Can one be an active participant within any professional domain without having some potential conflicts of interest? The enthusiastic pursuit of any scientific endeavor requires that an informed person take positions on various matters where controversy may exist, and one must presume that any and all experiences a practitioner endures may influence that party’s perception of certain issues. The NIH website defines that a conflict of interest... “occurs when individuals involved with the conduct, reporting, oversight or review of research also have financial or other interests, from which they can benefit, depending on the results of the research.”
It came as no surprise that the April 4th edition of JAMA.com included a special communication authored by 11 individuals entitled “Professional Medical Associations and Their Relationship with Industry - A Proposal for Controlling Conflict of Interest”. Issues involving conflicts of interest have permeated recent professional and lay press, including events involving several high profile PMA (professional medical association) groups. In many ways, the commentary and suggestions provided in this article are welcomed and appropriate - especially relating to the absolute need for transparency and avoidance of conflicts for those involved in drafting practice guidelines and similar standards.
However, in the NFL parlance of “upon further review”, the fervor of this article’s plea for near-absolute separation of PMAs and pharmaceutical industry (ironically, also termed PMA - the Pharmaceutical Manufacturers Association, until a name change a decade ago to PhRMA) includes very curious exclusions permitting professional groups to accept advertising in medical journals, as well as sponsorship of exhibits at PMA conferences. The article notes in one section that “Under no circumstances should PMAs collaborate in industry marketing activities or profit from them.” (when discussing guidelines for satellite symposia), while elsewhere in the text stating “Although attracting advertising and exhibit hall fees might possibly bias the activities of PMAs, officers and members can easily distinguish these marketing activities from educational presentations and are free to ignore them”. Aside from the contradictory nature of the two preceding statements - unless one presumes that ads do not constitute marketing (and it would be hard to refute that of all industry pursuits, simple advertising is the most overtly commerical venture, and hence that with the clearest financial conflict), or that physicians are not sufficiently insightful to use their judgement in any but the most overt circumstances - both of which are misrepresentations at best, the broader implications of the PMA recommended actions could play out quite remarkably.
It is tempting to speculate that the pharmaceutical industry may view this JAMA article as a “wake up call” regarding the fact that they have continued - like somnambulists - to subsidize their harshest critics - the professional journals such as JAMA and NEJM - via advertising revenues, without even the opportunity to provide fair balance in point/counterpoint editorial responses to scathing rebukes. One must wonder why big Pharma does continue to run ads for doctorly journal readers who can’t easily prescribe off-formulary and are in institutions which have banned sales reps, thus deafened to commercial appeals..... and perhaps the current economic climate will render this issue moot. However, given that medical journals are likely receiving millions in industry advertising revenues, it would be very appropriate for their editors to disclose to their membership (and the public) the percent of journal budgets covered by such pharma fees..... and would be an ironic juxtaposition to the journal attacks on PDUFA funding of FDA as being an implied conflict of interest (though PDUFA funds are actually taxes, and FDA is not bound to take any favorable actions for industry, merely to meet timelines for action - positive or negative...... and at least industry gets the chance for due process and hearings under the User Fee Act). Further, if any believe that the only conflicts which exist in research are financial matters (and therefore have no relationship to the pursuit of power, influence and other less tangible but equally compelling forces - though much more covert that commercial concerns.. and with equal potential for benefit by those with conflicts), might I suggest that those individuals sip a bottle of Evian and contemplate that brand name in reverse.
Pharma has not cornered the market for conflicts. In the future, in matters of conflict of interest, all parties are best served if policies concentrate on content, rather than source of data..... that uniform standards are agreed for all constituencies (not an isolated sector), and that failures to adher to proper transparency and disclosures be dealt with severely, and consistently.
