Undisclosed conflict of interest
Case text (Anonymised)
We published two peer-reviewed articles—one protocol and one paper with the results of a comparative analysis comparing a group of people associated with a specific “complementary medicine health care organization” (CMG), with the general population, which concludes that the group has “unusual health indicators” (more favourable than the general population).
The papers originally contained a conflict of interest (COI) statement stating that the authors were “insiders, in that they attend CMG events. However, they have received no funding, reimbursement, or other consideration from CMG or its stakeholders, and no instructions or directions of any kind from CMG or its stakeholders. No other competing interests exist.”
Our freelance copyeditor edited this statement out, to read “Conflicts of interest: None declared”, because “attending events” is not normally something that would be considered a COI. The authors approved the galleys and did not object to these copyediting changes.
Shortly after publication, we received a 12-page letter from a journalist, detailing extensive undisclosed COIs of the authors. The letter was also addressed to another journal which published another protocol from the group, as well as to the university (the lead author is associated with the university). In the letter, the CMG movement is characterized as a controversial, multimillion dollar international enterprise. The healing modalities promoted by CMG do not appear to be evidence based. In the letter, evidence was provided showing that all researchers are long term public promoters of the CMG enterprise, as well as being spiritual adherents to the CMG ‘religion’. One author is a former CMG company director. The letter also says that the lead researcher is the spouse of a current CMG “company director” (which is disputed by the author). The corporation is owned by another corporation which in turned is owned by the founder of the CMG enterprise.
As alleged in the letter (and confirmed by our own internet searches), all authors are influential persons within the CMG spiritual and business community. We confronted the lead author with these allegations and asked the authors to provide a more detailed COI statement for a possible correction of the original papers. In response, the lead author submitted a 1-page revised COI statement detailing that all four authors have varying degrees of association with the CMG and are members of the “Practitioners’ Association” which is the body regulating practitioners who are qualified to practice CMG modalities. Two authors have “occasionally offered paid private healing sessions”. The revised COI by the author also alleged that “all authors have experienced substantial health benefits since they started visiting CMG events”. In addition, they all have published blogs on CMG associated websites. The wife of the lead author is—according to the revised COI—involved in “voluntary activities around producing content for a CMG associated company and is a “company secretary” of the CMG associated company and “does this in an honorary capacity. She is not a director or shareholder” and “does not receive any financial incentives” from CMG.
We consulted the original peer reviewers, showing them the updated COI. They said they would not have accepted the manuscript had they known about these extensive COIs. We suggested to the authors that we feel that both articles should be retracted, and we would prefer to do this with their consent.
The lead author rejected this with the argument that “we originally submitted a COI statement which the journal removed. Subsequently, you falsely asserted that my wife, is a Director and employee of a CMG associated company when she clearly isn’t and has never received any fund from CMG.”
We checked the company registration and the spouse is actually listed as company secretary, which is considered an ‘officer’ of a corporation in the country of registration, so they have many of the same duties and obligations as directors. Our concerns with the COI of the lead author (and his spouse) go beyond financial COIs, as in his blog the lead author describes how meeting the CMG founder “changed our lives profoundly”, and his spouse is describing “seemingly miraculous changes” as a result of CMG. This level of passion for CMG and their involvement may affect the authors’ scientific judgement.
The university has launched an investigation as a result of the journalists’ letter, but the investigation is not complete. Meanwhile, the case has also been picked up by the mainstream media, who is putting pressure on the university to distance themselves from CMG, which is described by the media as a “cult”.
Question(s) for the COPE Forum
• Should we publish the updated COI statement as a corrigendum, perhaps with a notice of editorial concern, and wait for the outcome of the university investigation to decide on further steps.
• Or should we retract the papers due to non-disclosure of COI (and also due to concerns over the content and practices of the CMG enterprise, the scope of which neither reviewers nor editor were aware of when accepting the paper)?
• Is there any third option we have not thought of?
The Forum advised that there do not appear to be grounds for retraction. The COPE guidelines on retraction state that “Retraction should usually be reserved for publications that are so seriously flawed (for whatever reason) that their findings or conclusions should not be relied upon.” A conflict of interest is not in itself a reason to retract an article, particularly in an original research paper, unless there are serious concerns with the data. Hence the Forum would agree with the publication of an updated COI statement as a corrigendum, perhaps with an editorial notice. The Forum also suggested collaborating with the institution on their investigation. If the institution finds there are fabricated or serious flaws in the data, then the editor may wish to consider retracting the article. But a retraction at this stage is not appropriate.
The journal published two expressions of editorial concerns and corrections (one for the protocol and one for the final paper, correcting the conflict of interest disclosure as well as correcting the data, as per the corrigendum submitted by the authors). Regarding the third paper, a protocol published by another publisher, to our knowledge they have not taken any action, such as publishing an expression of editorial or updating the conflict of interest. The journal is collaborating with the authors' institution which is currently still investigating this case and will await their recommendation on whether or not the paper should be marked as retracted.