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Conflict of Interest Roundup

Conflict of interest policies have been a hot topic in recent weeks. Here’s an unscientific roundup of some recent articles on the subject:

A couple of weeks ago Science Insider reported on new conflict of interest guidelines from the National Institutes of Health. Jocelyn Kaiser writes: “NIH wants to lower the definition of “significant” financial conflict
from $10,000 to $5000, or any equity in a nonpublicly-traded company
(the
previous cutoff was 5%). Researchers would have to tell their
institutions about all conflicts over this threshold that “reasonably
appear to be
related to the Investigator’s institutional
responsibilities”–leaving administrators, not the investigator, to
decide which are related to a
specific NIH-funded project.”

In a
May 21 JAMA editorial
about the proposed regulations, NIH Director Francis Collins and Deputy Director for Extramural Research
Sally Rockey wrote: “Capitalizing on innovation to benefit health requires a robust partnership that joins bias-free research with the most effective methods for translation and dissemination. As NIH strives to accelerate the movement of discoveries from the laboratory to the clinic, it is clear that already complex relationships between NIH-funded researchers and industry will likely become more complicated, even as they become more exciting and more productive.”  That editorial also includes a handy table to illustrate the current and proposed rules.

In today’s JAMA, Bridget Kuehn writes about provisions in the health reform law passed in March that will require drug and device manufacturers to report any payments they make to physicians and hospitals. The new law “will require manufacturers to disclose individual payments or goods or services with a value of $10 or more and cumulative payments or gifts exceeding $100, including travel, meals, consulting fees, honoraria, research funding, and royalties,” Kuehn writes.

The May/June issue of Boston Review includes an editorial by Marcia Angell, former executive editor and editor in chief of the New England Journal of Medicine, called “How Corporate Dollars Corrupt Research and Education.” She writes, “Much of the time, the institutional conflict-of-interest rules ostensibly designed to control these relationships are highly variable, permissive, and loosely enforced. At Harvard Medical School, for example, few conflicts of interest are flatly prohibited; they are only limited in various ways.”
And later on:
“To be clear, I’m not objecting to all research collaboration between academia and industry–only to terms and conditions that threaten the independence and impartiality essential to medical research. Research collaboration between academia and industry can be fruitful, but it doesn’t need to involve payments to researchers beyond grant support. And that support, as I have argued, should be at arm’s length.” She goes on to suggest her three “essential” reforms.

In a February Perspective in the New England Journal of Medicine, UC San Francisco professor of medicine Bernard Lo discusses conflicts of interest in the context of the differing missions of academic health centers and for-profit companies. “Sound conflict-of-interest policies require careful analysis of the benefits and risks of a relationship between academia and industry,” he writes, following that with several questions policymakers should ask when crafting conflict-of-interest policies.

Later, Lo summarizes the responsibility of the individual physician-investigator in developing such policies: “In their roles as clinicians and researchers, physicians tackle difficult, complex problems, clarify countervailing interests and values, make tradeoffs explicit, develop innovative approaches, and rigorously analyze the advantages and disadvantages of various options. Physicians should apply these skills to help improve conflict-of-interest policies for AHCs and professional societies.”

While it’s important to communicate potential conflicts to scientific peers, the true end users of that information are patients. Do they really care? An April study in the Archives of Internal Medicine suggests that they do. In a literature analysis of studies of patients’, research participants’, and journal readers’ views of financial ties to drug and device companies, researchers found that, overall, patients do believe disclosure of financial ties is important, and research participants say that such disclosures would affect their decision on whether to participate in a clinical study.