Simon Wessely on COIs in 2003

[Esther12]

I thought I'd repost this on the new forum, as many may have missed it:

https://www.bmj.com/rapid-response/2011/10/29/enough-already

I started pulling out bits to summarise his position, but ended up quoting most of the short Rapid Response.

He's complaining that attempts to restrict the influence of those with COIs will exclude almost everyone.

Thought this bit was relevant to concerns about the way Wessely built his career by telling people with power what they wanted to hear:

Few can be said to be
funding research purely out of a disinterested pursuit of the truth,
science for science’s sake. Those who spend our money – be it raised by
taxation or from charitable donations, are as aware of their
constituencies as any one else. Indeed, many have rather more powerful
agendas than even pharmaceutical companies – some subtle, some not subtle
at all.

And I have succumbed to these pressures myself? But of course. Grow
up. When one approaches a funding body, even the saintly MRC or Wellcome,
let alone the single issue charities or government, one knows what is
flavour of the month, the current political concern, the bee in the bonnet
of the Chief Executive, the particular piece of political correctness
needed to achieve success this year, and the roads down which one should
not travel. As every academic who has ever had a grant rejected (and is
there another other academic?) will tell you, good science is the ticket
of entry, but doesn’t guarantee the prize.

The final paragraph returns to a common theme of Wessely's writing of the time, the importance of respect for institutions:

But there is another unwelcome sub text to the theme of the
entire issue. It is easy to point out the agendas of industry. Indeed,
anyone who did not realise this is, in my opinion, too naïve to practice
medicine seriously. And one can point out similar agendas, hidden or not,
conscious or unconcious, in most of the insitutions that we come into
contact professionally – Royal Colleges, medical journalists, the BMA,
government, quangos, even, God forbid, medical journals. Sensible
reasonable people know this, and act and interpret accordingly. But what
is the result of this constant stream of articles that bring to our
attention what we already knew? It is a gradual erosion of something far
more important – that of trust. Eventually we will trust no one and
nothing. We will take nothing at face value, and see conspiracy and plot
behind every official or institutional action, prisoners of our own
paranoia. As Oonora O Neil demonstrated in last year’s seminal Reith
lectures, it is this erosion of trust in our institutions, public and
private, that may ultimately be more corrosive to the public good and well
being than a few more company pens.

I wonder if he warned Watt of the damage she'd do to trust in the MRC by defending PACE? I suspect not, and that he isn't that concerned about the public good but really just wants more trust and respect in the institutions that he is a part of, and that serve his interests and ego.

 

[Snowdrop]

SW is very good at this. And it seems he has had a gift for it from the start.

I'd call this kind of thinking 'holistic deception. He takes a real problem that is undeniably an issue to be addressed and that he is guilty of and expands the guilty to everyone and everything.

Yes, there is bias, this should be acknowledged. We all have biases, we all have conflicts of interest, we all are mind and body therefore we should see mental health as just another medical condition (which can expand into all bodily med conditions).

The insidious nature of this is always the kernel of truth at it's core. It's just that this kernel is smoke and mirrors because it obfuscates the specific in favour of the general.

Specific biases in research should be acknowledged and dealt with not embraced because 'we all have them'. Having an investment in the outcome as a patient is not the same as a medical research scientist having a CoI because they consult for a health insurance company. These responses to concerns by people outside their little group is a lot of philosophical posturing meant only to divert attention away from real concrete issues.

Our best defense is in the details.

 

[James Morris-Lent]

Sometimes multiple values in tension with one another must be balanced order to produce the greatest good. In this case (1) the need to trust institutions and rely on them to operate themselves must be balanced against (2) the need to monitor institutions for trustworthiness and hold them to account when they fail.

Now, serious people understand this and do not fight for one side or another, but, if able, push in the direction needed to achieve the best possible balance given reality. On the other hand, it appears that our dear young Simon would like there to be as little baseline scrutiny of the medical establishment as possible. One can only speculate as to the reasons for his zeal.