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Oh, the Conflict

In a series of three articles and a related editorial, the New England Journal of Medicine has been examining conflict-of-interest policies and argues that they go too far.

In introducing the series, NEJM editor-in-chief Jeffrey Drazen writes that in today's environment, Selman Waksman, a soil microbiologist who, along with his team, discovered streptomycin, would be unable to be the sole author of a review paper about streptomycin and neomycin, as he was in 1950. That's because, Drazen says, Waksman collaborated with Merck to produce streptomycin for the clinic.

In her series of articles, NEJM's Lisa Rosenbaum argues that there's been a sort of moral panic regarding conflict of interest, and little-to-no data that shows ties to industry negatively affect how physicians do their jobs.

NEJM itself was at the forefront of developing COI policies, putting its policy into place in 1984.

When such policies work, Rosenbaum says they do "protect us and our patients from fraudulent marketing and twisting of facts." But, she adds, "when the rules merely cloak an anti-industry bias in the false promise of scientific virtue, we undermine potentially productive research collaborations, dissemination of expertise, and public trust."

Three former NEJM editors argue in an essay at The BMJ that the assertion that COI policies and regulations are harmful is "fanciful and data-free." Robert Steinbrook, Jerome Kassirer, and Marcia Angell, now at Yale, Tufts, and Harvard, respectively, write that financial conflicts of interest aren't beneficial in medicine.

"Unmistakably, collaborations between academia and industry can speed medical progress and benefit patients," they note. "Such partnerships, however, can flourish with far less money in aggregate flowing from drug and device manufacturers to physicians and their institutions, and without the web of other lucrative ties between industry and physicians that lack a clear scientific or medical purpose."