y patient scanned the prescription I had handed
her, then idly glanced at the elegant ballpoint pen I had used to
sign it. The same drug brand name appeared on both.
She said nothing, but I knew just what she was thinking.
I had the same thoughts a few months before, listening to a
researcher at a medical conference present the results of a new
treatment combination for hepatitis C. The data were unambiguous:
The drugs were mediocre at best. Still, the researcher methodically
minimized the drugs' problems and urged us all to begin prescribing
"I wonder whose pocket he's in," I muttered to myself.
Earlier this month, consumer groups raised exactly the same issue
when they questioned a federal panel's recommendation that Americans
at risk for heart disease sharply lower their cholesterol levels.
Most of the panel members had financial ties to pharmaceutical
companies that make statins, powerful cholesterol-lowering drugs
whose use will soar with the new guidelines. Were the panelist's
recommendations truly impartial, or was their integrity suspect? The
consumer groups also criticized the press, including this newspaper,
for not explicitly addressing the financial links. However,
resolving these apparent conflicts of interest is far from easy. It
is becoming one of the biggest medical challenges of the 21st
century. Sometimes drug company ties taint a doctor's or
researcher's judgment. Often though, they do not. How is it all to
be sorted out?
What Sinclair Lewis admiringly described 80 years ago as "the
cold, clear light" of medical science - a single-minded impartial
commitment to truth and human welfare transcending all external
influence - is becoming hard to find. Instead, we often see only a
refracted spectrum of partisan interests that can be impossible to
reassemble into truth.
Is the nice pen I accept from a drug company an implicit promise
that I will prescribe the drug whose name is etched on its barrel,
or is it just a pen? Does the grant money a researcher receives from
a pharmaceutical company indicate that the research will be subtly
prejudiced, or is it just money? And even when financial issues are
not involved, what about all the other less tangible factors that
may sway scientific judgments, from the philosophical convictions of
interest groups to individual researchers' determination to enhance
their own reputations?
These questions have escalated in our time, experts say, because
our society increasingly forces us to trust the expertise of
professionals who are strangers to us.
"We are now much more dependent on the judgment of others, much
less able to evaluate their judgment decision by decision, and
indeed generally know much less about those individuals than we
would have even 50 years ago," wrote the philosopher Michael Davis
in a 2001 book, "Conflict of Interest in the Professions."
In medicine, the problem has been compounded by the increasing
public distrust of the pharmaceutical companies, as controversy
about drug pricing mounts. Meanwhile, the fraction of biomedical
research sponsored by the pharmaceutical and other for-profit
industries has soared, rising to 62 percent in 2000 from 32 percent
in 1980, as government research support declines.
As medical research and business jostle ever closer, medical
journals are devoting quantities of editorial commentary to the
question of whether financial ties create partisan research and, if
so, what to do about it.
The problem appears real. One study, published in 1998, examined
dozens of articles about calcium-channel blockers, a controversial
family of blood pressure medications that some doctors feel are
dangerous for certain patients. Authors who championed the drugs'
safety proved far more likely to have financial relationships with
the manufacturers than did the critics. A similar study linked
authorship of articles discounting the dangers of passive smoking
with financial ties to the tobacco industry.