Michael Woods: Financial ties in research community disturbing

July 31, 2000

Mention academic medicine, and people think of scientists who do research and teach students in medical schools. You know, professors selflessly searching for new knowledge about disease, isolated from the crass motivations such as money that drive people in the outside world?

Surprise. Things have changed over the last 20 years.

Medical schools, professors, and drug companies are working hand-in-hand. The many financial ties between academic medicine and the pharmaceutical industry is raising questions and causing plenty of hand-wringing.

Are the financial ties a hidden factor in driving up the prices of prescription drugs? Do they affect the objectivity of studies done to test new drugs?

The New England Journal of Medicine raised those concerns in a May editorial aptly headlined: "Is Academic Medicine for Sale?" Written by former NEJM editor Dr. Marcia Angell, it issued a blunt warning to medical school administrators and professors about cozy financial ties to drug firms, conflicts of interest that contribute to high drug prices, and other problems.

In 1984, NEJM became the first major medical journal to require authors to disclose financial ties with companies that make products discussed in their reports. Most other journals followed suit.

An anti-depressant study made NEJM realize that financial ties between medical school professors and drug companies had grown unbelievably pervasive. The study had 12 principal authors and 17 secondary authors from some of America's top medical colleges. Their financial ties to the drug industry were so extensive that NEJM didn't have room to print a full list. Instead, it put the list on its Web site.

Eleven of the 12 main authors, for instance, had financial ties to the drug company that sells the drug tested in the study. That company also paid medical schools to conduct the study. Most also had financial ties to other makers of anti-depressants.

NEJM described them:

"Researchers serve as consultants to companies whose products they are studying, join advisory boards and speakers' bureaus, enter into patent and royalty arrangements, agree to be listed as authors of articles ghostwritten by interested companies, promote drugs and devices at company-sponsored symposiums, and allow themselves to be plied with expensive gifts and trips to luxurious settings. Many also have equity interest in the companies."

Medical schools themselves are following suit, NEJM explained. Some, for instance, have become partners with drug companies in setting up research centers where faculty members and students carry out industry research.

Drug company representatives also routinely supply meals and other gifts for young doctors training in hospitals. As NEJM noted, the companies hope to create goodwill that will encourage young physicians toward career-long prescribing of their drugs.

Scientists, of course, react with outrage to the mere hint that taking money from a drug company can affect their objectivity. "We can't be bought," they insist.

NEJM pointed out that the appearance of a conflict should be enough for academic medicine to reconsider the situation.

"It is well to remember that the costs of the industry-sponsored trips, meals, gifts, conferences and symposiums and the honorariums, consulting fees, and research grants are simply added to the prices of drugs and devices," NEJM observed. http://www.toledoblade.com/editorial/woods/0g31wood.htm