When profit motive and the advancement of personal careers become too entangled with how Americans make decisions about their health, the least that can be done is to point out those conflicts of interest. Better yet, those involved in healthcare must look for ways to blunt these unhelpful influences.
Both the Food and Drug Administration and the National Institutes of Health, which play crucial roles in advising individuals and doctors on what is sound medical treatment, have been criticized for being unduly influenced by the medical industry.
Now scholarly medical journals, another trusted source, are under fire, too. Most prominently, the Journal of the American Medical Association (JAMA) has admitted that in several instances authors of articles failed to disclose inappropriate financial ties or other conflicts of interest, despite a long-standing JAMA policy requiring such disclosure. "[T]here simply is no way to guarantee that all financial relationships and arrangements of all authors are disclosed," said JAMA editor Catherine DeAngelis, in an explanatory editorial Monday. "It is not feasible to independently investigate the financial relationships of every author...." In other words, it's an honor system.
More egregiously, the journal Neuropsychopharmacology gave a controversial new treatment for depression a favorable review but didn't disclose that the article's authors had ties to the company making the new treatment. Those authors included the editor of the journal itself.
Disclosure of financial ties seems the very least journals should demand. Reformers such as Jerome Kassirer, a former editor of the New England Journal of Medicine, go further and would have journals ban authors with conflicts of interest. "The cure for public distrust is to employ people who have opted not to be compromised by money," he wrote recently in The Boston Globe. If top-quality experts without close ties to industry can't be found to write and review articles, he says, "what does it say about the extent to which the medical profession has been co-opted by the pharmaceutical, biotechnology, and device industries?"
A few journals have begun to ban offenders from their pages. Dr. DeAngelis urges medical schools to be the enforcers. A San Jose Mercury News investigation last month into researchers at the school of medicine at Stanford University found that of the more than 700 faculty members, 299 had potential conflicts of interest related to their research. They included at least 26 of 67 administrators, department heads, and other leaders – the supposed role models for students and young faculty members.
Calls for ethics in healthcare aren't new. The founder of this newspaper, Mary Baker Eddy, undertook a lifelong quest to help individuals find health and wholeness. She expressed great respect for medical practitioners whose only desire was to benefit their patients. More than a century ago, she wrote: "Physicians, whom the sick employ in their helplessness, should be models of virtue."
That standard hasn't changed. Most researchers, and the journals that report their work, are trying to live up to it. But they must now ask themselves if they are really doing everything possible to promote honest research.