Barry Blackwell’s reply to Donald F. Klein’s comment on his comment on Thomas A. Ban’s essay on “Conflict of interest in neuropsychopharmacology”

I agree with Don Klein’s point concerning Pharma’s current stranglehold on data and the consequent absence of independent peer review to which he and Ira Glick have drawn attention.

This is certainly the contemporary focus of concern but both Tom Ban and my comments were embedded in a more historical and fundamental analysis of conflict of interest. My own focus which, while it may appear “rather abstract”, goes to the roots of a problem that involves far more than industry and its latest maneuvers.

It includes trial study clinicians who relinquish their data for analysis and publication in return for money without critical oversight; academics who provide paid for endorsements of industry claims; professional and advocacy organizations that accept funding for meetings or organizational support in return for access to the public  and spurious legitimacy; practicing physicians of all stripes who accept lavish dinners, golf outings and office paraphernalia in return for prescribing a company’s products; journal editors who publish flawed articles and print dubious advertising claims; Presidents and Department Chairs of prestigious universities who accept million dollar grants to support faculty stipends and research with the naiveté of a Robin Hood robbing the rich to help the poor; the FDA and Congress for turning a blind  eye to flawed products and over the top television advertising to the public which drown out bad news with distracting visual images. In its broadest sense conflict of interest is about how greed and money suborn scientific integrity.

Contemporary opinions about “conflict of interest” continue to debate its meaning  and implications as recently as the current issue of JAMA, “Potential Conflicts of Interest for Academic Medical Center Leaders” (JAMA. 2014; 312(5): 558. My sentiments echo those of Arnold Relman, long time former editor of the New England Journal of Medicine, expressed in his final letter to JAMA, submitted a few short sad weeks before his death. “Academic medical centers and pharmaceutical companies are quite different social functions. The companies are obligated to maximize profit for its owners and shareholders.  In contrast, AMC’s have a moral commitment to serve the public interest before their own. No individual can simultaneously serve as a leader in both these institutions without compromising obligations to one or both.”

While these caveats are directed to leaders at the apex of the most involved and prestigious organizations, my own concerns, expressed above, cover a wider range.

Barry Blackwell

September 11, 2014