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Biomedical researchers in Britain have recently become worried that public trust in medical research may have been undermined by the misbehaviour of pharmaceutical companies [1]. In recent years, the pharmaceutical industry has been criticized for, among other things: selectively publishing positive clinical trials of selective serotonin reuptake inhibitor (SSRI) antidepressants in adolescents [2]; delaying reports of adverse events caused by cyclo-oxygenase 2 (COX-2) inhibitors [3]; ‘disease-mongering’ via direct-to-consumer advertising in the United States [4]; and developing and marketing profitable ‘me-too’ drugs that involve minor tweaking of profitable molecules used to treat the prevalent but minor ailments that afflict the affluent (e.g. impotence and elevated blood cholesterol) while failing to develop new drugs for major causes of disease among the poor [5].

Surveys suggest that the public still has high levels of confidence in medical research conducted by university researchers [1], but this is no reason for complacency. The pharmaceutical industry is playing an increasing role in funding biomedical and clinical research [6], as governments have reduced research funding while encouraging researchers to ‘partner’ with industry by patenting discoveries, commercializing research and conducting industry-sponsored clinical trials. A potential cost of the progressive privatization of medical research may be a decline in public confidence in the impartiality, disinterestedness and honesty of scientists and, consequently, in the trustworthiness of their research.

In the addiction field, concerns about public trust have been raised more often by the behaviour of the tobacco and alcohol industries than ‘big Pharma’. The Tobacco Industry Documents held at the Minnesota Tobacco Document Depository, for example, reveal examples of malfeasance (designed and supervised by ethically challenged lawyers) that make the pharmaceutical industry’s actions seem like misdemeanors [7,8]. The alcohol industry has more subtly exploited the deregulatory enthusiasm of governments, using selective reviews of the evidence to promote the policies—school-based education [9,10] and self-regulation—that are the least likely to reduce alcohol-related harm [11]. More recently, they have created ‘arms-length’ agencies, such as the International Centre for Alcohol Policy, to advocate politically attractive ‘motherhood’ causes such as education about ‘responsible drinking’ in order to avoid more effective alcohol control policies that threaten their profits [9,10,12].

Private industry is not alone in attempting to skew addiction research to serve its interests. Governments have been accused recently of censoring the unwelcome results of research on illicit drugs for which they are often the primary funders [13]. The latter practices are not yet as well documented as those involving the alcohol and tobacco industries, but there are claims that governments have attempted to suppress the publication of findings that adversely affect their reputations, restricted researchers’ access to data and used threats to future funding to influence researcher’s behaviour [13].

Leading medical journals have attempted to restore public trust in biomedical research by reducing the influence of the pharmaceutical industry on research publication [14]. These journals now require conflict of interest disclosures by authors and reviewers to make the role of financial interests more transparent. Authors must also assert that the design, analysis and write-up of their research were under their own control rather than that of the research sponsors or funders. To minimize selective publication of clinical trials, these journals will now review papers only on clinical trials in which a detailed protocol specifying the design and statistical analysis has been registered in advance.

Addiction journals have begun to adopt some of these editorial practices [15]. Authors are often required to state who funded the study and identify any conditions imposed upon them by the funders. The lead author often has to assert that he or she had complete control over the study data, analysis, decision to publish and the preparation of the published paper. Addiction journal editors could also consider the option of requiring that all protocols for clinical trials are registered with the journal as a precondition for review.

Private industry and government are not the only groups to threaten the credibility and trustworthiness of addiction research. In a peer review system, with increasing competition for scarce space, hostile reviewers can prevent the publication of research with which they disagree. The British Medical Journal and some open-access e-journals (e.g. BioMed Central and Public Library of Science) have attempted to reduce the effects of such reviewer bias by adopting ‘open peer review’. Reviewers must sign their reviews and they are published on the journal’s website along with the authors’ responses and amendments. The aim is to encourage greater accountability by reviewers and make the process of peer review more transparent to authors and readers.

It is early days in the experiment with open peer review, but it is an idea worth considering in the addictions field. Anyone who has worked in the field for long enough will have experienced hostile reviewers who use the protection afforded by anonymity to prevent the publication of research that is contrary to their views.

The addiction field, like the biomedical field more generally, needs to take steps to ensure that the public has confidence in its research. To earn the public’s trust we must show that we are deserving of it, not only by greater openness about our funding sources and their role in research design, analysis and publication but by honesty and openness on the part of authors and reviews about personal and professional interests that may compromise our impartiality.

References

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  2. References
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    Kipling J., Smith M. Biomedical Science and Public Trust: 2005 Science Policy Conference. London: Wellcome Trust, Glaxo-Smith-Kline and the Academy of Medical Sciences; 2006.
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    Avorn J. Powerful Medicines: the benefits, risks and costs of prescription drugs. New York: Vintage; 2005.
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    Moynihan R., Cassels A. Selling Sickness: how the drug companies are turning us all into patients. Sydney: Allen & Unwin; 2005.
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    Angell M. The Truth About Drug Companies: how they deceive us and what to do about it. Melbourne: Scribe; 2005.
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    Patsopoulos N. A., Ioannidis J. P., Analatos A. A., Origin and funding of the most frequently cited papers in medicine: database analysis. BMJ 2006; 332: 10634.
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    Glantz S. A., Slade J., Bero L., Hanauer P., Barnes DE. The Cigarette Papers. Berkeley: University of California Press; 1996.
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    Kessler D. A Question of Intent: a great American battle against a deadly industry. New York: Public Affairs; 2001.
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    Room R. Drinking patterns as an ideology. Addiction 2005; 100: 18034.
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    Foxcroft D. International Center for Alcohol Policies (ICAP)’s latest report on alcohol education: a flawed peer review process. Addiction 2005; 100: 10668.
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    Hall W. D. British drinking: a suitable case for treatment? BMJ 2005; 331: 5278.
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    Edwards G., West R., Babor T. F., Hall W. D., Marsden J. An invitation to an alcohol industry lobby to help decide public funding of alcohol research and professional training: a decision that should be reversed. Addiction 2004; 99: 12356.
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    Miller P., Moore D., Strang J. The regulation of research by funding bodies: an emerging ethical issue for the alcohol and other drug sector. Int J Drug Policy 2006; 17: 126.
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    International Committee of Medical Journal Editors. Uniform Requirements for Manuscripts Submitted to Biomedical Journals: writing and editing for biomedical publication. 2006: Available at: http://www.parint.org/isajewebsite/ethics.htm (accessed 14 April 2006).
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    International Committee of Medical Journal Editors. Ethical Practice Guidelines in Addiction Publishing. 2005. Available at: http://www.isaje.net (accessed 14 April 2006).