Disclosure—in the blink of an eye
Authors: I.F. Tannock
Journal: Annals of Oncology (2018)

I attended and presented recently at the annual meeting of the European Society for Medical Oncology (ESMO) in Munich. I was pleased to listen to many high-quality presentations, some reporting clinical trials that will change clinical practice. There was heightened sensitivity about the need to disclose potential conflicts of interest (COI) in view of recent publicity about non-disclosure in the New York Times and other lay publications. ESMO ensured that all presenters had a disclosure slide immediately after the title slide, so assuming that presenters were including all possible conflicts, effective disclosure was achieved. Or was it? As I sat through multiple presentations, the brevity with which the disclosure slide was shown was striking: in many cases far too brief to be read. To quantify this impression, I have reviewed the 143 webcasts that were available for the 3 presidential and 19 proffered paper sessions, including those of the invited discussants. In total, 129 of the presenters (90%) disclosed potential COI, and most had multiple disclosures. The median time for which the disclosure slide was shown to the audience was 3 s (range 1–22 s). This experience complements a review of presentations at the 2014–2015 annual meetings of the American Society of Clinical Oncology (ASCO) [1.Boothby A. Wang R. Cetnar J. Prasad V. Effect of the American Society of Clinical Oncology's conflict of interest policy on information overload.JAMA Oncol. 2016; 2: 1653-1654Crossref PubMed Scopus (15) Google Scholar] and indicates further shortening of the median time of presentation of the disclosure slide (from 5 to 3 s), and a further increase in the proportion of presenters disclosing potential COI from 70% to 90% I make the following conclusions from this experience: 1.Almost all oncologists have potential financial COI and most are receiving personal payments from companies. As stated in an earlier editorial [2.Tannock I.F. Joshua A.M. Purchasing silence.Ann Oncol. 2018; 29: 1339-1340Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar], companies are purchasing the silence of oncologists—it is difficult to be critical of a company's policy, trial results, and especially the cost of their drugs, when accepting some of their profit.2.Disclosure as practiced at the meeting is not meaningful. ESMO and its presenters are satisfying a legal requirement but this is lip service if disclosure slides are shown so briefly that they cannot be read. A similar level of disclosure could have been achieved by including a statement on the meeting web site and in its programme such as: 'All presenters should be assumed to have potential conflicts of interest, unless they state otherwise, but there is insufficient time to show or discuss them during the conference presentations'. So what should be done? It is known that disclosure of potential conflicts does not prevent or lessen bias [3.Brennan T.A. Rothman D.J. Blank L. et al.Health industry practices that create conflicts of interest. A Policy Proposal for Academic Medical Centers.JAMA. 2006; 295: 429-433Crossref PubMed Scopus (575) Google Scholar, 4.Loewenstein G. Sah S. Cain D.M. The unintended consequences of conflict of interest disclosure.JAMA. 2012; 307: 669-670Crossref PubMed Scopus (182) Google Scholar], but it probably helps members of the audience to recognize or search for bias if a presenter has received financial reward from a company that may profit from the report of a trial. To facilitate this, I suggest that: (i) the disclosure slide be shown for a minimum time (perhaps 10 s), (ii) the list of disclosures identify specifically (and with minimum 24 font size) those that are relevant to the trial that is being reported and (iii) that disclosures relevant to the trial being reported indicate the amount of personal payments received in the prior 2 years to the nearest 5000 Euros (or US dollars). Beyond disclosing potential COI, ESMO, ASCO and other medical societies should take efforts to avoid having speakers at their meetings with financial COIs. One cannot be involved in trials of new treatments without working with companies that are developing the drugs, and hold patents for them. Companies must pay the expenses for running trials that evaluate their drugs (given the lack of funding from government or charitable sources to cover such expenses), and it is appropriate that they receive advice from a small number of experienced oncologists in designing trials and writing good protocols. However most oncologists are (i) already well paid and (ii) receive professional advancement from being a senior investigator on a trial and publishing and presenting its results (sometimes referred to as intrinsic rather than financial conflict of interest [5.Gray S.W. Hlubocky F.J. Ratain M.J. Daugherty C.K. Attitudes toward research participation and investigator conflicts of interest among advanced cancer patients participating in early phase clinical trials.J Clin Oncol. 2007; 25: 3488-3489Crossref PubMed Scopus (30) Google Scholar]). These oncologists do not need personal payments. Financial relationships related to other activities are even more problematic. These include speaker's fees and honoraria for attending (pseudo-) advisory board meetings, better described as marketing meetings. Some institutions prohibit receipt of personal payments to their staff from companies—ESMO, ASCO and other major organizations should set a timetable for introducing the same requirement for those that present at their meetings. In undertaking this review, I did not look at webcasts of other types of session during the ESMO meeting, or at those from meetings of other large medical societies such as ASCO. However, experience at these meetings over the past decade indicates a similar short duration for which the disclosure slide is presented [1.Boothby A. Wang R. Cetnar J. Prasad V. Effect of the American Society of Clinical Oncology's conflict of interest policy on information overload.JAMA Oncol. 2016; 2: 1653-1654Crossref PubMed Scopus (15) Google Scholar]. When I made my own presentation in a special session of ESMO, I remarked on the brevity of disclosure and counted slowly to 10 while my own disclosure slide was shown; this garnered applause from the audience. Perhaps they do believe that having time to read and digest the disclosure slide is important. The author thanks Dr Christopher Booth and Dr Allan Detsky for their constructive comments on an earlier version of this article. None declared.