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- Clinical research ethics
- conflict of interest
- drugs and drug industry
- interests of health personnel/institutions
- medical decision-making
- medical ethics
- scientific research
The policy changes governing the relations between the pharmaceutical, medical device and service industries (‘the commercial sector’) and academic clinical research physicians, recommended by the Institute of Medicine,1 the American Academy of Medical Colleges,2 and much discussed in the media and on our campuses, aim to create some protective ethical firewalls. However, some potentially critical consequences of these steps are missed if we do not acknowledge what else is on the table, and who is sitting at it.
By only reacting defensively to the juggernaut of righteous indignation over the loss of purity in a faculty physician's approach to medical problem solving, we are allowing the process to blind us to the difficulties in establishing fair and equitable management of all of the potential conflicts of commitment and conflicts of interest we incur, not only as faculty members, but also as departments and academic medical centres (AMC). Critically, this involves all sources of revenue—private, commercial and public—that support our professional and institutional commitments as well as our personal finances.i To counter the present crackdown on inappropriate financial relationships effectively, we will need to reframe the questions, and convince all stakeholders to the process that there is more to this crisis than can be resolved through our public confessions of commercial largesse obliged.
The Phrma Code guidelines3 have resulted in what is believed to be a defensible, if as yet legally untested, compartmentalisation of the commercial sector's marketing, medical education and research sponsorship activities. We at the AMC are a long way from understanding how those same missions, as they emanate from our multifarious commitments, can be isolated and individually managed. Defining the parameters for establishing institutional conflicts of interest and commitment are beyond our essay's scope, but with the very public emphasis on capitalist subversion of …
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
↵i There is more to being a physician than being the delivery end of the government–industrial medical complex. This argument for the consideration of what constitutes the requisite and unique sources and justification of the moral authority of physicians will be discussed in further contributions to this journal, and is the subject of an editorial by the author, from which some of the material for this commentary is redacted.12
↵ii I am indebted to Ezekiel Emanuel, MD, PhD, for his permission to modify his presentation on this subject for this publication.