Conflict Of Interest

By

Leonard Zwelling

I recently presented a talk to grand rounds of the Department of Pediatrics at the UT School of Medicine in Houston about conflict of interest. It is a presentation I have given many times before, but always seems to catch the audience by surprise. First, most members of the academic medical community are unaware of the extent to which conflict of interest has pervaded our profession. Second, most people do not understand that this is ethically (and sometimes legally) untenable. Third, financial conflicts as are rampant in academia undermine the integrity of research and the trust of the public in that research. Finally, it is up to us in academia to stop it.

There are several key takeaways from the talk, I believe.

First, conflicts of interest have been going on in academic medicine since the 18th century, but have gotten worse of late because the federal government now encourages the commercialization of science discovered on NIH grants. Thus, public money is being used to generate private wealth. This is just plain wrong. Think about it. Tax payers are supporting science the fruits of which (novel therapies) they may not be able to afford when the drug companies license out the discovery, generate a drug and price it out of the reach of many Americans. It happens every day.

Second, the only way to regulate conflicts is to eliminate them. They cannot be managed because to manage them means managing the state of mind of a scientist when he or she publishes a finding. Who is to know whether the result is tainted by the interest the scientist may have in the financial prospects of his discovery?

Third, some very high profile people, including two presidents of MD Anderson have been caught up in scandals involving conflict of interest and the response of the oversight Board of Regents was tepid at best. In other words, the presidents got away with it.

Fourth, conflict of interest alters the practice of medicine. How? Every time a drug company gives a doctor a pen, or stickees, or a free meal or free drug samples, the mind set of that doctor is altered favorably toward that drug company and that has been shown to alter prescribing practices of clinicians. Simply put, the last person to feed you who loved you was your mother. Drug companies are feeding you to change your mind about their products. You are being marketed to. You are for sale.

I write this again because no sooner had I left the podium at UT Houston than I was made aware that many of the pediatricians who had just heard me talk about getting fed by drug companies regularly get meals provided by the companies making baby formula. In other words, it’s not just the drug companies using marketing dollars to alter your perception of their products.

I have also been made aware that there are basic scientists in academia with large equity positions in companies they have founded and for which they are still doing research. This too is a conflict of interest and ought to stop. A key finding published in a prestigious journal by such a scientist will line his or her pockets if the publication raises the value of his or her portfolio. In other words, his or her findings are altering the market value of the stock. How is anyone to trust those findings? I don’t.

And what happens if the data come under scrutiny with regard to their validity? Can an institution with millions of dollars at stake in the company the data are supporting (the institutions have stock, too) really be expected to perform a valid misconduct inquiry? I doubt it.

The mission of academic medicine is to further man’s knowledge and to improve health care and its delivery. If what you want to do with your research is make money, go into the private sector. Do not collect a state-supported paycheck while also advancing the value of your privately- or publicly-held stock portfolio. From what I can tell, the efforts made by some of us to revise the Anderson conflict of interest policies after the original problem with ImClone stock held by the president of MD Anderson when ImClone’s drug was being tested at Anderson without the president’s interests being acknowledged to those human subjects participating in the trial, are still not effective. The next president’s pushing his own drug on national television proved that.

Academic medicine still does not have its act together with regard to conflicts of interest and undoubtedly there will continue to be incidents where prominent people will be caught with deep conflicts. Unless the leadership of MD Anderson prevents those with vested interest in their own company from owning stock and continuing to do research on the products of the company, a disaster is bound to occur. Again.

Leonard Zwelling