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.