Cochrane has a commitment to independence, transparency, and integrity in healthcare research and strives to minimize the impact of conflicts of interest in the conduct of Cochrane Reviews. 

Although Cochrane’s current conflict of interest policy is stricter than most journals, over the past year we have revised our policy with the aim of strengthening our approach to financial conflicts of interest, and clarifying our position regarding non-financial interests. [1] This work was led by a panel of experts that included Cochrane’s Conflict of Interest arbiters, members of the Cochrane Governing and Editorial Boards, and other Cochrane members with expertise in conflict of interest. [2] 

To inform the policy revision we: 

1. examined conflict of interest policies from 33 healthcare-related organizations, including journals, guideline developers and research funders; 
2. conducted an open, online survey resulting in contributions from nearly 1000 Cochrane members; and; 
3. interviewed 16 internal and external stakeholders. 

At the end of this process, we proposed a series of recommendations to strengthen Cochrane’s policy regarding financial and non-financial conflicts of interest. Cochrane’s Governing Board recently approved these recommendations, and work has begun to rewrite Cochrane’s current policy accordingly. The new policy will come into force early in 2020, and will apply to all newly registered Cochrane Reviews.

Cochrane’s new, more rigorous approach includes the following key changes: 

1. The proportion of conflict free authors in a team will increase from a simple majority to a proportion of 66% or more. 
2. Last authors will be treated in the same way as first authors and, therefore, must be entirely free of conflicts.
3. Authors of industry-funded clinical studies eligible for inclusion in a Cochrane Review will be prohibited from being the first or last author on that review.
4. Reviews funded by not-for-profit organizations with a specific interest in the outcome will be assessed by Cochrane’s Conflict of Interest Arbiter Panel and the Editor in Chief,  who will judge whether the review is conflicted.
5. Cochrane authors will need to declare non-financial interests, and think critically about how these might influence the results of the review.

The board has issued a statement saying that they aspire to make Cochrane systematic reviews completely free of commercial influence, and to minimize other conflicts of interest, as soon as possible.

A recently updated Cochrane Review provided evidence that industry-sponsored studies favour the sponsor’s products disproportionally. [3] This influence can manifest at various points in the process: in the way a review question is phrased, and the way research is designed, conducted, and published. [4] Cochrane is seriously committed to mitigating the impact of financial interests in research, which is why its policy has been strengthened. 

Recently, there has been debate about whether research organizations overlook personal non-financial interests, and we considered this during revision of the policy. To date, there is no empirical evidence of the influence of these interests on research results, so concerns about this potential type of conflict need to be balanced with the possibility of unfair representations concerning them. [5] Therefore, we have decided to ask review authors to declare relevant non-financial interests on the understanding that this will not restrict their participation in Cochrane Reviews.  

Cochrane’s desire to increase the level of trust that readers have in Cochrane Reviews, and our support for efforts to improve integrity in healthcare research have motivated us to strengthen our conflict of interest policy, however, the ability of any new policy to effect desired change depends on how well it is implemented. To that end, we will support implementation of this policy through the appointment of a dedicated team that will include a Research Integrity Editor with expertise in the field of conflict of interest. We will re-emphasize the independence of the Conflict of Interest Arbiter Panel and initiate changes in our editorial management system to enable improved monitoring of reporting of conflicts of interest throughout the life cycle of reviews. As an organization, Cochrane looks forward to the improvements this policy will bring in keeping Cochrane Reviews demonstrably independent and impartial in their reporting and conclusions.

Read the full collection: Commercial influence in health: from transparency to independence

 

Karla Soares-Weiser is a board-certified psychiatrist with a Doctorate in evidence-based healthcare and over 25 years of experience in evidence synthesis. She was appointed Cochrane’s Editor in Chief in June 2019 after working as its Deputy Editor in Chief for four years. 

Competing interests: I have been a full-time employee of Cochrane since 2015. From 2009 to 2015 I managed a small business that provided research synthesis expertise mostly to not-for-profit organizations. In this Opinion I have summarized work commissioned by the Cochrane Governing Board and performed by a panel of Cochrane members that included the current Funding Arbiter Panel. My role was limited to managing the process, although I take full responsibility for its implementation. 

 

References

1. Bero L. https://blogsbmjcom/bmj/2018/11/12/lisa-bero-more-journals-should-have-conflict-of-interest-policies-as-strict-as-cochrane/
2. Tovey D, Macbeth F, Webster A, Foxlee R. Cochrane’s plans to update its COI policy: truth and fiction. Cochrane Database Syst Rev. 2018(11).
3. Lundh A, Lexchin J, Mintzes B, Schroll JB, Bero L. Industry sponsorship and research outcome. Cochrane Database Syst Rev. 2017;2:MR000033.
4. Odierna DH, Forsyth SR, White J, Bero LA. The cycle of bias in health research: a framework and toolbox for critical appraisal training. Account Res. 2013;20(2):127-41.
5. Bero LA, Grundy Q. Why having a (non-financial) interest Is not a conflict of interest. PLoS Biol. 2016;14(12):e2001221.