In a very interesting development, the Office of the Inspector General of the US Department of Health and Human Services recently released a report (summary and complete report) that found that while there have been important improvements in the development of policies to manage individual researcher COI, there are real problems with the management of institutional COI. [See also Report prods NIH to address institutional conflicts of interest]
The OIG argues that the
NIH should require grantee institutions to identify, report, and address institutional conflicts in a consistent and uniform manner. It is important that NIH know of the existence of such conflicts so it can ensure that the related research is free from any intended or unintended bias. Therefore, we recommend that NIH promulgate regulations that address institutional financial conflicts of interest.
The January edition (11/1) of the American Journal of Bioethics (AJOB) has an excellent article by Howard Brody – Clarifying Conflict of Interest – which stimulated a flurry of interesting peer commentaries. My editorial/commentary in this issue, entitled Beyond a Pejorative Understanding of Conflict of Interest, makes the argument (to which readers of this blog will be familiar), that one of the major problems with COI is that there is still a widely held view that COI = financial fraud. A result of this pejorative or negative connotation is that the term loses much of its utility, in practice. So in line with Howard Brody, I argue that we in the academic community need to do a much better job of clarifying the concept, and in particular, that we move beyond a focus on financial COI to deal with the range of other personal interests at stake, in order to better manage COI when they cannot be avoided.
[Unfortunately these articles aren't open access].
The 2010 AMSA PharmaFree Scorecard — which “evaluates conflict-of-interest policies at 152 medical colleges and colleges of osteopathic medicine in the United States” – came out December 15th, and as noted in their executive summary, “over 50% of medical schools, now have grades of A or B (78 schools). This is a tremendous increase over 45 A and B schools (30%) in 2009 and shows a continued progression from 29 A and B schools in 2008.”
This improvement (see the AMSA ranking methods) would seem to bode well for the increasing oversight and regulation of COI across academic institutions. But as the following stories show — Med school docs still break conflict-of-interest rules and Faculty still paid by drug firms — even the “best” policies will still be limited if 1) there aren’t effective and transparent procedures in place, and 2) there isn’t an institutional culture that promotes disclosure and dialogue, and ensures that people now how to manage COI situations when they cannot be avoided.
P.S. Feb 8, 2011: See this story about applying the AMSA ranking to Australian medical schools [and full text of study]
When surgeons get royalties from the operations they perform, its worth questioning whether these operations are all that necessary or appropriate (Top Spine Surgeons Reap Royalties, Medicare Bounty). Similarly, when going to the pharmacy and seeking advice from a pharmacist, people – as consumers of health care services/patients – might quite reasonably expect that the health professional serving them will provide guidance in their, the patient/consumer’s, best interests (Some pharmacies may have conflict of interest with Medicare). At issue in both these stories is the trust that an individual should have (and can reasonably expect) in a health professional, something that is seriously threatened when their are important financial COI.
Chris MacDonald, over at the Business Ethics Blog, has provided the following interesting entry : Is a Board Position a Conflict of Interest? Now this analysis by Chris is focused on businesses, but it is also directly applicable to the academic context. One simply has to think about the roles and responsibilities that senior academics, researchers, or administrators may have in their home institutions, and then how these may align with or conflict when they also sit as members of boards of directors of companies…
P.S. Nov 19: See these two stories regarding different types of board membership 1) Tobacco control and the collateral damage of conflict of interest (editorial in Open Medicine) and 2) Koch Leaves Federal Cancer Panel as Groups Urge Ethics Probe (NY Times).