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PubMed Central’s Failures in Handling Conflicts of Interest with eLife

Adaptation of above image illustrating an Inte...

Adaptation of above image illustrating an Internet meme (Photo credit: Wikipedia)

The story of eLife at PubMed Central (PMC) has many layers, one of which regards conflicts of interest (COI), also known as competing interests, and how these have been handled within the PMC National Advisory Committee (NAC), a group which has had its share of COI to manage over the years, based on its membership. For instance, members have included representatives from PLoS, other publishers, and Wellcome Trust.

Competing interests are perceived conflicts. That is, there’s an arrangement of incentives that can appear to compete for someone’s loyalty, someone in a position of power. The actual competition doesn’t need to occur for there to be a perception of conflict. Why is this so?

All conflicts of interest involve perceptions or appearances because they are specified from the perspective of people who do not have sufficient information with which to assess the actual motives of a decision maker and the effects of those motives on the decisions themselves.

The appearance of conflict of interest is what an organization has to manage, and it exists once the potential for acting on that conflict exists. The definition of a conflict of interest utilized by the Institute of Medicine’s Committee on Conflict of Interest in Medical Research, Education, and Practice, and published on an NIH Web site (hosted at NCBI), underscores this:

A conflict of interest is a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest.

There is no need for further evidence to find a conflict of interest. It is based on risk, circumstances, and appearances. Any act of impropriety is the act of impropriety — e.g., insider trading. The circumstances and arrangements that created the potential for that is the conflict of interest or competing interests.

A conflict of interest can begin to look like impropriety if it’s not managed carefully, transparently, and proactively.

To manage conflicts of interest it was facing because of the composition of its board, PMC needed to ensure that any actions or decisions subsequently showed that they realized these conflicts existed, and that they acted to avoid the risks or at least reduce the risk to themselves, the members of their NAC, and their reputation. As the IOM writes:

Conflict of interest policies are attempts to ensure that professional decisions are made on the basis of primary interests and not secondary interests. . . . such policies work best when they are preventive and corrective rather than punitive. To the extent that they are effective, they serve two overarching purposes: maintaining the integrity of professional judgment and sustaining public confidence in that judgment. That professionals should promote these purposes constitutes the fundamental principle underlying any respectable conflict of interest policy.

PubMed Central’s governance should have been acutely aware that they needed to behave scrupulously with regard to the conflicts of interest inherent on their board (the NAC), especially in the case of the Wellcome Trust member, whose membership gained a new dimension as soon as eLife was announced. Suddenly, Wellcome Trust was running a publishing business and was not just a funder. As soon as this occurred, PMC should have been working to avoid actions that would undermine public trust or bring their professional judgments into question.

So, there were competing interests (aka, conflicts) on the PMC board over the past year (and beyond, but we’ll focus on recent events). How did they manage them? In a manner that maintained “the integrity of professional judgment” and sustained “public confidence in the judgment”?

There are many tools organizations can employ to handle situations like these. On an individual level, people can recuse themselves from deliberations in which their participation might be perceived as a conflict. On an organizational level, governance structures should work to ensure that the organization is not perceived as operating at the behest of certain members and their particular interests, usually by avoiding situations in which a reasonable person would perceive a conflict. It’s particularly bad when a body charged with enforcing objective rules and regulations — say, an accounting firm — begins to have either an interest in its customers’ businesses or allows interested parties to have a role in its operations.

What did PMC do in the case of having a Wellcome Trust member on its NAC and facing the imminent launch of eLife? Did it avoid instances when eLife would become a prominent factor in their deliberations and actions? Register concerns in this regard? Ask the Wellcome Trust member to recuse himself from any such discussions? All these options and more were available to them. Just “doing nothing” with regard to eLife — just following its own rules and requirements — would have been acceptable.

In the case of eLife, PubMed Central took specific actions — the NAC not only invited the managing executive editor for eLife in for an unprecedented meeting via videoconference, putting their Wellcome board member’s conflict front and center, but then short-circuited their own processes to get eLife up and running before it had met their published criteria for inclusion. Finally, the head of the NCBI is minuted as giving business advice to eLife, as I’ve indicated before.

This all amounts to significant mismanagement of conflicts of interest.

Taking these actions was unwise for an organization with conflicts of interest on its board. It indicates either arrogance or ignorance regarding conflicts of interest and how to manage them. Recusal and refusal are the main tools to manage these things. PMC’s NAC should have been responsible enough to know that it would be viewed as improper for a new entity supported by one of its board members to be given special treatment. The conflict of interest was incipient. They failed to manage it responsibly. There is no indication that the Wellcome board member recused himself from any deliberations regarding eLife, and PMC didn’t refuse to help eLife despite its board containing conflicted members. There isn’t even an indication that conflicts of interest are considered within the NAC — the only time the words “conflict of interest” or its synonyms appear in all their minutes is once in 2004, regarding a software vendor.

Perhaps the concept of conflicts of interest has eluded everyone involved. As I’ve pointed out elsewhere, there are major conflicts of interest built into eLife — from its founding entities to its editors. Perhaps there’s a feeling that these organizations are impervious to conflicts of interest. It’s hard to understand, especially in an era full of scandals and governance strictures based on COI.

PubMed Central is an initiative from a government agency charged with oversight of what should be a neutral and objective assemblage of information tools in the service of biomedical information. Its governance structure has always had some publishers within it. Over the years, it’s not been clear that PMC has managed its conflicts of interests well, or even attended to the basic governance functions involved in assessing and preventing conflicts of interest.

Recent behavior and actions regarding eLife indicate that PubMed Central is not actively managing conflicts of interest. Worse, its mismanagement, and active pursuit of initiatives despite conflicts, is leaving members of the NAC, and the organization itself, open to criticism, and shaking confidence in the NLM and NCBI.

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About Kent Anderson

I am the CEO/Publisher of the STRIATUS/JBJS, Inc., the home of the Journal of Bone & Joint Surgery, JBJS Case Connector, JBJS Reviews, JBJS Essential Surgical Techniques, the JBJS Recertification Course, PRE-val, and SocialCite. Prior to this, I was an executive at the New England Journal of Medicine. I also was Director of Medical Journals at the American Academy of Pediatrics.

Discussion

12 thoughts on “PubMed Central’s Failures in Handling Conflicts of Interest with eLife

  1. I’m disturbed that the president-elect of SSP is spending so much effort in attacking PubMed Central. I’m happy to have my federal taxes subsidizing PMC. However I have serious concerns about tacitly supporting Mr. Anderson via my SSP membership dues.

    Posted by Laura | Nov 15, 2012, 5:20 pm
    • Well, this is a very interesting ad hominem attack. You’re attacking me and my unpaid, elected position in an all-volunteer organization devoted to cultivating networking and idea-sharing. The Scholarly Kitchen is actually one of the most valued SSP benefits, whether you happen to like each and every post or not, and fits with the spirit of the organization.

      You apparently don’t think PMC should create a level playing field, abide by its own stated rules, treat all publishers equally, avoid conflicts of interest, and spend taxpayer monies doing its job rather than helping billion-dollar entities launch a new journal. You also apparently think that openly exploring these problems in a public forum in a rational manner amounts to “attacking” PMC. What do you think about the fact that the head of NCBI, David Lipman, is on record as saying he feels no need to respond to these criticisms? Don’t you think he has a responsibility to explain to taxpayers why he opted to show such favoritism to a new journal with ties to a member of his board? Why he flouted the rules that PubMed Central imposes on other publishers, as documented in that original post?

      Your serious concerns should go to government accountability and your tacit support of the NCBI, which doesn’t enforce its rules uniformly, manage its conflicts of interest, or treat everyone in its ambit with fairness and objectivity. PMC wasn’t on my radar at all until they violated their own rules so flagrantly. Don’t make this my problem.

      Posted by Kent Anderson | Nov 15, 2012, 7:48 pm
    • I’m not sure why there are those who are upset by Kent’s bringing this situation to light? For other publishers who’ve had to “play by the rules” (past & future) regarding PMC this is a very legitimate concern. I don’t agree with 100% of Kent’s (or others) opinions but that does not negate the fact that he has raised what is, in my opinion, a valid issue here. This isn’t an Open Access Vs. Traditional publishing issue; it seems to be a case where a COI has led to one party being favored over others, despite rules being in place to prevent that. That’s something any objective individual should be worried about.

      Posted by Adam Etkin (@adametkin) | Nov 16, 2012, 10:21 am
  2. I agree with the above comment; will you give it a rest on Pubmed please (and I’ll say it so we don’t have to do this again in the future, open access publishing). We’ve all heard your arguments for and against, let’s move onto something else.. I think this is a really good blog site, but these constant one sided blogs do the site no good. The other cooks need to rein Kent in a bit please.

    Posted by Nial | Nov 15, 2012, 7:28 pm
    • The PubMed Central scandal is actually pretty important, and bears untangling for all the things they’ve done wrong, which the eLife situation has revealed. Nobody’s forcing you to read these posts, we publish every weekday, and I’ve spread these posts out to limit the concentration of them, and allow the other authors and other topics to have the spotlight. But, no, this will not be the last post, in all likelihood. When an organization we all depend upon for objective, fair treatment so clearly violates that responsibility — and in multiple ways — I would hope we’d all feel a little indignant and want to understand exactly what occurred and how extensive the problem is (and, more importantly, how to fix it).

      This particular post came about because I’d mentioned the COI problem in a comment thread, and someone argued there had been no conflict of interest. I wanted to explore the notion for myself, by writing about it. The result is this post. If you think PMC didn’t succumb to conflicts of interest, let’s have that discussion. But if you’re just waiting for a different topic . . . just wait until tomorrow.

      Posted by Kent Anderson | Nov 15, 2012, 7:55 pm
    • As a publisher frequently trying to get journals into PubMed Central and indexed in MedLine, I have to vehemently disagree. Kent’s articles can only help drive progress in getting PMC and the NLM to better define their procedures and provide a better level of transparency for their policies. I’m told that as a result of the controversy, OASPA has written a letter asking that PMC officially change their policies to allow all journals the same level of privilege granted to eLife. That means faster acceptance and broader immediate reach for new journals.

      I know many have a kneejerk reaction and see Kent as the enemy, automatically opposing anything he says. But raising this issue and demanding fairness for all benefits all (well, perhaps all other than eLife). There are many journals, particularly fully OA journals, that will be much better served by a fast, well-defined and fair system, rather than the current one which is opaque and seemingly capricious.

      See the reaction from Biology Open as one example:

      Posted by David Crotty | Nov 16, 2012, 10:14 am
      • Yet again we have a confusion about MEDLINE/PubMed/PMC. There is no such thing as “PubMed acceptance.” Did Biology Open apply for MEDLINE or for PMC? They are two different things. If you participate in PMC you’ll have citations added to PubMed, but you’ll still have to apply for MEDLINE MeSH indexing and wait for the LSTRC decision.
        I previously defended SSP and the Scholarly Kitchen, but lately its tone is reminding me too much of the fearful knee-jerk reactions from publishers who are afraid of libraries, afraid of losing money, afraid their business models are collapsing.
        What is the point of distinguishing ourselves as “scholarly publishers” if we behave like desperate media companies? Don’t journals exist to disseminate peer-reviewed, scholarly information?

        Posted by Laura | Nov 16, 2012, 12:24 pm
        • You’d have to ask Open Biology what exactly they meant, but there are certainly requirements and acceptance processes for getting papers listed in PubMed search results. One must pass muster and be accepted by PMC at the very least, or go through the lengthy MedLine acceptance process.

          The problem that you repeatedly fail to recognize is that there is an enormous level of confusion among the research community as to the subtle nuances and differences between PubMed, MedLine and PMC. For the researcher, all they care is whether their paper turns up in PubMed search results. That, as far as most researchers are concerned, means a journal is “in PubMed” and that’s all that matters to them. You can continue to split hairs, but in the real world, this is how scientists see things. I have to explain this at nearly every editorial board meeting I attend. Many have never even heard the term “MedLine”. I can’t tell you the number of times I’ve been asked about whether the journal deposits NIH funded papers “in PubMed”.

          As for publishers acting like media companies afraid to lose money, this question is of massive importance for not-for-profit, open access publishers. Many societies and university presses are working very hard to make OA work. Our efforts are harmed when well-funded, well-connected publishers are given shortcuts and headstarts. They get an unfair advantage, further consolidating power with the haves, and making life harder and harder for the independent, community-owned publisher. If the goal is indeed to “disseminate peer-reviewed, scholarly information,” then why is it wrong to ask for a system that does this quickly, fairly and broadly across the literature instead of favoring the elite?

          Posted by David Crotty | Nov 16, 2012, 12:51 pm
        • Here’s a quick example of the typical confusion that conflates PMC, PubMed and MedLine from NIH Neurobiologist Douglas Fields. Note no mention of MedLine yet he is clearly referring to the MedLine indexing process:

          http://www.huffingtonpost.com/dr-douglas-fields/50-shades-of-grey-in-scientific-publication-how-digital-publishing-is-harming-science_b_2155760.html

          Nearly all this published material is dumped into the government-run PubMed and PubMed Central biomedical indexes. At one time it took years for a new journal to prove itself before PubMed would index the journal, but not now. PubMed, once the authoritative index of biomedical publication, is now apparently competing with Google Scholar.

          Posted by David Crotty | Nov 20, 2012, 12:06 pm
  3. As a younger author, it’d be nice if you guys could stop fighting about this. I have published in Springer, as well as American Chemistry Society journals. I have a PhD in Chemistry (2008) and currently do research for better, more sensitive instruments that can aid in rapid intra-operative biomedical diagnostics for brain tumor resections.

    I am of the opinion that SOME information must be free to ensure things like the health of the human population, or rapid and reliable documentation of discovery- and the discoverers- about natural laws that lead to direct economic benefits down the line. Scientists make contributions to the human record of the laws of the natural universe, which you cannot- and must not- patent. Applied fields- like engineering, where theoretical ideas from physics, chemistry, and other basic sciences are shaped into a concrete design built to exacting standards- they get the patents. And that info should be paid for for a while, with patents or subscription journals, to compensate the engineer for their time, care, and expertise.

    Posted by antistokes | Nov 16, 2012, 11:26 am
    • I don’t see this as a problem having anything to do with open access per se. The issue is a serious conflict of interest affecting how a government-funded operation is being run, and I think Kent is absolutely justified in raising the questions he has about the favoritism that has been uncovered here.

      Posted by Sandy Thatcher | Nov 20, 2012, 12:54 am

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