AIDS Treatment Research Disputed

      CHICAGO (AP) - A funny thing happened to Dr. Jerome Kassirer at a recent lecture to medical students about financial conflicts of interest for doctors: It turned out the free buffet was provided by a major drug company.

      Kassirer had a blunt message: Medical schools and training programs ``must teach that there is no free lunch. No free dinner. Or textbooks. Or even a ballpoint pen.''

      From freebies for medical students to research funding that can taint study results to the growing practice of marketing prescription medicine directly to consumers, drug companies have a growing and sometimes unseemly influence on doctors, according to articles, studies and editorials published Wednesday in the Journal of the American Medical Association.

      The relationship between research and industry appears to be under growing scrutiny. The editor of the New England Journal of Medicine wrote an extraordinary critique in May, saying science is being compromised by the growing influence of industry money.

      That same month, the Harvard Medical School said it would not ease its conflict of interest standards, considered the toughest in the nation, and Dean Joseph B. Martin called for a national dialogue on the issue.

      Most experts agree that research needs industry dollars. The top 10 pharmaceutical companies spent nearly $23 billion on clinical research last year - more than the nearly $18 billion provided by the National Institutes of Health, JAMA editor Dr. Catherine DeAngelis said.

      The problem is when researchers have financial interests in companies funding their work. DeAngelis said such research is lower in quality and more likely to report findings favorable to the company.

      One JAMA study outlines the dispute between Immune Response Corp. and researchers who say the company tried to squelch their findings suggesting that its vaccine-like AIDS treatment is ineffective.

      Another study found that 7.6 percent of the faculty researchers at the University of California at San Francisco had personal financial ties to their drug company sponsors last year. Most were short-term speaking engagements or consulting agreements with minimal payments.

      State and federal guidelines require researchers to disclose certain financial ties, and a UCSF policy prohibits faculty involved in industry-sponsored research from receiving any compensation from the company during the study.

      Elizabeth Boyd and Lisa Bero, with UCSF's Institute for Health Policy Studies, said a campus committee ``worked to accommodate all but the most overtly conflicting relationships in the interest of encouraging its faculty, and, presumably, encouraging future outside investment in the university.''

      The authors suggested that financial ties may be more prevalent at other universities with less stringent policies.

      A 1998-2000 study of 89 major universities found that only 17 - 19 percent - had specific limits or prohibitions on relationships with industry.

      While most had conflict of interest policies, they were not as effective because they don't spell what is prohibited, the authors said.

      Kassirer, a former New England Journal of Medicine editor, says many doctors begin to feel entitled to pharmaceutical manufacturers' largesse in medical school and suggested that school administrators address the problem by refusing drug company support of any events.

      Dr. Jordan Cohen, president of the Association of American Medical Colleges, announced last weekend that the group is forming a task force to investigate conflicts of interest and reach a consensus on what types of relationships with drug companies should be allowed.

      On the Net:

      JAMA: http://jama.ama-assn.org

      Harvard Medical School: http://www.hms.harvard.edu/integrity

      Stanford Center for Biomedical Ethics: http://www.stanford.edu/dept/scbe

     

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