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。
Perhaps this just means these conflicts are thankfully rare? This seems unlikely. Lieb’s team found that 34 of the reviews covered at least one and sometimes many more experimental studies authored by the reviewers themselves: not a crime in of itself, but a sign of at least a potential conflict. What’s more, Lieb’s group investigated these 34 reviews using a standard protocol to check for signs of “research allegiance”, that is whether the article betrayed a belief in the superiority of a treatment. Fifteen of the 34 reviews met these criteria, meaning that one or more of the authors had a vested interest in the conclusions.
也许这仅仅意味着这些冲突是十分罕见的？这似乎不太可能。Lieb的研究小组发现在34个评论至少涵盖了一个甚至更多的实验研究由审稿人自己撰写评论的现象：这本身不是犯罪，但至少是一个潜在冲突的信号。更重要的是，Lieb的研究小组使用标准协议调查了这34项综述，以检查“研究忠诚”的迹象。也就是检查文章是否违背了治疗优先的信念。34个综述中，15个符合这些标准，这意味着一个或多个作者在结论中有既得的利益。
Lieb and a co-author, Jan von der Osten-Sacken, also read through anonymised versions of all 95 reviews and labelled a conclusion as “spinned” when they felt it wasn’t consistent with the empirical results reported. Based on this, they claimed that reviews they’d identified earlier as having non-financial conflicts also tended to have biased conclusions. However, this link wasn’t statistically significant, so at best this tentative finding indicates something to be studied in the future.
Lieb和合著者，Jan von der Osten，仔细阅读了95个综述的匿名版本，并且，当他们觉得文章不符合实证结果报告时，标记了一个“spinned”的结论。基于这一点，他们声称，他们以前认为有非经济冲突的评论往往也有偏见。然而，这个联系没有统计学意义，所以最好这个初步的发现指明了未来要研究的东西。
Lieb’s team emphasise they are not claiming that there is rampant fraud and deliberate misrepresentation. They suspect that “researchers may simply not be seeing the necessity of declaring non-financial interests, or be clear on what this includes”. So it’s incumbent on journals to outline more explicitly what constitutes a conflict of interest, and request and reveal them with more vigilance. Researchers themselves should take to heart the foundation on which the search for truth is built: to let go of your beliefs and be willing to be wrong.
Lieb的团队强调，他们不是声称此地有猖獗的欺诈和故意的失实陈述。他们怀疑“研究人员可能根本就没有看到宣布非财务利益的必要性，或者不清楚这种申明要包括什么”。因此，期刊杂志更明确地勾勒出到底是什么构成了利益冲突，并更警惕的要求和揭示这些，是义不容辞的责任。研究者自己应该将探寻真理的基础铭记在心：放弃你的信仰，勇于试错。
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