There are many ways to drive medicine forward. One is to work to remove economic, political, or geographic barriers to accessing care, and thus aid those whose suffering can be assuaged but is not being so. Another is to work to develop treatments for types of suffering poorly eased (or addressed) by current care. Both are important. Serious pursuit of the second strategy, however, requires the participation of industry; to translate bench science into benefits for real people will usually require manufacture of new medicines or devices, a function that universities and public institutions do not do but industry does well.
But for those students, like myself, currently training in MD-PhD programs in hopes of pursuing this goal of translational medicine, it is not at all clear what attitude we should take towards industry. On the one hand, the vision to move science from bench to bedside would seem best served by those clinician-scientists who do not see publication as the end result but are devoted to responsibly guiding their discoveries into the industrial setting and propelling them to patients. On the other hand, connections between industry and academia are often described categorically as “conflicts of interest” that must be disclosed and ideally divested. I will not attempt to comment here on the events that have led to a prima facie (pharma facie?) negative valence of academic-industrial connections; I was struck to hear, however, one of the panelists (an academic) on a recent panel discussion on translational medicine open with a slow and measured statement affirming her belief that collaborations between academics and industry can be a “good thing.” She then paused, as if to let the shock of the statement permeate the audience.
If a significant reason we put public funds into research (and, for some of us, our lives towards doing it) is the hope that that work will one day ameliorate human suffering, we should ensure that our concerns about conflicts of interest does not itself create an unnecessary conflict between young researchers’ interest in being taken seriously as scientists in academia and their interest in benefiting patients by translating that work into more than journal publications. Toward that end, I agree with others on this blog who call for more critical approach to thinking about conflicts of interests. We should certainly be concerned about preventing abuses of academic-industry partnerships for financial gain, but rather than risk throwing out the therapies with the thieves by endorsing an all/none approach to conflicts of interest, we should continue the hard work (much of which is being done by our colleagues at the Safra Center) of defining what interests matter in what contexts, which conflicts are acceptable if managed and which are not.
Lie down with dogs, wake up with Avandia?
A word from the community side – I think there is an overwhelming need for the relationship between the pharmaceutical/device industry (the medical/industrial complex) to be under continuous observation – much more so than it is now and with much greater transparency. That the pharmaceutical industry could cough up $10 billion in fines and penalties in fiscal 2010 and the entire NCATS annual budget is approximately 1/20th of this speaks volumes – particularly when you notice that the EAB’s for most, if not all of the CTSA’s have substantial representation from the corporate side and very little to none from either the community side or other disinterested parties.
To the extent that we wish to build community level confidence in research and create interest and personal value in clinical trial participation (cf. the NYT article today, 12/20/13, on the disparities in breast cancer outcomes particularly in the American South), allowing corporations that (putting it bluntly) in another context might be considered criminal enterprises in terms of their effects on public health (fragmenting hip replacements, unreported negative outcomes, etc.) to have an influential and unquestioned place at the table does little to increase public confidence in medical research.
Having Petrie-Flom as a partner on the current Harvard Catalyst CTSA is, I hope, an indication that there will be a stronger emphasis on the ethical implications of translational science and a closer watch on conflicts of interest at all levels of an enterprise that should bestow benefits on more than the corporate shareholder.