Allergan, Its Lap-Band, and the Curious Case of a Doctor Who Insists a Conflict Isn't a Conflict

Last Updated May 17, 2010 3:53 PM EDT

To hear many medical-journal editors tell it, full disclosure of pharma support for studies of drugs or medical devices should suffice to calm fears that corporations are corrupting medical research. It's not true, and an odd case involving an Australian researcher, the Journal of the American Medical Association and Allergan (AGN) helps show why.

JAMA published a curious letter recently in which Paul O'Brien, the lead author of a study of Allergan's Lap-Band (a stomach-restricting device for the obese), apologized for failing to report some of his financial conflicts accurately. Among other things, O'Brien owned up to wrongly stating that he'd received funds from Allergan itself.

As it turns out, though, the correction provides a down-the-rabbit-hole look at how technically accurate conflict-of-interest reporting can give readers a distorted view of whether academic research is free of corporate funding or bias. It's also a lesson for managers on the ethics of transparency -- a lesson that JAMA, in this case, has failed.

Even though the JAMA study (and its correction) doesn't list Allergan as having any relationship with the authors, the fact is that O'Brien's economic life is completely dominated by the company. By favoring technicalities over substance, JAMA's correction seriously misleads its readers.

In his letter, O'Brien said he had not received compensation as an advisor to Allergan, as reported, but rather from Inamed, a company acquired by Allergan about five years ago: "[I] have never provided these services to Allergan," he wrote.

But O'Brien is the director of the Centre for Obesity Research and Education at Monash University in Melbourne, Australia, which regular BNET readers know has a longstanding association with Allergan. In CORE's 2008 annual report, the institute said Allergan was "our principal sponsor," and that "Allergan Health is CORE's major funding source." (CORE hasn't published an annual report that lists its funding for 2009.) CORE's web site also lists O'Brien as a contact for the Lap-Band on a page with half a dozen Allergan staffers, and CORE maintains a web page dedicated to the wonders of the Lap-Band.

O'Brien's other job is as the national medical director of the American Institute for Gastric Banding, whose Web page says the organization is "America's #1 Provider of the LAP-BAND System."

But the icing on the cake can be found in this brochure for a gastroenterology conference. It describes O'Brien's speeches as "proudly sponsored by Allergan" in 10 different places.

To sum up: Aside from his academic research funders, his private practice and his speaking engagements, O'Brien does indeed have no conflicts with Allergan.

JAMA has failed twice here. The O'Brien study included just 24 patients in the Lap-Band arm and reached the unsurprising conclusion that gastric intervention is more effective than diet and lifestyle changes among very obese teens. In other words, even if it advanced our knowledge of obesity treatments it's still too statistically feeble to count. The study did, however, generate an enormous amount of attention from the mainstream media. Would it be too cynical to suggest that this was the main point all along?


Image by Flickr user toby otter, CC.