Conflict of interest

&
health research
Aasim Ahmad

Introduction
Public trust in universities and research
institutions (and researchers) is
embedded in the notion of intellectual
integrity and independence.
To maintain public trust scientists and
researchers like judges should not only
be unbiased but also appear to be
unbiased.

Introduction (contd.)
Scientists often mum about ties to
industry (NY Times, April 25, 2001)
Standing up to industry: As
corporations increasingly hold their
purse strings, many researchers feel
pressed to deliver favorable results
(Baltimore Sun June 26, 2001)

Introduction (contd.)
Drug testing under ethics microscope
USA Today, August 7, 2001)
The charitable arm of the American
Academy of Pediatric Dentistry has
signed an agreement with the Coca-Cola
Foundation, and Coke will distribute the
academy's education messages, (NY
Times, March 4, 2003)

Scenarios
An assistant professor of medicine is starting
a research where he is recruiting participants
from the patients presenting to his clinic.
A researcher conducting a clinical trial is going
to receive a certain amount of money to be
used for academic purpose, including a
conference attendance abroad, from the
pharmaceutical company sponsoring the trial
A researcher based in a renowned university
receives a grant. 35% of the grant money has
to be given to the university from a total of 1
million dollars.

Definitions
Conflict of interest- a set of conditions
in which professional judgment
concerning a primary interest (welfare
of patient or validity of research) tends
to be unduly influenced by a secondary
interest (such as financial gain or
recognition).
It is a condition not a behavior.

Definitions (contd.)

Conflicting interests: This term is used

for overt conscious violations of
obligations, favor of self (secondary)
interest and willful disregard of
research (primary) interest.
Conflicts of interest: Disparity between
primary and secondary interest more
subtle and unknowingly affects
judgment.

Definitions (contd.)
Competing interests: conflicts with
primary interest but not necessarily
raise the issue of inappropriate
response to self-interest

Conflict of interest
Financial
Individual

Per capita payments, Finders fee, bonus payment

Gifts
Trips
Stocks
honorarium
Directorship/ownership

Institutional
Reliance on industry
Patents

Conflict of interest (contd.)

Non-financial

Publish or perish
Advancement in career
Prestige
Academic standing

Background
Shift in the source of funding from
government and private foundations to
industry.

US $60 billion spent by industry on research

10 pharma companies spent US $22.7 billion as
compared to US $17.8 billion spent by NIH

Shift away from academic centers to

non-academic research centers for
trails.

Contract research organization receive 60% of

industry money

Background

(contd.)

Shift in the free flow of information

Restricted communication with colleagues.

Shift to entrepreneurial ethos in

research institutions and universities.
Bayh-Dole Act in 1998 encouraged the
transfer of technology from universities to
the private sector
University generated patents increased
from 250/yr in 1980 to 5000 in 1998

Evidence
Poor study design
Marginalized recruited
Lack of adverse event reporting
Influences authors conclusion
More likely to show benefit/have
favorable results
Conduct lower quality research
Delay publication
Not publish at all

Thank you