The Trouble with Disclosures of Industry Relationships

Potential or perceived conflicts of interest have received much attention in recent months. PhRMA guidelines have further reduced spending on items or programs that may influence or be seen to influence physician prescribing, and the AMA has called on professional medical associations to reject certain industry sponsorships and questionable relationships with pharmaceutical companies, such as offering endorsements for particular products or services. As scrutiny of industry relationships becomes ever more focused, "conflicts of interest" are becoming a scapegoat for numerous ills within the medical/research/pharmaceutical marketing/academic/publishing complex and drawing attention away from more serious problems.

Continued fallout from the now several-years-old Vioxx debacle continue to illustrate significant problems that persisted for years in the pharmaceutical industry and related enterprises. Just last month reports emerged that a Massachusetts-based anesthesiologist may have fabricated data for 21 papers published in anesthesiology journals to promote the benefits of Bextra, Celebrex, and Lyrica (all from Pfizer) and Vioxx (Merck). The author had received research grants from Pfizer and was on its speakers bureau. The company has denied any knowledge of the data falsification. In fact, as much as the medical community and patients, Pfizer may be a victim, having funded research that may not have taken place.

Also last month, attention once again turned to Harvard University where 200 medical students and faculty members participated in a demonstration aimed at exposing and addressing industry ties to the University, its faculty and researchers, its affiliated hospitals and medical centers, and staff. It's worth noting that Harvard earned an "F" from the American Medical Student Association, suggesting the school does not effectively monitor and control drug industry spending.

These two cases are clearly not the norm for physician-researchers or academic centers nationwide. Outlying abuses or misuses of the system do not warrant the type of reactionary behavior that is taking place in medicine today. Building a firewall between industry and physicians makes no sense, since physicians must be involved in the development and testing of drugs. If they don't work closely with drug manufacturers and marketers, how will clinicians learn what they need to know to safely adopt drugs into practice? Plus, as the costs of education and research grow, it would be foolish for universities to refuse funding from industry's deep coffers. On the flip side, over-emphasis of disclosures may lead to false security about the quality of research. Just because one lacks a "relationship" with industry does not mean he or she lacks bias. Nor does acknowledging a relationship amount to a guarantee of fair balance.

Clearly problems exist and must be addressed. But now is the time for meaningful and comprehensive practical and ideological changes, not just band-aid measures enacted piece-meal by disparate individuals, institutions, professional groups, and companies.