Association Between Conflicts of Interest and Authors' Positions on Harms of Varenicline: a Cross-Sectional Analysis

Alice Fabbri; Camilla Hansen Nejstgaard; Quinn Grundy; Lisa Bero; Adam G Dunn; Annim Mohammad; Barbara Mintzes

doi:10.1007/s11606-021-06915-1

Association Between Conflicts of Interest and Authors' Positions on Harms of Varenicline: a Cross-Sectional Analysis

J Gen Intern Med. 2022 Feb;37(2):290-297. doi: 10.1007/s11606-021-06915-1. Epub 2021 May 26.

Authors

Alice Fabbri^{1

2}, Camilla Hansen Nejstgaard^{3

4}, Quinn Grundy^{5

6}, Lisa Bero⁷, Adam G Dunn⁸, Annim Mohammad⁶, Barbara Mintzes⁹

Affiliations

¹ Centre for Evidence-Based Medicine Odense (CEBMO), University of Southern Denmark and Odense University Hospital, Odense, Denmark.
² Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK.
³ Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
⁴ Open Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark.
⁵ Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
⁶ Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
⁷ School of Medicine and Colorado School of Public Health, University of Colorado Anschutz Medical Campus, University of Colorado Center for Bioethics and Humanities, Denver, CO, USA.
⁸ School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
⁹ Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. Barbara.mintzes@sydney.edu.au.

Abstract

Background: Few studies have investigated the relationship between industry funding/conflicts of interest and authors' positions in opinion pieces on drug safety. Harmful effects of varenicline, a treatment for smoking cessation, have been highly contested.

Objective: To examine the association between pharmaceutical industry funding/authors' financial conflicts of interest and position on varenicline in opinion articles, especially in relation to the minimization of harms; to assess whether opinion pieces on drug safety issues written by authors with conflicts of interest are more frequently cited in the news or social media.

Design: Cross-sectional analysis.

Participants: English language opinion pieces and narrative reviews about varenicline published between May 2006 and February 2019.

Main measures: Odds ratios and 95% confidence intervals; the Mann-Whitney two-sample statistic was used to test for differences in Altmetric scores, a measure of media attention.

Key results: Of the 221 included articles, 30.3% (67) disclosed the funding source and 62.9% (139) disclosed authors' conflicts of interest. Authors of opinion pieces on varenicline who reported financial ties to the pharmaceutical industry (as a conflict of interest or funding source) were more likely to minimise the cardiovascular and psychiatric risk of varenicline compared to those without conflicts of interest or industry funding (OR: 4.00; 95% CI: 1.32 to 12.16 for cardiovascular risk; OR: 8.51; 95% CI: 3.79 to 19.11 for psychiatric risk). These associations persisted in sensitivity analyses. No statistically significant difference in Altmetric score was found between articles with (mean 15.83, median 3) and without (mean 11.90, median 1) conflicts of interest, indicating similar media attention (p-value=0.11).

Conclusions: We found that authors with financial ties to drug companies were more likely to publish opinion pieces that minimised harms of varenicline. These results raise questions about journals' editorial policies to accept reviews of treatments from authors with financial relationships with manufacturers.

Keywords: conflict of interest; drug safety; pharmaceutical industry.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Conflict of Interest*
Cross-Sectional Studies
Disclosure
Drug Industry*
Editorial Policies
Humans
Varenicline / adverse effects

Substances

Varenicline