Conflict of Interest and AJOB

As a matter of long-standing editorial practice, some of the most prominent peer-reviewed journals of natural science and healthcare have required authors to disclose, in print, the sources of funding of research submitted for publication. Most societies in the biomedical sciences have also endorsed disclosure. Yet just about everyone agrees that when it comes to addressing dangerous conflicts of interest, disclosure is neither happening, nor, when it happens, is disclosure changing the way in which conflicts of interest are managed by scientists. Sheldon Krimsky's 2001 study demonstrated that only 15.8% of 1,396 high impact journals had a conflict of interest policy in 1997, and among those 90% were medical journals. More interesting, he found that only 0.5% of the papers published in those journals in 1997 included a disclosure of conflict of interest, while 65.7% of the journals published no disclosures at all (Krimsky and Rothenberg 2001). Mildred Cho notes in Nature, the "financial ties of the editor will determine what gets published" at some journals (van Kolfschooten 2002). Peer reviewers, including editorial board members of the most important journals in the world, have conflicts of interest that may or may not have been disclosed to editors before or during the peer review of articles. Why should there be so many problems at the top journals of science and medicine? The answer is not in the journals but upstream: in the funding of bench and clinical biomedical research.

Money is powerful, all the more where its powers have not been thought through by those who receive it. Presented with wads of cash and promises of future support for their research, today's clinical and bench investigators are poorly situated to say "no," and even less equipped to say "yes" to corporations or foundations without compromising the integrity of the research. By all accounts few in the social or natural sciences, and almost no one in the humanities, has received any significant training in the ethical issues associated with accepting corporate or foundation dollars. Yet there is no question that some kinds of research funding have eroded the academic freedom of those investigators who receive it: control over the design and execution of research, and the manner, timing and even cancellation of its publication.

Corporations have borne the blunt of almost all of the attacks on the increase in "conflicted" research. Industry funding of research, and specifically funding by industry of research within universities, has dramatically increased over the past twenty years. But virtually all funding of research has become more targeted to the achievement of specific goals and even to the production of specific products. As purse strings have tightened in government, and as foundations have sought to play a more pivotal role in clinical innovation, the style of grant-making in government and foundations has become just as constricting as that of corporations. It is clear that the choice of research topics by investigators can be influenced by the lure of easy funding or the opportunity to work with an investigator or funder who controls it.

Conflicts of interest have affected bioethics too, as funding of institutions and individuals that study bioethics has shifted from the dean's office (the typical source of funding for bioethics centers in the 1980s) to external sources of dollars: government ethics funding, foundations, and gifts and contracts with companies. Attention to the strings that come attached to some of this funding has come in the form of a swift attack by critics of scholarly bioethics, bolstered by a wave of new scandals: In 2002, a bioethicist was named in a lawsuit that alleged that conflicts of interest led to the death of a gene therapy volunteer; the nation's most prestigious medical school, home of one of the largest bioethics centers, was shut down for several days over a clinical trial...