Editorial

Revisiting the Commercial–Academic Interface

List of authors.
  • Jeffrey M. Drazen, M.D.

Article

In the mid-1940s, Selman Waksman, a soil microbiologist, and his team discovered streptomycin, an antibiotic with action against the tubercle bacillus.1 Although he was able to show efficacy in the laboratory, Waksman realized that if his discovery was to be of value to the world, he needed a partner capable of manufacturing adequate amounts of the material under conditions that would make it suitable for use in humans. He therefore struck a deal with Merck to produce streptomycin for clinical use.1 Soon thereafter, the British Medical Association undertook a large randomized, controlled trial of streptomycin for the treatment of tuberculosis. The results, including a description of the utility of streptomycin and resistance to it, were published in the British Medical Journal.2 This partnership between an academic researcher and a drug company went on to alleviate substantial human suffering and should be a model for current behavior. Unfortunately, it is not.

In 1950, Waksman, who was arguably the world’s leading authority on antibiotic treatment of tuberculosis and who 2 years later received the Nobel Prize in Physiology or Medicine, was the sole author of a review article on streptomycin and neomycin published in the British Medical Journal.3 That would most likely not happen today. Over the past two decades, largely because of a few widely publicized episodes of unacceptable behavior by the pharmaceutical and biotechnology industry, many medical journal editors (including me) have made it harder and harder for people who have received industry payments or items of financial value to write editorials or review articles.4 The concern has been that such people have been bought by the drug companies. Having received industry money, the argument goes, even an acknowledged world expert can no longer provide untainted advice.

But is this divide between academic researchers and industry in our best interest? I think not — and I am not alone. The National Center for Advancing Translational Sciences of the National Institutes of Health, the President’s Council of Advisors on Science and Technology, the World Economic Forum, the Gates Foundation, the Wellcome Trust, and the Food and Drug Administration are but a few of the institutions encouraging greater interaction between academics and industry, to provide tangible value for patients. A cogent example has been a vaccine against Ebola virus disease. All the candidate vaccines currently in trials have grown out of collaborations among academics, industry, funders, nongovernmental organizations, and patients. But Ebola is only the most recent crisis; we have yet to deal with the infectious threats of human immunodeficiency virus (HIV), malaria, and tuberculosis and the noninfectious threats of cancer, heart disease, chronic lung disease, obesity, and diabetes. Simply put, in no area of medicine are our diagnostics and therapeutics so good that we can call a halt to improvement, and true improvement can come only through collaboration.

How can the divide be bridged? And why do medical journal editors remain concerned about authors with pharma and biotech associations? The reasons are complex. This week we begin a series of three articles by Lisa Rosenbaum5 examining the current state of affairs. We hope that you will find the series engaging and provocative and that it will perhaps reshape the way you think about interactions between physician-scientists and industry. Beginning at 5:00 p.m. (ET) on May 20, we will invite you to put yourself in the role of a journal editor and to comment at NEJM.org on the suitability of three hypothetical potential authors of review articles. The questions will be challenging; we will report on the feedback from the community sometime in the summer. We look forward to the insight your comments may provide.

Funding and Disclosures

Disclosure forms provided by the author are available with the full text of this article at NEJM.org.

Supplementary Material

References (5)

  1. 1. Waksman S. My life with the microbes. New York: Simon and Schuster, 1954.

  2. 2. Medical Research Council. Streptomycin treatment of pulmonary tuberculosis. Br Med J 1948;2:769-782

  3. 3. Waksman SA. Streptomycin and neomycin: an antibiotic approach to tuberculosis. Br Med J 1950;2:595-600

  4. 4. Drazen JM, Curfman GD. Financial associations of authors. N Engl J Med 2002;346:1901-1902

  5. 5. Rosenbaum L. Reconnecting the dots — reinterpreting industry–physician relations. N Engl J Med 2015;372:1860-1864

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