NIH Conflict of Interest Proposal Dodges Pharma's Control of Research
The National Institutes of Health (NIH) has made a gesture to address "perceived" conflicts of interest among researchers who have NIH grants. Under a proposed NIH rule, researchers who get payments from pharmaceutical companies would have to report them publicly if they receive more than $5,000, as opposed to $10,000 under the current rules. But the NIH proposal fails to acknowledge the elephant in the room: the dominance of commercial funding in clinical research.
As John Abramson points out in his superb book Overdosed America, drug and biotech companies now fund more than 80 percent of clinical trials. With only a third of studies still being done in academic medical centers and universities, institutions are under heavy pressure to accept the drug companies' requirements for clinical studies. Those terms, according to a 2001 joint statement by leading medical journals, threaten the objectivity of research. Medical scientists working on corporate-sponsored research, the journals warned, "may have little or no input into trial design, no access to the raw data, and limited participation in data interpretation."
Of course, that isn't true of NIH-sponsored trials. The basic research funded by NIH appears to be fairly free of taint. But the industry-sponsored clinical trials that flow from some of that research are a different story. Sponsored studies are about four times as likely as trials without commercial funding to favor the drug under study.
The NIH also proposed that academic institutions, rather than individual investigators, be held responsible for conflicts of interest. That means that the universities themselves would have to investigate potential conflicts and report them to the NIH. I'm sure the institutions will take that seriously, because they don't want to lose NIH funding, either. But what they report will still be the tip of the iceberg in terms of the money that influences drug research.
A year or so ago, there was an outcry about the government's plans to conduct comparative effectiveness studies. Of course, pharma and device companies were concerned that their products might be found lacking. But the drug firms were also undoubtedly afraid that control of the research enterprise would be taken away from them. It is this control, along with the marketing apparatus that influences doctors and consumers, that helps keep the drug companies in business. But their continued dominance of research is driving up healthcare costs and may not be good for our health, either.
Image supplied courtesy of Fillmore Photography at Flickr