The Sydney Morning Herald

Potential conflict in research linking back pain and infections

Author: Nicky Phillips
Date: 28/05/2013
Words: 645
Source: SMH
          Publication: Sydney Morning Herald
Section: News
Page: 10
A widely publicised study claiming many people's lower back pain could be treated with antibiotics has been accused of failing to declare several authors' links to a company that certifies doctors in antibiotic therapy.

On May 7, media around the world reported that the cause of up to 40 per of lower back pain was a common bacterial infection that could be cured with antibiotics. The reports were based on the work of researchers at the University of Southern Denmark.

A British spine surgeon, Peter Hamlyn, said the findings were "the stuff of Nobel prizes" that would "require us to rewrite the textbooks". While several researchers have questioned the study's methodology, the article, published in the peer-reviewed European Spine Journal, did not state that three authors were board members of the Modic Antibiotic Spine Therapy Academy, or MAST Academy.

Most media, including Fairfax Media, publisher of the Herald, also failed to mention Dr Hamlyn was a MAST Academy board member, who would stand to benefit from the publicity of the research findings.

The academy, a publicly listed company with Companies House in Britain, operates to educate the public and medical professionals on this type of back pain, and certify clinicians in how to identify and treat the condition, for a #200 ($314) fee.

A British pharmacology professor, David Colquhoun, said clinical journals required authors to declare any conflicts, so the Danish academics should have reported their association with the company. "It's obvious that you can't be relied upon to be objective about the results of an experiment or clinical trial if you stand to make money from a particular outcome," the University College London professor said.

Victorian pain specialist Michael Vagg said while the link between bacterial infections and some back pain was plausible, the researchers had not demonstrated this type of infection was the cause of the patient's pain.

The paper had only described a reduction in pain, so the idea that antibiotics could cure 40 per cent of back pain was misleading and overblown, he said.

Australian surgeon and ethicist Charles Douglas said whether a conflict of interest existed would depend on when the scientists had started thinking about making money from their research outcomes.

"If they had one eye on the financial potential when they submitted their papers I think they had a conflict that they should have declared," said Dr Douglas, a medical ethics academic at the University of Newcastle.

One of the authors and academy board member, Claus Manniche, said the company was established in 2010 but remained dormant, and without a bank account, until after the manuscripts were accepted for publication. Only after the journal accepted the papers did the group launch a website, he said.

Professor Manniche said the site's aim was to inform the public of this condition and prevent doctors over-prescribing antibiotics.

"This activity in no way differs from teaching courses or seminars. Our group has published approximately 25 papers in peer-reviewed journals," he said.

Dr Manniche said the journal had been told of their involvement with MAST Academy, but he did not clarify if this occurred before or after publication.

Another author, Joan Solgaard, said she had never heard of the MAST Academy until a month ago, when she was asked to be a board member. She had no ownership in the company, she said.

Dr Hamlyn said the company had cost the team money, and he openly "boasted" about being a member of the academy's board during a media conference.

"We are not talking about some rare condition; we are talking about low back pain; 8 per cent of the planet gets severe, persistent low back pain and [these] discoveries may help 20 to 40 per cent of them. Twelve years of research, I do not have to be paid to say [the lead author] needs a Nobel prize."

Neither the journal editor nor the paper's lead author, Hanne Albert, responded to emailed questions.

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