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Medical Ethics and Conflicts of Interest in Scientific Medicine

Jonathan Quick, director of essential drugs and medicines policy for the World Health Organization (WHO), wrote in a WHO bulletin:

If clinical trials become a commercial venture in which self-interest overrules public interest and desire overrules science, then the social contract which allows research on human subjects in return for medical advances is broken. 353

As former editor of the New England Journal of Medicine, Dr. Marcia Angell struggled to bring greater attention to the problem of commercializing scientific research. In her outgoing editorial entitled “Is Academic Medicine for Sale?” Angell wrote that growing conflicts of interest are tainting science, and called for stronger restrictions on pharmaceutical stock ownership and other financial incentives for researchers: “When the boundaries between industry and academic medicine become as blurred as they are now,” Angell wrote, “the business goals of industry influence the mission of medical schools in multiple ways.” She did not discount the benefits of research but said a Faustian bargain now existed between medical schools and the pharmaceutical industry.354

Angell left the New England Journal in June 2000. In June 2002, The New England Journal of Medicine announced that it would accept journalists who accept money from drug companies because it was too difficult to find ones who have no ties. Another former editor of the journal, Dr. Jerome Kassirer, said that was not the case and that plenty of researchers are available who do not work for drug companies.355 According to an ABC News report, pharmaceutical companies spend over $2 billion a year on over 314,000 events attended by doctors.

The ABC News report also noted that a survey of clinical trials revealed that when a drug company funds a study, there is a 90% chance that the drug will be perceived as effective, whereas a non-drug-company-funded study will show favorable results only 50% of the time. It appears that money can’t buy you love, but it can buy any “scientific” result desired.

Cynthia Crossen, a staffer for the Wall Street Journal, in 1996 published Tainted Truth: The Manipulation of Fact in America, a book about the widespread practice of lying with statistics.356 Commenting on the state of scientific research, she wrote: “The road to hell was paved with the flood of corporate research dollars that eagerly filled gaps left by slashed government research funding.” Her data on financial involvement showed that in 1981, the drug industry “gave” $292 million to colleges and universities for research. By 1991, this figure had risen to $2.1 billion.

Universities have been treading on dangerous ground with their increasingly complex financial ties to industry. . . . They are worried that these things could ultimately affect their tax-free status,” Dr. Kassirer said in September 2008.357

In September 2008,

The Wall Street Journal reported that Chair of the Senate Finance Committee Sen. Chuck Grassley . . . confronted about 20 universities across the nation, including Brown, Harvard and Stanford for failing to publicize additional grants obtained from drug makers.358

The university is not the only venue for pharmaco-gifts. “Right now the public has no way to know whether a doctor’s been given money that might affect prescribing habits,” Grassley said as he introduced the Physician Payments Sunshine Act for public disclosure of payments to physicians. Sen. Grassley continues:

Payments to a doctor can be big or small. They can be a simple dinner after work or they can add up to tens of thousands and even hundreds of thousands of dollars each year. That’s right—hundreds of thousands of dollars for one doctor. It’s really pretty shocking. Companies wouldn’t be paying this money unless it had a direct effect on the prescriptions doctors write, and the medical devices they use. Patients, of course, are in the dark about whether their doctor is receiving this money.

This practice, and the lack of transparency around it, can obscure the most important question that exists between doctor and patient: what is best for the patient?359

”More Studies!”

Scientists claimed there were never enough studies revealing the dangers of DDT and other dangerous pesticides to ban them. They also used this argument for tobacco, claiming that more studies were needed before they could be certain that tobacco really caused lung cancer. Even the American Medical Association (AMA) was complicit in suppressing the results of tobacco research. In 1964, when the Surgeon General’s report condemned smoking, the AMA refused to endorse it, claiming a need for more research. What they really wanted was more money, which they received from a consortium of tobacco companies that paid the AMA $18 million over the next nine years, during which the AMA said nothing about the dangers of smoking.360

The Journal of the American Medical Association (JAMA), “after careful consideration of the extent to which cigarettes were used by physicians in practice,” began accepting tobacco advertisements and money in 1933. State journals such as the New York State Journal of Medicine also began to run advertisements for Chesterfield cigarettes that claimed cigarettes are “Just as pure as the water you drink . . . and practically untouched by human hands.” In 1948, JAMA argued, “More can be said in behalf of smoking as a form of escape from tension than against it . . . there does not seem to be any preponderance of evidence that would indicate the abolition of the use of tobacco as a substance contrary to the public health.”361 Today, scientists continue to use the excuse that more studies are needed before they will support restricting the inordinate use of drugs.