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Physicians fight back against disclosure rules

Pressure group calls for stronger links with industry.

Boston, Massachusetts

Even as US legislators work to limit ties between academic physicians and industry, a small group of doctors is calling for greater industry collaboration. On 23 July, they gathered at Brigham and Women's Hospital in Boston to launch a new organization opposed to strict conflict-of-interest rules.

Thomas Stossel: vocal critic of conflict-of-interest rules. Credit: S. G. HENRY

The Association of Clinical Researchers and Educators (ACRE) is the brainchild of Thomas Stossel, a haematologist at Harvard Medical School. Stossel has been a vocal critic of conflict-of-interest rules since the late 1980s, when he was on the board of the Cambridge-based biotech firm Biogen and Harvard adopted its first conflict-of-interest policy.

"Tom, for many years, was pretty much the lone voice," says Laurence Hirsch, an endocrinologist with the medical-technology firm BD in Franklin Lakes, New Jersey.

Now, however, Stossel has company. He and the five other physicians who lead ACRE argue that they are part of a "silent majority" who think the move to curtail physician–industry relations has gone too far. In Massachusetts, a law came into effect on 1 July that requires drug and medical-device manufacturers to inform the state health department about payments of $50 or more made to physicians for marketing activities; gifts are banned. Vermont has adopted a tougher law, and Congress is considering legislation that would set up a national reporting requirement.

ACRE does not yet oppose specific laws, it says, but rather the climate of distrust it claims tough conflict-of-interest rules create. The notion that a physician is automatically tainted by financial interest in a company is "obnoxious", says Michael Weber, a cardiologist at the State University of New York Downstate Medical Center in Brooklyn, and a member of ACRE's steering committee. "Just because something is good for industry doesn't mean it has to be bad for everyone else."

“The notion that a physician is automatically tainted by financial interest in a company is obnoxious. ”

Still, last year, a congressional investigation revealed that three Harvard psychiatrists had reported to their university only a fraction of the million or more dollars each received from drug companies. And psychiatrist Charles Nemeroff of Emory University in Atlanta, Georgia, stepped down after the same probe uncovered that he failed to report at least $1.2 million he earned from drug companies. "I do not believe that a physician that takes more than a million dollars in money from industry can possibly be objective," says cardiologist Steven Nissen of the Cleveland Clinic in Ohio, a strong supporter of curbing industry–physician ties.

Not all instances are so clear-cut, argued some at the ACRE meeting. After Hurricane Ike destroyed the cafeteria and much of the first floor of a University of Texas Medical Branch hospital in Galveston, Avi Markowitz, chief of oncology and haematology, agreed to allow the pharmaceutical industry to provide food for the staff. When hospital officials found out, Markowitz says, they told him to stop, as it contravened university policy. "They had no problem at all letting the students, the trainees and the staff go hungry," he says.

At the meeting, similar frustration was palpable. One attendee complained that he couldn't buy a $12 hamburger for a consultant who had agreed to speak for free. "They're giving us a pro bono service and we're going to ask them to pay for their own lunch?" he lamented.

Stossel and other ACRE leaders argue that stringent policies call into question physicians' integrity. The gift ban, for instance, suggests that physicians "have a corruption problem", he says.

Nissen acknowledges that academics and industry need to work together, but he says firewalls are needed between the two. "When money becomes involved, it no longer becomes a scientific collaboration but a commercial one," he says. "So transparency is an absolute minimum."

Markowitz points out that restrictive rules won't stop misconduct. He says the new conflict-of-interest rules are like "cutting off everyone's hands to prevent stealing". Rather than focusing on "up-front prohibition", Stossel says, institutions should "emphasize vigilance and punishment".

ACRE's membership is small, with only about 100 people. And the group has not yet decided whether to allow industry employees as members.

For now, at least, funding comes from its $200 annual membership fee. Accordingly, the kick-off gathering was far from opulent. At lunchtime, participants gathered at folding tables to eat ham sandwiches and potato crisps.

Weber says the next step is to come up with a proactive code of conduct outlining ethical interactions. "If we can't say what would be appropriate," he says, "then we don't have a position at all."

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Willyard, C. Physicians fight back against disclosure rules. Nature 460, 557 (2009). https://doi.org/10.1038/460556b

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