When a good doctor encounters research comparing the effectiveness of drugs A and B, she knows to beware the fact that B was created by the people paying the researchers’ salaries. Pharmaceutical industry funding can be complex, but the general principle of declaring financial conflicts of interest is now embedded in medical research culture. Unfortunately, research into psychological therapies doesn’t yet seem to have got its house in order in an equivalent way. That’s according to a new open access article in the journal BMJ Open which suggests that, while there is less risk in this field of financially-based conflicts, researchers may be particularly vulnerable to non-financial biases, a problem that hasn’t been adequately acknowledged until now.
当一个好医生遇到一项对药物A和药物B的有效性进行比较的研究时,她懂得提防的事实是,药物B是由支付研究人员薪水之人创造的。医药行业的资金相当的复杂,但是,现在,财务利益冲突的申明已经内嵌在医学研究文化原则之中了。不幸的是,似乎心理治疗方法的研究还没有以同等的方式整顿好它的内务。《英国医学杂志》可公开访问的文章认为,当这一领域经济基础的矛盾风险较少时,研究人员可能特别容易受到非财务的偏见,这个问题,直到现在还没有得到充分的承认。
The research team, led by Klaus Lieb of the University of Mainz, examined 95 systematic and meta-analytic reviews that had evaluated the efficacy of psychological therapies by looking at the weight of evidence across multiple randomised controlled trials. Such reviews are generally used to give a balanced picture of what really works, above and beyond a single trial.
美因茨大学Klaus Lieb领导的研究小组,检验了95个系统元分析综述,通过观察多个随机对照试验中证据的权重,评价了心理疗法的疗效。这些综述通常会有一张图片,以说明哪些是真正有效的、高于或超越单一的试验。
The journals that publish this kind of research tend to be on the look out for financial conflicts of interest that could lead to a bias: for example, if the author of a meta-analysis of Therapy X was a license-holder for that therapy but chose not to declare that interest when reviewing it. Indeed, Lieb and his team found that four out of every five journals they investigated had explicitly asked that such conflicts be declared.
发表这类研究的期刊倾向于提防可能导致偏见的财务利益冲突:例如,如果X疗法的元分析的作者是该疗法的持证者,但是,该作者选择在审查时不声明利益关系。事实上,Lieb和他的团队发现,每五个期刊研究中,就有四个明确要求宣称这样的(利益)冲突。
But only a third of the journals asked the same of non-financial conflicts of interest, such as a review author being trained in one specific therapy, or otherwise being a particular advocate of one over others. Lieb and his colleagues argue that this presents a real problem because unlike a pharmaceutical researcher who becomes disenchanted with their favoured drug, “psychotherapy researchers who realise that the effect of the therapy to which they are allied is less beneficial than another therapy cannot easily switch their research programme to another therapy (since they have often been trained in that therapy for many years)”. This is especially true if they have been on record as a cheerleader for a particular therapy, or as a critic of its alternatives. Incidentally, at the end of their paper, Lieb and his colleagues act by example, providing a thorough outline of their own therapeutic training and related information.
但是,只有三分之一的期刊要求类似的非财务利益冲突,例如某个综述作者接受过某种特定疗法的训练,或者特别支持某个人的主张,而不是别人。Lieb和他的同事认为,这提出了一个实际问题,因为这不像那些对他们青睐的药物不再抱有幻想的医药研究员,心理治疗的研究人员意识到,与他们相关的疗法效果略为逊色于另一个疗法,他们不能轻易的将他们的研究计划切换为另一种疗法(因为他们已经在那个疗法中训练了多年)”。如果他们一直被记录为一个特定疗法的拉拉队,或者是替代疗法的批评家的时候,这就不会错了。顺便说一句,Lieb和他的同事们在他们论文的最后为之做出了榜样,他们提供了自己参加的培训及相关信息的全面大纲。
So these conflicts may be especially pernicious for psychological therapies, and the fact that so few journals ask for declarations of these kind of allegiances is alarming. Even in cases where journals had asked for this information, only four researchers volunteered it.
所以,这些冲突对于心理治疗而言是毁灭性的,而事实是令人震惊的,很少有期刊要求这种忠诚的声明。即使在期刊要求这些信息的情况下,只有四名研究人员自愿这么做了。