Handling Conflicts of Interest Between Industry and AcademiaHandling Conflicts of Interest Between Industry and Academia

To the Editor: In their discussion of institutional conflicts of interest, Dr Johns and colleagues¹ observed that "trustees, presidents, chancellors, provosts, deans, [and] department chairpersons also have developed extensive financial ties with industry." They concluded that these conflicts "should be managed rather than eliminated." The authors, however, never discussed the central issue—how to manage this imbalanced relationship in which industry has considerably more resources and markedly different priorities than medical schools. Angell² has asserted that "For-profit businesses are pledged to increase the value of their investors' stock. That is a very different goal from the mission of medical schools . . . academic medical centers should be wary of partnerships in which they make available their precious resources . . . to carry out research that serves primarily the interests of the companies. That is ultimately a Faustian bargain."

The source of research funding often determines what research questions get asked. Corporate funding of universities aligns institutional research with the business agenda rather than that of other constituents—notably patients and students—whose interests should be paramount.

Another problem arises when medical center physicians with corporate equity holdings serve on federal advisory boards. For example, a congressional panel investigated 2 vaccine advisory committees and concluded that "conflicts of interest rules employed by the FDA [Food and Drug Administration] and CDC [US Centers for Disease Control] have been weak, enforcement has been lax, and committee members with substantial ties to pharmaceutical companies have been given waivers to participate in committee proceedings."³ The panel concluded that such practices were in violation of the Federal Advisory Committee Act. Similarly, an investigation into 159 FDA advisory Committee meetings found that more than half of the members at 55% of the sessions had conflicts of interest.⁴

Finally, we doubt that academicians and medical leaders can effectively make policy decisions in the public interest once they have developed interlocking directorates, personal friendships, financial interests, etc. Such conflicts of interest may make it impossible for them to manage such conflicts themselves.

Financial Disclosure: Dr Egilman serves as an expert witness in toxic tort litigation cases at the request of plaintiffs and defendants, but receives no direct payment for this service.