Is Academic Medicine for Sale?

A life-and-death question is in the air, about medicine and money.

Recently the New England Journal of Medicine voiced growing unease with conflict of interest, in a landmark editorial titled "Is Academic Medicine for Sale?" Conflict of interest means financial ties that confer inappropriate or even illegal income to a scientist. In the same issue, NEJM's national correspondent, Dr. Thomas Bodenheimer, described two major studies in which most of the researchers have money ties to manufacturers of the very drugs they're studying.

Any Internet search shows that issues of "ivory tower crime" have been hotly debated since the late 1980s -- mostly behind the scenes, in scientific publications and the so-called alternative media. Some scientists view the debate as an attack on science, while others welcome it. In 1996, Scientific American complained that some scientists' secrecy around important discoveries is motivated by their intent to file lucrative patents. The magazine quoted Steven A. Rosenberg, chief of surgery at the National Cancer Institute, as saying that, "it is a very clear moral issue.... humans beings suffer and die who need not have done so."

In a word, some people are getting too cozy at that nexus where health science, government, business, nonprofits and media all intersect. In the current permissive atmosphere, some scientists can reap huge profits and power from unchallenged conflict of interest. Along the way, not only can "scientific truth" be skewed, but people's lives and health can be destroyed.

The New England Journal of Medicine, feeling that the public should know who is paying who, now requires financial disclosure by authors of original research articles. Some disclosures are so lengthy that the magazine can't print them all, so posts them on its website! The NEJM confessed that it had a hard time finding editorialists whose financial profile is clean enough for credibility. It said:

"Ties between clinical researchers and industry include not only grant support, but also a host of other financial arrangements. 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 the listed 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."

Added NEJM: "Many researchers profess that they are outraged by the very notion that their financial ties to industry could affect their work. They insist that, as scientists, they can remain objective, no matter what the blandishments. Can we really believe that clinical researchers are more immune to self-interest than other people?"

Prodded by this controversy, the U.S. government may be on the verge of tightening federal standards on how scientists operate. Indeed, the Public Health Service started its Office of Research Integrity in 1989, in the wake of scandals around HIV research done by Robert Gallo's "dream team". The problem is, ORI doesn't look closely at conflict of interest. It focuses on what's called "scientific misconduct" -- namely fabrication, falsification or plagiarism in research data. Last year the Public Health Service proposed stricter standards -- but these do not address financial misconduct.

For politicians, conflict of interest is a deadly issue -- especially in election years. As I write this, Al Gore fights off those stinging wasps of allegations about the Buddhist temple fundraiser, while George Bush and running-mate Dick Cheney fight off stinging allegations about their financial ties to the Texas energy industry. Newt Gingrich stopped being a contender when the public realized he'd been lobbied by Big Tobacco. Financial misconduct can heat up special-prosecutor investigations (as in the Monica Lewinsky affair), even result in indictments (as it did recently with alleged pay-offs around the Salt Lake City Olympic Games).