Facing Conflicts: The Battle between Medicine and Industry

Bradley F. Marple, MD, a member of the ENT Today editorial board, is Professor and Vice-Chair, and Matthew W. Ryan, MD, is Assistant Professor, in the Department of Otolaryngology at University of Texas Southwestern Medical Center in Dallas.

By the end of 2008, almost two dozen inquiries had been sent to several major academic institutions requesting financial information on individual physicians involved in federally funded studies. Through this process, Senators Herb Kohl (D-WI) and Charles Grassley (R-IA) intend to work with universities to compare honoraria received from the pharmaceutical and device industry with that reported by these federally funded investigators, while simultaneously sending a firm message regarding the current state of financial conflict of interest in the medical profession.(1)

Sens. Kohl and Grassley, in their ranking roles on the US Senate Special Committee on Aging and Committee on Finance, respectively, share responsibility for 80 million Americans covered by Medicare and Medicaid and the health services that apply to this population. From this perspective, they have launched a series of investigations intended to better understand influences on the cost and delivery of health care, and in so doing, have shed light on the potential that industry is inappropriately influencing medical professionals through monetary inducements.

The recent increase in scrutiny is a direct result of revelations over the past few years suggesting that, in some cases, the line between the role of a physician as a patient advocate and as an agent of industry has been blurred.

One such well-publicized example is that of Charles Nemeroff, MD, PhD. As Chair of the Department of Psychiatry at Emory University School of Medicine, he had become a prominent researcher and educator, and had developed a well-recognized expertise in the area of clinical depression. As the recipient of several large NIH grants and author of nearly 600 peer-reviewed articles, he possessed the credibility and experience that would make him an attractive consultant to the pharmaceutical industry. As such, he became active in several pharmaceutical advisory boards and frequently lectured at the request of the pharmaceutical industry. In a letter to the Emory administration dated July 15, 2004, Dr. Nemeroff claimed receiving no more than $10,000 a year in the form of honoraria from GlaxoSmithKline (GSK).(2) It later became apparent that he had failed to report more than $800,000 that he received from GSK over a period of several years as a part of an estimated $2.6 million he had received from drug companies between 2000 and 2006.(1) Following this revelation by the Senate Finance Committee, the NIH chose to freeze $9 million in funding for a clinical study of depression at Emory.