Correspondence

Industrial Collaboration

N Engl J Med 2003; 348:863-864February 27, 2003

Article

To the Editor:

I was disappointed to note that, in their discussion of the issues surrounding relationships between academia and the biomedical science and pharmaceutical industries, Moses et al. (Oct. 24 issue)1 neglected to comment on one of the most frequent commercial ties that faculty members have — namely, being paid spokespersons for drug companies. Even a cursory review of this or any issue of the Journal would reveal the number of authors who are spokespersons for companies with which they also have a commercial research relationship. It is all too common that one receives invitations to attend “seminars” given by prominent members of the academy, often with a high-priced meal and an “honorarium” thrown in, all sponsored by a drug company. This is an area of conflict of interest that has received the attention of journal editors who require that such relationships be revealed before an article is published, but it seems to have escaped the attention of deans, provosts, and institutional review boards. It is high time that the discussion of ties between industry and universities included consideration of this type of activity as well.

Philip M. Rosoff, M.D.
Duke University Medical Center, Durham, NC 27710
rosof001@mc.duke.edu

1 References

1
Moses H III, Braunwald E, Martin JB, Thier SO. Collaborating with industry -- choices for the academic medical center. N Engl J Med 2002;347:1371-1375
Full Text | Web of Science | Medline

Author/Editor Response

We agree with Dr. Rosoff that the common practice of faculty members' promoting products, both drugs and devices, is troublesome. It is an area in which additional ground rules need to be established. Our article emphasized research relationships between companies and medical schools that come at an earlier stage, with the goal of finding new biologic mechanisms, novel drug targets, or new materials. These activities are frequently called “translational” by researchers or “discovery-stage” by industry because they precede clinical trials. Our commentary was intended to guide decisions in those areas where conflicts are less well understood and less often openly discussed.

In our analysis, we asked, “Should faculty members be identified by companies?” and advocated that the roles of the faculty member and the company promoter be clearly separated. Playing both parts is troublesome, because it blurs the distinction between independence and partisanship. Yet it is precisely that blurring that is sought by companies, who view academic opinion leaders as highly desirable components of their marketing efforts. We believe that faculty members should make a choice between these activities, as unpopular as it may be to ask them to do so. Not everyone will agree.

Questions surrounding the promotional role of clinicians are not new. Beginning in the early 1960s, leaders at many medical schools sought to discourage faculty members' acceptance of speaking fees from industry. These attempts did not prevail, because many argued successfully that detached academic clinicians were best equipped to weigh the pros and cons of products and convey their recommendations to others. One often hears that argument today, and it has much merit. Were the 1960s a simpler time, when economic pressures were less intense, opportunities for conflict fewer, and audiences more skeptical?

Perhaps the academic medical community — ideally, in collaboration with the specialty societies — should address new rules of engagement. These might go beyond disclosure to include other means for maintaining independence. Clarity on these vexing issues will, in the long run, be in the best interests of both companies and medicine.

Hamilton Moses, III, M.D.
Boston Consulting Group, Bethesda, MD 21084

Eugene Braunwald, M.D.
Partners Healthcare System, Boston, MA 02199

Joseph B. Martin, M.D., Ph.D.
Harvard Medical School, Boston, MA 02115

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