Reveal all to keep faith with the public

November 25, 2005

Even the appearance of conflicts of interest destroys society's trust in scientists, says Richard Horton

Pity scientists in today's turbulent environment of conflicts of interest. They are pushed and pulled in different directions by forces largely outside their control. One fears for their sanity - and certainly for their security.

On the one hand, they are pilloried (by the likes of medical journals) for getting too close to the corporate sponsors of their research. Scientists in academic settings, according to this view, have become simply the friendly forward guard of the pharmaceutical industry. On the other hand, they are urged by the Government and by research councils to collaborate in ever more creative ways with the private sector, not only to bolster their research portfolios but also to help their universities profit from their work.

Editors of medical journals have been slow to get wise to these dilemmas.

But after several high-profile disasters, we have begun to press scientists to say who has been in control of the research they front. We ask authors of research papers whether they have had full access to raw data. And we want them to tell readers what part the sponsors had to play in the work.

This way, we hope naive readers can decide whether the research they are seeing is truly independent or heavily spun.

But these demands fail to get to the root of the problem. For that, we need to know what research is being done and by whom. Incredibly, these basic facts are hidden. There is no requirement for studies on patients to be registered with any public authority. This lack of transparency could allow companies to manipulate who knows what about their drug - a licence for deceit. Later this month, experts will meet at the World Health Organisation to discuss ways of creating a public database of all clinical research. This is a prerequisite to protecting the public from biased evidence about the safety of new drugs.

The final part of this clean-up of medical research is some way off. To ensure completely independent science, we must require all research to be analysed by independent scientists - scientists without ties to the pharmaceutical sponsors of research.

In January, editors of some of the world's leading medical journals will meet to consider ways of doing so. Will they have the courage to act? If they do not, I think it is fair to say that scientists and the universities that employ them are going to suffer a stormy future. As institutions of independent inquiry, universities have a privileged place in society. They are highly trusted by the public and the Government alike. Anything that harms their independence will harm the credibility they enjoy with their most important constituencies.

And yet the unprecedented financial pressures facing our leading academic centres force them to metamorphose into businesses. Enterprise is now as important as education. Teaching has given way to "translation" - for which one can read the creation of spin-off companies to capitalise on a university's innovation and intellectual property.

This change in the ethos of academe is not all bad. An upsurge in public-private partnerships involving universities has breathed life into the previously moribund world of neglected diseases. The incentives for the private sector to invest in the diseases of poverty are non-existent.

Public-sector values, nurtured in the university, combined with private-sector entrepreneurship have produced a virtuous alliance.

But the management of commercial arrangements between university scientists and industry remains a cause for profound concern. A first and minimum step must be complete transparency. Financial links between scientists and companies must be fully disclosed.

Universities will have to go further, however. It seems reasonable, as the US National Institutes of Health have done, to put a limit on these monetary arrangements. At some point, financial conflicts of interest become so great - in fees, consultancies, patents and shares - that the notion of independent inquiry becomes a sham.

It is time for the university to draw a line and ask scientists to choose.

If scientists wish to earn substantial amounts from the private sector, that is where they should go. If they prefer to bask in the proud glory of their university's reputation for research and education, they may have to forgo some of the material benefits offered by industry.

As the rewards of science become ever greater, these choices are going to become more acute, not only for individual scientists but also for university deans. The stakes are high.

Richard Horton is editor of The Lancet .

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