a bearing on the article written.  The sales divisions of
journals seek and accept ad money ... but they operate separately from the
content editors, who are reviewing submissions of articles.

Disclosure helps the reader assess the article.  Surely if you got a chunk
of money from Chocolate Land, and you have written an article raving about
the dark chocolate at Chocolate Land, the reader is entitled to be apprised
of the financial connection.  It allows the reader to ask herself, "Well,
hmm.  I wonder if this rave review is because Chocolate Land gave the
author a chunk of money."

Whether an article passes academic and peer-review muster, and is published
by a scholarly journal, is a separate COI analysis than one  examining an
assn's tangible support for the [WHO ] Int'l Code by refusal of advertising
dollars.  If the content editors of the journal accept an article, and if
it is to be published, there will also be the required full disclosure by
the author of any real or perceived COIs.

But it gets even trickier.  Elliott waxes eloquent about this conundrum of
"coming clean but playing dirty:" "Disclosure of conflicts is usually
presented as a win-win solution.  Doctors get to keep accepting industry
money; the drug companies get to keep giving it; and anyone else who might
be affected can be reassured by the knowledge that the transactions are no
longer secret." p. 92.  And yet, research at Carnegie Mellon Univ "suggests
that, far from remedying the bias created by COIs, disclosure may actually
make the bias [of the researcher] worse." p. 93.

That a published research article was disclosed as underwritten by a
commercial entity goes to the disclosure requirements for subject matter
content in a journal.

That a journal publishes advertisements from a commercial entity goes to
the sales rules established for ads in a journal.

-- 
Liz Brooks JD IBCLC FILCA
Wyndmoor, PA, USA

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