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Research and Reporting Methods |

Financial Conflicts of Interest and Conclusions About Neuraminidase Inhibitors for Influenza: An Analysis of Systematic ReviewsConflicts of Interest in Systematic Reviews of Neuraminidase Inhibitors

Adam G. Dunn, PhD; Diana Arachi, MPH, MA; Joel Hudgins, MD; Guy Tsafnat, PhD; Enrico Coiera, MBBS, PhD; and Florence T. Bourgeois, MD, MPH
[+] Article, Author, and Disclosure Information

From the Centre for Health Informatics, The University of New South Wales, Sydney, Australia, and Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.

Grant Support: From the National Health and Medical Research Council (project grant 1045065).

Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0933.

Requests for Single Reprints: Adam G. Dunn, PhD, Centre for Health Informatics, The University of New South Wales, Sydney, NSW 2052, Australia; e-mail, a.dunn@unsw.edu.au.

Current Author Addresses: Drs. Dunn, Tsafnat, and Coiera and Ms. Arachi: Centre for Health Informatics, The University of New South Wales, Sydney, NSW 2052, Australia.

Drs. Hudgins and Bourgeois: Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115.

Author Contributions: Conception and design: A.G. Dunn, J. Hudgins, E. Coiera, F.T. Bourgeois.

Analysis and interpretation of the data: A.G. Dunn, D. Arachi, J. Hudgins, F.T. Bourgeois.

Drafting of the article: A.G. Dunn, D. Arachi, G. Tsafnat, E. Coiera, F.T. Bourgeois.

Critical revision of the article for important intellectual content: A.G. Dunn, D. Arachi, G. Tsafnat, E. Coiera, F.T. Bourgeois.

Final approval of the article: A.G. Dunn, D. Arachi, J. Hudgins, G. Tsafnat, E. Coiera, F.T. Bourgeois.

Statistical expertise: G. Tsafnat, F.T. Bourgeois.

Obtaining of funding: A.G. Dunn, E. Coiera.

Collection and assembly of data: A.G. Dunn, D. Arachi.

Ann Intern Med. 2014;161(7):513-518. doi:10.7326/M14-0933
Text Size: A A A

Background: Industry funding and financial conflicts of interest may contribute to bias in the synthesis and interpretation of scientific evidence.

Objective: To examine the association between financial conflicts of interest and characteristics of systematic reviews of neuraminidase inhibitors.

Design: Retrospective analysis.

Setting: Reviews that examined the use of neuraminidase inhibitors in the prophylaxis or treatment of influenza, were published between January 2005 and May 2014, and used a systematic search protocol.

Measurements: Two investigators blinded to all information regarding the review authors independently assessed the presentation of evidence on the use of neuraminidase inhibitors as favorable or not favorable. Financial conflicts of interest were identified using the index reviews, other publications, and Web-based searches. Associations between financial conflicts of interest, favorability assessments, and presence of critical appraisals of evidence quality were analyzed.

Results: Twenty-six systematic reviews were identified, of which 13 examined prophylaxis and 24 examined treatment, accounting for 37 distinct assessments. Among assessments associated with a financial conflict of interest, 7 of 8 (88%) were classified as favorable, compared with 5 of 29 (17%) among those without a financial conflict of interest. Reviewers without financial conflicts of interest were more likely to include statements about the quality of the primary studies than those with financial conflicts of interest.

Limitations: The heterogeneity in populations and outcomes examined in the reviews precluded analysis of the contribution of selective inclusion of evidence on the discordance of the assessments made in the reviews. Many of the systematic reviews had overlapping authorship.

Conclusion: Reviewers with financial conflicts of interest may be more likely to present evidence about neuraminidase inhibitors in a favorable manner and recommend the use of these drugs than reviewers without financial conflicts of interest.

Primary Funding Source: Australian National Health and Medical Research Council.


Grahic Jump Location

Summary of evidence search and selection.

Eligible systematic reviews included those with outcomes related to the prophylaxis or treatment of influenza.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Posted on November 14, 2014
Puja Myles, MD, Stella Muthure, MD, Sudhir Venkatesan, MD
The University of Nottingham
Conflict of Interest: None Declared

I am writing to you on behalf of my colleagues, Dr Stella Muthuri and Sudhir Venkatesan, and myself about your recent publication in the Annals of Internal Medicine titled ‘Financial conflicts of interest and conclusions about neuraminidase inhibitors for influenza: An analysis of systematic reviews’ as we have been listed as researchers with a conflict of interest in your paper (Appendix Table 1). We wanted to clarify that while we have been involved in work that has been funded from an unrestricted educational grant from F.Hoffman La Roche, none of us have received funding from GSK. In addition, Dr Muthuri would like to clarify that she has not been in receipt of a personal grant from F. Hoffman La Roche. Both our publications as listed in your paper included specific conflict of interest (COI) statements for all individual authors to ensure that our financial COIs were very clear.

Dr Puja Myles, Associate Professor

In Response
Posted on November 14, 2014
Adam Dunn, PhD
The University of New South Wales
Conflict of Interest: None Declared
In our article, we defined a financial conflict of interest (COI) as “employment, the funding of grants paid to an author or an author’s research group, and the funding of medical writers for the systematic review.”

The information provided by Drs Muthuri, Myles, and Venkatesan is consistent with our identification of COIs. As such, the clarifications sought by Drs Myles, Muthuri, and Venkatesan do not alter the COIs we identified for the two systematic reviews and do not affect any of the conclusions in the article.

In the systematic review labelled Muthuri et al 2013 (36) in Appendix Table 1, we attributed COIs from GSK to the research group of Drs Muthuri, Myles, and Venkatesan from the disclosure in the systematic review, stating “The University of Nottingham Health Protection and Influenza Research Group is currently in receipt of research funds from GlaxoSmithKline and an unrestricted grant from Astra Zeneca”. In the third column of Appendix Table 1 “Financial COI type and recipient”, the research group is listed as the recipient.

In the systematic reviews we labelled Muthuri et al 2013 (36) and Muthuri et al (54), we attributed COIs from Roche to the authors of the systematic review. In this case, the recipient is listed as Muthuri as the first author of the manuscript but could be attributed to all authors. The information we used to identify these COIs come directly from the systematic reviews: “This work was funded via an unrestricted grant from F. Hoffmann–La Roche” and “Funding F Hoffmann-La Roche.”

Since the information provided is consistent with our identification of COIs, we do not believe that an erratum is needed in response to these concerns. However, we would be willing to clarify how to interpret the information presented in Appendix Table 1 to indicate that the funding from Roche used to undertake the systematic reviews could be attributed to all authors and not just the first author.

Yours sincerely

Adam Dunn
Senior Research Fellow
Centre for Health Informatics
Australian Institute of Health Innovation
Macquarie University
Submit a Comment/Letter

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