Is 'Conflict of Interest' Hampering Cancer Research?

John L. Marshall, MD


March 09, 2015

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Taking on a Tough Issue

Good morning to you. I want to tackle—not tackle, but take on—a difficult subject. I don't have the answers for this, but I think we ought to start talking about it: the issue of conflicts of interest.

Some 15 years or so ago, we could partner with our corporate friends because we were all in it together. If we were going to cure cancer, we had to work together. Funding from companies and various sources, from academic and medical centers, all went together to try to solve this.

And then something happened. I think business got too big, money got too big, concerns were raised, people did stupid things, and all of a sudden we have this issue of conflicts of interest, where we have got to disclose everything we do. It has really gotten to be a witch hunt on the other end of the spectrum. If you have a relationship with some company, it is perceived as dirty, and somehow you no longer can have an independent thought. So it swung very far the other way.

On a personal level, I am on speakers bureaus, I consult, and I do clinical research. The list of companies that I work with is long, and I publish that list all the time. I have to disclose to patients if there is a clinical trial in which I have a conflict with the company [funding the trial]. I have to worry about different signatures. We disclose all of that so that [the information] is out there, but it is perceived as sort of dirty, on some level, and that is why we are disclosing it.

Splitting the Brain Trust Down the Middle

It happens on the pharmaceutical side as well. We are forming a global alliance with our pharmaceutical partners, molecular profiling companies, and other academic institutions. I invited some thought leaders from the pharmaceutical industry to join a board that would help oversee this alliance. I was really naive about this because they couldn't do it. They needed a lawyer to come with them, for goodness' sake, just to attend our meeting. They are afraid of their conflict with us academics. So they [pharmaceutical companies] have rules that are just as strict and maybe stricter. What we have done is separated the brain trust—the corporate brain trust and the academic brain trust—to where they can't work together in a more collaborative way, and I think that is wrong.

I was then thinking about the American Society of Clinical Oncology (ASCO). We just had GI ASCO out in San Francisco. I was on the program committee, and some names were put forward to do presentations. After review, one of the people selected was thought to have a conflict of interest and was removed [from the list of those] to speak at GI ASCO, even though the program committee thought this was the right person to speak to us all and teach us. The conflicts committee, said, "No, we don't want to hear from that perspective. It might be a tainted perspective." We are not really good at judging this. We don't have real, consistent measures. It's a sort of "we know it when we see it" kind of thing. It is very easy for a judgment to go one way or another.

Are Other "'Conflicts" Not Accounted For?

"Big" ASCO (the ASCO annual meeting) is coming up, and the plenary session is right across the hall from the biggest oncologic corporate display that was ever assembled. I always wonder about that conflict. If you try to read the Journal of Clinical Oncology, the print version, you have to plow through the ads that are there. Maybe ASCO needs to list how much money everybody paid to help support the meeting. Should the journals disclose how much money has gone to the operation of the journal? Maybe that is all on there somewhere and I just don't know.

I think the problem is that it has gone way too far. Sure, disclosure is a good idea, but we need to somehow get it back off the witch-hunt mentality so that the best brains, whether they work for a corporation or an academic institution, can share their information with us and we can work together without feeling like we somehow cheated or need to take a bath afterwards.

Once we get reestablished on that level, I believe we will make faster progress in the war against cancer. John Marshall for Medscape.


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