Conflict of interest comes in two varieties. The first kind of COI has been treated extensively. COI type 1 is most relevant to medical literature as a scientific endeavor: science tends toward truth if its methodologies and data are transparent and free of bias. Various blog posts, most notably at the Incidental Economist group blog, have made the point that we are not there yet. Data is not fully open; methodologies are underspecified. We know that pharmaceutically funded studies are more likely to produce positive findings and demonstrate fewer harms (see this Cochrane review); but there are plenty of other biases affecting the scientific literature. and it makes sense to try and track them down for the sake of scientific rigor.
By COI type 2, on the other hand, I mean that which questions are found to be worthwhile, prestigious, fundable, popularizable in the lay press, and - in short - “important” tend to align with the drive to innovate, market, and sell new pharmaceutical products and medical devices. The “front-page” randomized controlled trial in the New England Journal of Medicine is often devoted to trials of statistical but dubious clinical significance. A recent instance was the IMPROVE-IT trial, showing that adding a non-statin to a statin slightly improves the rate of a composite cardiac outcome a number of years after starting the combination, compared to a statin alone, in patients who have had acute coronary syndrome.
By COI type 2, on the other hand, I mean that which questions are found to be worthwhile, prestigious, fundable, popularizable in the lay press, and - in short - “important” tend to align with the drive to innovate, market, and sell new pharmaceutical products and medical devices. The “front-page” randomized controlled trial in the New England Journal of Medicine is often devoted to trials of statistical but dubious clinical significance. A recent instance was the IMPROVE-IT trial, showing that adding a non-statin to a statin slightly improves the rate of a composite cardiac outcome a number of years after starting the combination, compared to a statin alone, in patients who have had acute coronary syndrome.
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