Rise in unpaid consultants conceals conflicts of interest



Are authors of articles in leading medical journals playing down the extent of ties to drug and other for-profit companies? That appears to be the case, according to a new study in the Journal of General Internal Medicine by Associate Professor David Menkes and colleagues, who found a dramatic increase in the use of the term “unpaid consultant” in author disclosure statements.

For example, the use of this term during 2002-2004 (11 instances) jumped nearly fifty-fold to 500 instances during 2012-2014. 


In their paper, “What does ‘unpaid consultant’ signify? A survey of euphemistic language in conflict of interest declarations,” Associate Professor Menkes, of the University’s Waikato Clinical Campus, says declaration of potential conflicts of interest is required when submitting manuscripts to almost all biomedical journals, but there is uncertainty around what these declarations actually mean.


“While financial payments to authors obviously need to be disclosed, other benefits from industry involvement can also constitute conflicts of interest but are seldom described in sufficient detail,” Dr Menkes says.


“Instead, authors are increasingly referring to themselves as ‘unpaid consultants’, an almost meaningless term that appears to have been accepted without question by many journals.”  


Co-author Alan Blum, a Professor of Family Medicine at the University of Alabama, noticed the term repeated in disclosure statements by two authors in a single issue of the highly influential Journal of the American Medical Association (JAMA) in 2012. He and Dr Menkes decided to systematically study “unpaid consultant” in medical article disclosures by analysing its use over time and links with vested interests and particular journals and authors.


After analysing over 1000 articles, from journals including JAMA, New England Journal of Medicine and The Lancet, Dr Menkes and co-workers identified not only a marked increase in the use of the term, but also showed it to be overwhelmingly associated with service to for-profit companies, most notably in the pharmaceutical, device, and biotech industries. 


Disclosing an ‘unpaid’ relationship with a for-profit company typically signals but does not explain a potential conflict of interest. While authors may not intend to mislead, such declarations simply aren’t good enough; the same applies to other uninformative expressions, such as “non-financial support”. Our findings challenge editors to respond to the increasing use of language that may conceal rather than illuminate conflicts of interest.”


Dr Menkes says disclosures should be as complete and accurate as possible to enable readers to appraise the relevance of an author’s competing interests to their study findings and recommendations. “Our results are consistent with the view that current standards for disclosure statements are inadequate. We can do better.”