The Sixth Estate

The Fraser Institute’s latest propaganda piece is Access Delayed, Access Denied, an attempt to solve the very real problem of delayed access to important new medications in Canada by bogus methods, like more private insurance and less Canadian inspection of new drugs. This is a very silly idea, and I’ll get into that tomorrow, but first I have something very exciting to report. The Fraser Institute, it seems, has taken the long-offered advice of people like myself and instituted some important reforms to an editorial process that involves undisclosed conflicts of interest and long-dead editors serving, supposedly, as “final arbiters” in the peer review process.

Unfortunately, it fails miserably in the process. For instance, the Editorial Advisory Board has now been updated to indicate that five dead men are now merely former members. Their death had nothing to do with this demotion; they were dead, active members earlier this year. While this sounds impressive, it has all the hallmarks of a meaningless paper reshuffling. Sir Alan Walters is still listed as an active living member, despite the fact that he has been dead for two years. Whether other “members” have gone to meet their own final arbiter in the meantime, I haven’t checked. Apparently the Fraser Institute hasn’t checked either.

Another gratifying development was the announcement by the authors that they will be complying with the ethical disclosure requirements of the International Committee of Medical Journal Editors, which require authors to disclose sources of funding which might call into question the independence of their research. Unfortunately, one sentence after making this announcement, they cheerfully proceed to blatantly violate ICMJE policy by failing to disclose potential financial conflicts of interest. Here’s what they say about financial contributions:

The authors acknowledge with sincere gratitude those who financially support the Fraser Institute and this research including research-based pharmaceutical companies (whose contributions make up less than 5% of the Fraser Institute’s budget), as well as the general membership and other supporters of the Institute. With respect to this manuscript, no drug-maker or other donor had any input into the… manuscript’s writing… The donations we receive are unrestricted and come only from private foundations, organizations, or individuals.

Pay no attention to the “5%” figure. The Fraser Institute as a whole may receive only a minority of its funding from the healthcare industry, but then again, only a minority of Fraser Institute publications are relevant to the healthcare industry. And the majority of funding, in any case, comes from foundations owned by industry leaders, not direct from the companies themselves, so the real figure could actually be significantly higher than 5%. This could have been solved by actually following ICMJE policy, except that…

The authors do not seem to be aware of current ICMJE policy on disclosure — absurdly, they cite a 14-year-old statement in the CMA Journal, when all they really needed to do was go to the Committee’s own website. If they had, they would have noticed that the sample ICMJE disclosure statement requires names of specific donors, names of board members with an interest in the report, any payment for manuscript preparation, money for meeting expenses, and various other criteria as well, instructing the authors to “err on the side of full disclosure.”

So the Fraser Institute gets half a point for mentioning that donors exist, no points for identifying the relevant board members (and there are relevant board members, from medical companies), no points for mentioning conference support like this, and no points for mentioning whether or not money was paid to prepare this report. I don’t know whether it was or not. Certainly other reports, like the mining industry survey and the school report cards, appear to get specific linked donations from major backers, because the Fraser Institute goes to the trouble of thanking specific funders in those reports. Try and imagine the chilly reception if they’d sent this “disclosure” statement to a real medical journal.

Incidentally, if you’re thinking that that last part calls into question the Fraser Institute’s claim that donations are always “unrestricted,” you’re absolutely right. We don’t know exactly how new funding arrangements are made today. We do know what the procedure was a decade ago, though, when the Fraser Institute was taking money from tobacco companies to promote the ludicrous argument that cigarette smoke does not cause lung cancer. At that time, “unrestricted” was true only in the most “wink wink, nudge nudge” sense.

The Institute would approach a donor suggesting a research report and its general argument, and ask for a specific amount of money to produce the report. In that example, the Institute approached tobacco companies asking for money to produce reports and hold meetings opposing tobacco regulation. It set out the amount of money requested, and even listed various funding “options” — so much money for a book launch promotion, so much for a conference series, etc. It’s true that the Fraser Institute didn’t take “restricted” supervised donations from donors — but only because they sold a research agenda to the donor in the first place.

Nice try, Fraser Institute, but you’ll need to do much more to convince me that you take peer review and ethical disclosure sincerely. Unfortunately, there’s no space left to deal with the actual substance of the report. For that, check back tomorrow.