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New England Journal of Medicine Editor
says conflicts of
interest endanger research
from Associated Press,
May 18, 2000
(AP) -- The editor of one of the world's premier medical journals has
written a withering critique of the research system, saying science is
being compromised by the growing influence of industry money.
Dr. Marcia Angell, editor of The New England Journal of Medicine, joins
a wave of critics who say an explosion of research funding from drug and
medical-equipment makers has added commercial concerns to the scientific
process.
"When the boundaries between industry and academic medicine become
as blurred as they are now, the business goals of industry influence the
mission of medical schools in multiple ways," she cautioned.
She raised the questions in today's issue of the journal in an
editorial headlined "Is Academic Medicine for Sale?" The
Boston-based journal is widely regarded as medicine's most distinguished
periodical.
Angell, the journal's outgoing editor, acknowledged that rising
research funding from biotechnology and drug companies has helped lead to
dramatic advances against many diseases in recent years.
At the same time, she said, medical schools have struck a
"Faustian bargain" with industry.
She said industry representatives are lavishing giveaway products,
other gifts and trips on doctors. She said speaking and consulting fees,
along with other compensation, are subtly swaying researchers toward more
favorable findings on products of companies making the payments.
She said researchers may also be focusing on trivial -- but marketable
-- differences between similar drugs.
As a remedy, she said major medical schools should adopt a strong,
common code for conflicts of interest, banning some writing and speaking
arrangements and stock ownership in companies making the products under
study. She said drug companies should not promote products and offer gifts
to students and doctors at teaching hospitals. And she suggested that
researchers' consulting income could go into a common research pool.
Michael Werner, a lawyer for the Washington-based Biotechnology
Industry Organization, said disclosure of financial ties and government
regulation sufficiently protect the public. He said companies have every
reason to shun poor research because of
liability and the bad publicity that could result from a recall.
Dr. Jeffrey Drazen, an asthma researcher at Brigham and Women's
Hospital, has been named to replace Angell, probably later this year.
Drazen's own ties to the drug industry came under scrutiny February 24
when the journal disclosed that it had published 19 articles on drug
treatments without disclosing the authors' industry links. One of the
authors was Drazen, who had accepted grants or an advisory role at eight
companies.
Angell pointed to a study of depression treatments in today's issue
with an unusually long list of potential conflicts. Its lead author, Brown
University psychiatrist Dr. Martin Keller, said in an interview that
industry money was badly needed for the large study of 681
patients at 12 sites.
He said the personal integrity of scientists helps resist conflicting
pressures, and he suggested "a balance between what's reasonable and
fair -- and what would be so overly strict that it would be
restrictive."
His study was funded by drug maker Bristol-Meyers Squibb. Company
spokeswoman Tracy Furey said she does not feel that providing research
grants necessarily influences the outcome of medical research. Neither she
nor Keller would discuss details of personal
compensation to researchers.
Underscoring the editor's message in the same issue, journal
correspondent Dr. Thomas Bodenheimer of the University of California at
San Francisco said 70 percent of money for clinical tests of drugs and
devices now comes from industry, not government.
David Rothman, director of the Center for Society and Medicine at
Columbia University, said researchers used to face heavier pressure to
fudge research for reputation rather than for wealth.
"I think it is more benign to be after fame than after fortune.
You're less likely to cut corners," he said.
Harvard University, with some of the most stringent restrictions on
conflict of interest, is now under pressure from some researchers to ease
rules, acknowledged Margaret Dale, an associate dean at its medical
school. She said they argue that there is a potential even for a school
like Harvard to lose researchers to more laissez-faire schools.
Copyright 2000 The Associated Press.
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