IOM Report: Disclosure “Critical But Limited” to Addressing Conflicts of Interest
Conflicts of interest in the realm of biomedical research are nothing new. In 1984, a study found that half of the surveyed biotech companies provided financial support for university research. But as Institute of Medicine President Harvey Fineberg said yesterday morning, this old problem “seems to be coming forth with increasing force and frequency.”
Fineberg was speaking at a presentation marking the release of a new report from the IOM on conflicts of interest in medical research, education, and practice. Among the many recommendations in the 353-page document is one that will make sense to advocates in the transparency community. The committee authors recommend that individuals at medical institutions should regularly disclose to those institutions financial relationships with drug and device makers and biotech companies—but significantly, the study says that national organizations should agree upon a standardized format for disclosure information so that it can be made accessible in appropriate databases. They go so far as to compare the necessary software with that available for formatting journal references and offer a list of potential fields to facilitate ready information sharing.
“Disclosure is a necessary first step, but it is a limited first step,” cautioned committee chair Bernard Lo of the University of California, San Francisco. And disclosure is a two-way street, as the authors call as well for Congressional action to mandate that pharmaceutical, medical device, and biotechnology companies and related foundations disclose not only their payments to physicians and researchers, but also professional societies, advocacy groups, and continuing medical education providers.
The committee does not claim that disclosure alone will remedy conflict of interest issues, but the presenters offer it as a way to establish a comprehensive system for managing them. “You can’t manage what you don’t know about,” said committee member Eric Campbell, of the Massachusetts General Hospital and Harvard Medical School.
Lo described an ecosystem built on disclosure in which organizations had the responsibility to help enforce rules that manage conflicts. He highlighted the need for institutional responsibility, not just individual responsibility. At the current moment, there are instances where current parameters go ignored, as in the field of research publications. “Many journals do not comply with the recommendations of their professional group,” he said.
Lo also underscored that fact that not all relationships between physicians and industry are problematic. Indeed, they have lead in many instances to productive collaboration. As Campbell pointed out, virtually all medical devices and drugs on the market today would not be available without such relationships.
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