Facing Conflicts: The Battle between Medicine and Industry

The question then arises: How does one manage bias, if it is not recognized? In an early retrospective study examining the impact of sponsored attendance at CME programs provided to residents on prescription writing, Orlowski and Wateska found that an increase in usage of two drugs manufactured by the sponsoring pharmaceutical companies corresponded to resident attendance, despite the fact that the residents could not recall the names of the companies.(12) More recently, the impact of industry support on research outcomes has been studied. In a study by Alasbali, et al.,(13) the outcomes of 39 studies of ocular hypotensive treatments were examined based upon funding from industry versus non-industry sources. The primary outcome of the study was correspondence between the reported statistical significance of each publication’s main outcome measure and the study conclusion. In the 29 industry-sponsored studies, 62% of the abstract conclusions failed to reflect the study outcome, as compared to zero discordance in the non-industry-funded studies (p = 0.0006). Among the industry-sponsored studies, 90% reported pro-industry abstract conclusions.

The Need for Physician-Industry Collaboration

As many of the cases above demonstrate, failure to disclose financial relationships has been the primary concern of the Senate Finance Committee, NIH, and academic medical centers, yet disclosure alone may not be enough to absolve physicians and researchers from the burden imposed by their financial ties. Many have argued vehemently that disclosure is not a panacea, that the medical profession must be reminded that the goals and fiduciary responsibility of physicians and the health care industry are not the same, and that the only way to definitively address these conflicts of interest is for the financial relationship between physicians and industry to disappear.(9) In other words, the fiduciary responsibility of for-profit companies is naturally to generate a profit for the shareholders, whereas a physician’s primary responsibility is to the patient, and that these realms cannot coexist.

However, it may be naïve to believe that these relationships can or should disappear. Between 1980 and 2000, industry funding for internal and academic medical research increased from approximately $1.5 billion to $22.4 billion, and has resulted in important medical treatments and innovative technologies. In fact, most major academic institutions, recognizing the advantages of these collaborations, encourage industry-funded research.(14) It is not hard to recognize the potential synergy that these relationships have created. In essence, industry relies heavily on advice from physicians to develop advances in pharmaceuticals and health-related technologies, and medicine relies on industry to bring treatment innovations to market. Like it or not, an uncomfortable, yet necessary, relationship must exist.