CEBM and BMJ logo

Financial conflicts of interest in medical research: perspective from an early-career researcher

“If physicians are to represent their patients’ interests in the new medical marketplace, they should have no economic conflict of interest and therefore no pecuniary association with the medical-industrial complex.1
Arnold S. Relman, MD

There is an extant belief in the biomedical research community that financial relationships with for-profit pharmaceutical companies are to be encouraged, since such relationships represent “confluences” of interest2. That is to say, close financial relationships with industry are in the best interest of patients, since the exchange of medical knowledge for financial compensation advances patient care.

One can imagine ways that a physician may work closely with industry while maintaining ideological integrity. However, several data points suggest that true “confluences” of interest — cases where financial relationships with industry exist, but patient care is not affected —  are rare. First, regarding the published literature, several systematic reviews have demonstrated that industry sponsorship of medical studies and pro-industry conclusions are strongly associated3,4. One common critique of these findings is that industry sponsors are known to selectively publish studies on the basis of statistical significance5, begging the question of why physician-authors would consent to provide expert medical knowledge to companies who do not publish in the best interest of patients. Second, regarding individual prescribing practices, it is now well known that receipt of industry payments6–9 results in the prescription of the sponsor’s drugs, many of which are costly with uncertain benefit or known harms. Even relationships as seemingly trivial as meals10 have been shown to increase prescription of brand-name drugs.

Therefore, it is my hope to impart my personal charge to other evidence-based scientists who recognize that “confluences” of interest are largely based in fiction. I have charged myself, as a prospective physician-researcher, to reject personal industry payments and continue advocating for representation of conflict-free physicians on guideline panels, clinical trials, and editorial boards. The presence of for-profit companies in biomedical research is unlikely to fade, but physicians that serve only one master — patients — may continue to rise.

References

  1. Relman AS. The New Medical-Industrial Complex. New England Journal of Medicine. 1980;303(17):963-970. doi:10.1056/nejm198010233031703
  2. Cappola AR, FitzGerald GA. Confluence, Not Conflict of Interest: Name Change Necessary. JAMA. 2015;314(17):1791-1792.
  3. Lundh A, Lexchin J, Mintzes B, Schroll JB, Bero L. Industry sponsorship and research outcome. Cochrane Database Syst Rev. 2017;2:MR000033.
  4. Bekelman JE, Li Y, Gross CP. Scope and impact of financial conflicts of interest in biomedical research: a systematic review. JAMA. 2003;289(4):454-465.
  5. Turner EH, Matthews AM, Linardatos E, Tell RA, Rosenthal R. Selective publication of antidepressant trials and its influence on apparent efficacy. N Engl J Med. 2008;358(3):252-260.
  6. Singh P, Forman H, Adamson AS, et al. Impact of Industry Payments on Prescribing Patterns for Tumor Necrosis Factor Inhibitors Among Medicare Beneficiaries. J Gen Intern Med. 2019;34(2):176-178.
  7. Sharma M, Vadhariya A, Johnson ML, Marcum ZA, Holmes HM. Association between industry payments and prescribing costly medications: an observational study using open payments and medicare part D data. BMC Health Serv Res. 2018;18(1):236.
  8. Mitchell AP, Winn AN, Dusetzina SB. Pharmaceutical Industry Payments and Oncologists’ Selection of Targeted Cancer Therapies in Medicare Beneficiaries. JAMA Intern Med. April 2018. doi:10.1001/jamainternmed.2018.0776
  9. Fleischman W, Agrawal S, Gross CP, Ross JS. Association of Pharmaceutical Manufacturer Payments to Physicians and Prescribing Dosage of Opioids. J Gen Intern Med. April 2019. doi:10.1007/s11606-019-04897-9
  10. DeJong C, Aguilar T, Tseng C-W, Lin GA, Boscardin WJ, Dudley RA. Pharmaceutical Industry-Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries. JAMA Intern Med. 2016;176(8):1114-1122.

Conflict of interest statement: Mr. Wayant has no conflicts of interest.

Biography: Mr. Wayant is a 2019 Doug Altman Scholarship recipient and a dual-degree DO/PhD student at Oklahoma State University Center for Health Sciences in Tulsa, Oklahoma, USA.  His research explores how bias, poor methods, and poor reporting may affect study medical research conclusions, interpretations, and applications. Clinically, Mr. Wayant is interested in hematology/oncology.

 

2020 Registration
OPENING SOON

Call for Abstracts
OPENING SOON