Conflict of Interest in the Funding of Contemporary Science by nuhman10

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									Conflict of interest and the funding of biomedical research at
universities


Kent Dunlap, Department of Biology, Trinity College


      At a recent Fourth of July picnic, my two-year-old son abruptly started
complaining about a stomachache, and soon he was wailing in pain and clutching his
stomach. We rushed home, consulted two doctors, and gave him a small dose of
Tylenol®. About ten minutes later he stopped crying, and, in another ten minutes, he
was running around giggling. I was amazed and, indeed, grateful that the technology in
those few milliliters of drug could apparently eliminate such intense pain. But even
before the amazement and the gratitude, I had trust. In giving this drug to my child, I
implicitly trusted the judgment of two physicians who, in turn, trusted the judgment of
the corporate and academic scientists that developed the drug and the regulators that
deemed it safe.
      Biomedical research at corporate and academic labs has led to a remarkable set of
products and therapies, some of which have dramatically benefited our society.
Collaborations between researchers at pharmaceutical companies and universities, for
example, have produced drugs that have significantly eased the pain, prevented disease
and extended the lives of millions of people. Any discussion of our biomedical research
complex should not diminish the humane consequences of these technological
innovations. The phase of biomedical research I want to focus on is not the utility of the
end products, but the public trust in the process of biomedical innovation that precedes
its application. When the public consumes a biomedical technology, we implicitly trust
that many people in the development and approval of the technology -- most of whom
are scientists -- have made careful, independent judgements about its efficacy and
safety. I focus on this phase of technology application because I think certain changes
in the way scientific research is funded threatens the public trust in the independent
judgement of scientists. Over the last decades, biomedical research at universities is
increasingly funded by corporations. This increased reliance on corporate funds raises

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the basic question, How are scientists' judgements influenced by the interests of
corporations that fund them?
       In this paper I will first discuss the general ethical problems of conflict of interest
in science. Then I will discuss scale of corporate funding of academic research and some
of the motivations that have brought corporations and universities to seek closer ties
over the last decade. I will provide evidence that corporate money in fact influence the
direction and content of academic research. Finally I will suggest how many
organizations -- universities, corporations, the federal government, scientific journals
and the popular media -- need to explicitly confront the problem of conflict of interest if
academic research is to maintain its critical independence and keep the public trust. I
will focus on biomedical research, which is both my area of specialty and the field that
has received such a precipitous rise in corporate funding. However, similar conflicts can
be found in other sciences that have technological or policy applications.


What are the general ethical problems?
       Imagine loosing a sporting event over a controversial call by the referee and later
discovering that the referee was also an assistant coach for the opposing team. Imagine
being accused of a serious crime and learning that the presiding judge was a close
relative of the prosecuting attorney. These cases of decisions made by arbiters that
could benefit from the outcome of the decision are examples of the general ethical
problem termed conflict of interest. Many organizations in our society see that such
conflicts of interest undermine their mission and credibility, and they establish
structures (laws, codes of ethics, ethical review boards) for prohibiting or managing
such conflicts of interest. For example, government regulators cannot serve on the
boards of corporations and agencies they are commissioned to oversee, corporate
executives cannot own a lot of stock in a competing company, and politicians must
disclose their sources of income and campaign contributions. Importantly, we generally
object to the mere presence of conflict of interest, and not only the apparently unfair
decisions that may follow. That is, most of us would criticize the assistant coach for




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even accepting the position of referee and not just for making the controversial call. We
simply do not trust someone whose judgements might not be independent.


Conflict of interest in science
       Even in the best circumstances, maintaining independence as a scientist is
difficult. We all have our pet hypotheses, and we derive internal satisfaction and
sometimes external reward when our hypotheses concord with experimental results.
Scientists since at least the time of Galen (120AD) have recognized that one protection
against bias is full disclosure of one's methods and results so that the public and other
scientists can review, and ostensibly repeat the study if there is any doubt about the
researcher's bias. While serving as physician to the emperor Marcus Aurelius, Galen
promoted establishing a plaza where healers of all persuasion were required to post the
bases of their claims (2). In contemporary times, we have international scientific
journals that collectively publish about a half a million studies per year.
       The problem of maintaining independence is complicated by the fact that often
scientists need a lot of money to conduct their research. Unlike scientists of the 18th and
19th centuries, who were mostly wealthy aristocrats and their sons, scientists today have
expenses that far exceed their own ability to acquire wealth. Most academic scientists
rely, at least in part, on government funds. (Government funding has its own potential
conflicts of interest. For example, would a researcher who receives funding from the
Department of Agriculture to study the safety of pesticides be free to criticize the
agency's policies on pesticide use?) Increasingly, researchers and their universities have
received substantial funds from corporations, mostly pharmaceutical and biotechnology
companies, to fund their work (1, 3 - 7). But ties between industry and academic
researchers extend beyond direct funding of research. Some scientists whose work has
direct policy or technology applications can supplement their personal income by
serving as paid consultants to corporations. Some researchers and universities also hold
considerable amounts of stock in corporations whose profitability depends in part on
the results of clinical trials they conduct for the company (5, 7).




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What is at stake: public trust in scientists and universities
       Although the government still funds the majority of academic research,
corporations fund an increasing fraction of both basic and applied research at
universities. In theory, the funds come without any specific expectations for the
experimental results or their interpretation. In theory, a researcher who receives money
from a company, for example, will feel completely free to express his or her honest
opinion about the company's products and policies. In theory. In fact, corporations can
directly and indirectly influence academic research to serve their particular agenda,
interests that are sometimes contrary to the public interest. When receiving corporate
funds, some researchers sign contracts that limit their roles in determining how a study
is conducted and interpreted and when, if ever, it is published. In the worst and most
blatant cases, the health of people in clinical trials has been seriously damaged (4, 8).
Probably more commonly, the quality and reliability of academic research is
compromised and considerable time, money and human effort is wasted. Marcia Angel,
former editor of the New England Journal of Medicine, believes that the influence of
corporate money has so distorted the medical literature that we are at risk of entering
the "misinformation age" on medical research (6, 9). Ultimately, the most pernicious
outcome would be that the integrity of academic science and universities becomes
distrusted. Simply look at funding of political campaigns to see how poorly managed
conflicts of interest can lead to widespread distrust of people who allegedly work in the
public interest.


History and scale of corporate funding of biomedical research at universities
       The scale of biomedical research exploded after World War II. In the 1950's and
60's, research grants from the National Institutes of Health increased at an average
annual rate of 17.6%. However, from 1970-2000, the rate of increase averaged only 4.1%
(1). While federal funding began to slow, funding from corporations increased
dramatically, particularly in the 1990's. For example, at Johns Hopkins University,
corporate money for research quadrupled in the 1990's (5); at Duke Medical Center,
corporate sponsored research increased by 70% from 1997-1999 (1).


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       In addition to funding individual university research labs, corporations
increasingly have made contracts with entire university departments, often with the
proviso that they have first right to license patents that emerge from the department's
research. In 1998, Novartis, a Swiss drug and biotech company, gave the Department of
Plant and Microbial Science at University of California at Berkeley $25 million dollars,
an amount comprising a third of the whole research budget of that department (7).
Moreover, 2 out of 5 of the people who directly decide how the money is spent are
Novartis representatives (7). Similarly, Novartis paid 24 million dollars to the
University of Maryland Department of Psychiatry for exclusive access to its collection of
700 human brains. Again, this donation amounted to one third of the department's
budget, and 4 of the 8 people who decide how the money is spent are Novartis officials
(5). In total, corporations contribute over 2 billion dollars annually for academic
research and have paid American universities 641million dollars for licenses to their
patents (5, 7).
       At most universities, the government still provides the great majority of the
funds of biomedical research, and corporations contribute about 10% of the total
research budget. Nevertheless, the growing links between academic researchers and
corporations increasingly influence how science is conducted on American campuses,
and as I discuss below, the fraction of biomedical research that has the stamp of
corporate money.


Corporate interests in academic ties
       Why have corporations made such large contributions to university-based
research when most of them have large research teams and research facilities of their
own? Part of their motivation is no doubt the same as any corporate donor to a
university: the belief that society in general and their corporation in particular benefit in
the long-term from having well-trained scientists pursuing their best ideas. In some
cases, corporate money is donated with no obligation by the researcher or university.
But corporations also seek ties with more direct benefits (10). At the most basic level,
biomedical corporations make academic connections because often universities have


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access to two critical ingredients for many clinical trials: sick people associated with
university hospitals and healthy people to serve as control subjects. In addition,
universities have a wide variety of scientific expertise and facilities. Often it makes
more sense to contract out certain problems to university labs than to hire specialists to
work in the corporate labs. Moreover, work at university labs typically costs half what it
does in corporate labs, in part because a large portion of academic research is conducted
by graduate students and post-docs earning 15-30,000$ per year (6). Connections to the
university also gives corporations access to researchers who can serve as their
consultants or who may sit on important committees (e.g., at the Food and Drug
Administration) that make regulatory and policy decisions on the companies' products.
Tantamount to these practical considerations are the benefits of public perception.
Corporations and their products gain prestige by associating with universities (9), who
are, in general, trusted more than industry. Consumers, physicians and even FDA panel
members will no doubt tend to have more trust in products or procedures that have
been favorably reviewed by faculty at Harvard Medical School than those that are
promoted by corporate scientists.


Academic interests in corporate ties
       Given the potential problems with conflict of interest, why have research faculty
and their universities been so willing to encourage corporate-university financial ties?
Researchers simply need money to do their work; and in some cases their costs are very
high. Some molecular biology labs, for example, spend more than $10,000/month on
supplies (6), and many university labs have large groups of graduate students,
technicians, post-docs and research fellows whose salaries depend on a continual
stream of external money. Typically, biomedical researchers at universities apply to
governmental agencies (e.g. National Institutes of Health, National Science
Foundation). However, only about 10-20% of the grant applications to these federal
agencies are successful. In addition to these practical realities, university researchers
increasingly face an academic climate in which the absolute dollar amount procured
through external funding has become in itself a primary criterion for success (e.g.,


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tenure and promotion). Given, the rising costs of certain kinds of research, the increased
priority placed on external funding, and the low rates of funding from federal agencies,
university researchers are increasingly relying on private sources of funding.
       Increased corporate connections have also brought faculty more opportunities as
consultants that commonly pay as much as 1000$/day (1, 4, 7). In one particularly
notable case, the Chief of Psychiatry at Brown University recently received more than
$500,000 in consultant fees, a lot of it from the companies that make the antidepressants
he praised in journal articles (6). In general, an entrepreneurial spirit is growing among
medical faculty, with an increasing portion founding companies, serving on their
boards of directors or owning considerable quantities of stock in companies that make
products related to their research (6, 7).
       University administrators also have large incentives for strengthening the
connection to industry. For most grants to individual researchers, including those from
government, the university takes a portion of the money for indirect costs, expenses
such as staff, infrastructure and power. This fraction is usually between one third to one
half of the whole grant. University officials also pursue closer ties with industry because
of a new kind of financial arrangement that became legal only recently. The 1980 Dole-
Bayh Act allowed academic institutions to patent and license new products developed
by their faculty and to share royalties with the researchers (7). The payoffs can be huge.
Stanford University and University of California at San Francisco split 270million from
one genetics invention; Michigan State University earned more than 160 million from
royalties on two anti-cancer drugs (4). Most major research universities have whole
offices dedicated to encouraging and streamlining such technology transfer (7). Finally,
some universities are heavily invested in biomedical corporations. For example, Boston
University invested 85 million dollars -- a fifth of its endowment -- into one biotech
company, Seragen, and, at one point, BU owned 91% of the company's stock (5)


How does corporate money influence science?
       It is difficult to generalize about how corporate money influences academic
science because most corporate financial links to university research are defined by


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contracts that vary substantially in details. In some cases, money is donated with
relatively few strings attached, but in other cases, contracts place specific limitations on
university researchers. In some clinical trials, for example, university researchers mostly
organize the subjects and implement the procedures while the corporations have strict
control over the design of the study, the analysis of the results and the decision of
whether and when to publish the study (10). Contracts often specify that a committee of
corporate scientists can review and edit manuscripts before they are published.
Corporations often retain the right to delay publications so that patents can be filed on
any products that could emerge from the study. Sometimes, corporations hire
ghostwriters to write the manuscript and the university researcher does little more than
sign his or her name to the paper. In certain cases, the academic "author" is not even
permitted to see all the data generated by the study (9 - 11).
       Beyond these contractual arrangements, which are diverse but explicit, some
researchers feel unwritten, implied pressures in their financial ties to corporations.
Allen Arief, a diabetes researcher at University of California at San Francisco, explains,
"The drug companies, really, they make it very clear what the results had better be if
you want an more money from them" (1). In the most extreme manifestations, problems
with conflict of interest look like criminal bribery. The researcher changes the data to fit
the interests of the corporation and the corporation continues to supply the researcher
with grant money. Corporations have cut the funding, blocked publication and even
sued universities when corporate sponsored university researchers express doubt about
their product they tested. This extreme collusion or coercion has been reported in
dozens of high profile cases (1, 3 - 6, 8), but I suspect it is relatively rare. More
commonly, the influence is more subtle and indirect. It can shape the "spin" of research
results (9). For example, certain statistical analyses can be used to minimize the negative
and inflate the positive effects of a drug. Some papers may report only a fraction of the
tests that were performed on drug or therapy. Scientists and their corporate sponsors
can skirt outright scientific misconduct by reporting results that may be true but not
"the whole truth and nothing but the truth."




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       Finally, corporate money can broadly influence entire research agendas at
universities. With millions of corporate dollars available, researchers have strong
incentives to develop their research program in a product-oriented direction that is
fundable by corporations (7, 9). For example, consider a hypothetical researcher who
specializes in the effects of plant pathogens on crop productivity and who was recently
hired in the UC Berkley Department of Plant and Microbial Science. Which research
direction is most likely rewarded?
   a program that seeks to eliminate the crop pathogen by developing patentable
    chemical compounds, and is thereby fundable through the Department's abundant
    Novartis money, or
   a program that investigates crop rotation practices that inhibit the pathogen and
    which would require the researcher to write many grant applications to non-profit
    sources (government and foundations)?
Would the efficacy of the technology be the highest consideration when that researcher
establishes his or her research direction?
       To me, this bending of the academic research agenda is perhaps one of the more
dangerous and little recognized consequences of close academic-corporate ties. The
academy is one of the only places where people can pursue and share ideas for their
own sake. There are strong cultural arguments for preserving the university, of all
places, as primarily a sanctuary of the intellect. But beyond these lofty cultural ideals,
technological innovation also depends critically on intellectual breadth and freedom.
Numerous cases in the history of science and technology show the many of the greatest
technological innovations are based on science conducted outside a product-driven
agenda. As Nobel laureate Paul Berg points out, the entire biotech revolution that has
enabled pharmaceutical companies to develop many of their most effective and
profitable drugs rests on discoveries by academic scientists that had no notion of the
eventual market value of their discoveries (3).


How pervasive are financial conflicts of interest in academic biomedical research?




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       Several well publicized cases have demonstrated that conflicts of interest have
lowered the quality of clinical studies and, in cases, damaged the health of human
subjects in clinical trials (4, 8, 11). Perhaps these cases are isolated and rare events and
there is no reason for general alarm, but several prominent researchers and the authors
of several studies believe that the problem is quite broad. Journal editors anecdotally
report that they often have difficulty finding qualified, scientists to write reviews of a
drug who do not have financial interest in the drug's success (9). Similarly, it is even
difficult to find knowledgeable but disinterested scientists to serve on government
committees charged with regulating new products. At the Food and Drug
Administration, sometimes as many as half of the panelists have conflicts of interest in
the product they are evaluating… either working for the producer of the drug or the
producer's competitor (6, 8, 12).
       In addition to these anecdotal reports, systematic reviews of the primary
literature indicate that conflict of interest is widespread among biomedical researchers.
According to a recent review of 800 scientific articles, over one third of the authors had
significant financial interest in the findings of their report (7) About 20% of the articles
published in the Journal of the American Medical Association were delayed for proprietary
reasons (13). The extent of corporate funded biomedical research is particularly high for
certain products. One doctor found that 90% of the published information on a drug
came from research funded by the drug's manufacturer (1)


Do researchers with financial conflict of interest indeed show bias in their opinions?
       These studies indicate that conflict of interest is widespread, and a few
additional studies have presented strong evidence that corporate funds do in fact
influence the outcome of science (14 -19). In one broad study, 98% of articles based on
industry sponsored research report on the drug favorably while 79% of those without
industry ties gave favorable reviews (10,11). A more focused study of 70 reports on a
class of hypertension drugs (calcium-channel blockers) found that 96% of authors who
supported the use of these drugs had financial ties to the manufacturer of these drugs
while 37% of authors who wrote critical reviews were funded by these corporations


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(16). Such studies have caused one author to poignantly ask, "Might the public begin to
see academics less as stewards of truth than as hired hands?" (7).


How are conflicts of interest managed?
       The most common protection against financial conflict of interest is full
disclosure. For example, in 1996, the Public Health Service began mandating all
academic biomedical researchers to inform their institutions if they receive more that
$10,000 in payments from a corporation or hold at least 5% its stock (5, 6). Some journals
(about one third [20]) also require scientists who submit manuscripts to disclose their
financial ties. Such disclosures theoretically allow the public and scientific peers to
review the research in light of the potential bias associated with financial conflict of
interest.
       Disclosure is an important protection, but many current systems of disclosure
have considerable limitations. Although the Public Health Service requires researchers
to disclose their financial ties to their universities, universities are not required to make
this information available to the public. Thus, it is often difficult for an outside scientist
or organization to even determine whether a particular researcher has financial stake in
his or her research.
       Even when public disclosure is required, there are often no mechanisms for
assuring compliance, and recent studies of the medical literature indicate that financial
conflicts of interest are underreported. A recent review of over 60,000 articles in the
medical literature found that, despite the scale of corporate funding, less than 0.5% of
research articles disclosed financial conflicts of interest (21). In a more focused study of
researchers who published papers on hypertension drugs, 63% of the authors reported
in surveys that they had financial ties to the manufacturers of these drugs, but only 2.8
% of their journal articles contained conflict of interest disclosures (16).
       Given these problems, some universities and journals are beginning to limit
conflicts of interest as well as disclose them. About one fifth of the largest biomedical
research universities designate specific limits on faculty financial interest in corporate
sponsors of research, and about one eighth specify permissible limits in the delay of


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publications. Nevertheless, university conflict of interest policies vary substantially in
their limits and coverage. Mildred Cho, the author of a recent review of university
conflict of interest policies, believes that this variation among universities creates
confusion among corporations seeking academic connections and, worse yet,
competition among universities to weaken conflict of interest policies to attract more
corporate funding (22).
       Journal editors have also recognized the limits to disclosure and the dangers of
inconsistency in conflict of interest policies. In August 2001, twelve of the top
biomedical journals, including the New England Journal of Medicine, Journal of the
American Medical Association, and Lancet, constructed a joint policy of questioning
academic authors whether they had been guaranteed scientific independence by their
corporate sponsors. If not, they could exercise their right to refuse publication. Citing
the increasing corporate control over the publication of research results and the
common practice of corporate ghost writing for academic "authors", these journals
recognized that their own credibility was at stake (23).


What further reforms are needed?
       Universities ultimately have the responsibility of maintaining integrity and
freedom of academic research. Below I outline some recommendations that I believe
universities should enact to keep the public trust in academic, biomedical research.
   Universities should follow the example of the major biomedical journals by
    establishing broad and uniform policies for limiting and publicly disclosing conflicts
    of interest. At a minimum, they should prohibit faculty from signing contracts that
    limit their full control over the design, analysis, and writing of their studies.
   In addition to greater oversight of their faculty, universities can take the lead by
    restricting their own institutional conflicts of interest. For example, university
    administrators should prohibit their staff from testing products of corporations in
    which the university invests, or alternatively, avoid investing in companies that
    commonly have research relations with their faculty.




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   Universities should ensure that research programs that are not product directed are
    encouraged and well supported. They could diminish their heavy emphasis on
    external funding as a criterion for success, a pressure that may prompt some
    researchers to seek corporate funded research when they would not otherwise. They
    could establish separate pools of research funds that were available only to
    researchers who avoided financial conflicts of interest with corporations. Part of this
    separate fund could come from a fee, say 10% beyond indirect costs, charged to
    corporations who enter contracts with university research.


        Although making conflict of interest policies more stringent and uniform will
mostly be the primary responsibility of universities, I believe that changes in two other
sectors could help strengthen and maintain these reforms.
   Journalists in the popular media should more actively report conflict of interests in
    their articles on drugs and therapies. In a recent review of newspaper and TV stories
    on three drugs, over half the stories cited at least one scientist that had financial ties
    to the company that produced the drug. In these stories, the conflict of interest was
    reported in only 40% of the cases (24). (Part of the problem, however, is that
    journalists have difficulty even knowing where researchers receive funds.)
   Congressional representatives, state legislators and the public that votes for them
    should recognize that universities need increased public funding for research if
    universities are to maintain their critical independence.


Conclusion
       Corporations and universities can clearly benefit from each other, but ultimately,
they have -- and should have -- different aims. Their enterprises should never mingle
so closely that they compromise each other's ethical standards and the trust of those
they serve. I am not saying that all corporate funding of universities is intended to
deceive the public and boost profits. I am saying that the increasingly entwined
financial relationship between corporations and universities threatens the independence
of university research and could erode the credibility of university-based research.


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       At a recent scientific meeting, two university researchers argued about the best
treatment for a common bone disease, osteoporosis. One scientist claimed that the aim
of osteoporosis therapy should be to maintain bone density and that, according to his
research, the drug Fosamax® led to the greatest improvement in bone density. Another
scientist countered that reducing spinal fractures should be the most important
therapeutic goal and that the drug Miacalcin® best achieved this aim. On the surface,
this picture seems to exemplify the ideals of a free society: open debate among
professionals seeking the best treatment for the sake of public health. The picture takes
a different character when one looks behind the surface into the research budgets of
these two researchers. The first researcher received funding from the Merck
Corporation, the pharmaceutical company that makes Fosamax®, and the second
researcher had significant financial ties to Novartis, the maker of Miacalcin® (1).
       Did the financial interests of these researchers influence their stated scientific
opinions? It is difficult to know. What is more certain is that the financial connection
between the academic researchers and the corporations causes reasonable people to
doubt the independence of the researchers' judgments and the integrity of the whole
debate. In an era when technology increasingly surpasses the public's ability to judge its
safety and utility, preserving the public trust in the integrity of scientific research is
more important than ever.




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References
1. Kauffman, M., and A. Julien, "Medical Research; Can we trust it?" Hartford Courant, April 9. 2000, p.1A.


2. Siegel, R. Galen on sense perception. Karger Press, Basel, Switzerland, 1970.


3. Kauffman, M., and A. Julien, "Industry cash a potent habit," Hartford Courant, April 11. 2000, p.1A.


4. Birch, D. and Cohn, G., "How a cancer trial ended in betrayal," Baltimore Sun, June 24, 2001.


5. Birch, D. and Cohn, G., "The changing creed of Hopkins science," Baltimore Sun, June 25, 2001.


6. Birch, D. and Cohn, G., "Standing up to industry," Baltimore Sun, June 26, 2001.


7.Press, Eyal, & Washburn, Jennifer, “The kept university,” Atlantic Monthly, March 2000, p. 39


8. Kauffman, M., and A. Julien, "Scientists helped industry to push diet drug," Hartford Courant, April 10.
2000, p.1A.


9. Angell, M., “Is Academic Medicine for Sale?,” N. Engl. J. Med. 342: 1516 (2000)


10. Bodenheimer, T., “Uneasy Alliance,” N. Engl. J. Med. 342: 1539 (2000)


11. DeAngelis, C.D. Conflict of interest and the public trust. JAMA: 284: 2237 (2000)


12. Dennis, “FDA Advisers Tied to Industry,” USA Today, Sept. 25, 2000, A-1


13. Blumenthal, D., et al, “Withholding Research Results in Academic Life Science: Evidence from a
National Survey of Faculty,” J.A.M.A 277: 1224
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14. Campbell, E., Louis, K.S., & Blumenthal, D., “Looking a Gift Horse in the Mouth: Corporate Gifts
Supporting Life Sciences Research,” J.A.M.A. 279: 995 (1998)


15. Friedberg M, Saffran B, Stinson TJ, et al. Evaluation of conflict of interest in economic analyses of new
drugs used in oncology. JAMA. 1999;282:1453-1457.


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16. Stelfox HT, Chua G, O'Rourke K, Detsky AS. Conflict of interest in the debate over calcium-channel
antagonists.N Engl J Med. 338:101-106. 1998


17. Davidson R.A. Source of funding and outcome of clinical trials. J Gen Intern Med 1:155-8, 1986


18. Bero, L.A., Galbraith, A., Rennie, D. The publication of sponsored symposiums in medical journals N.
Engl. J. Med. 327: 1135 (1992)


19. Rochon, P. Gurwith J.H. Simms, R.W. et al, A study of manufacturer-supported trials of nonsteroidal
anti-inflammatory drugs in the treatment of arthritis Arch Internal Med 154: 157 (1994)


20. Wilkes, M.S., Kravitz, R.L. Policies, practices and attitudes of North American medical journal editors.
J Gen Intern Med 10:443-450 (1995)


21. Stolberg, S. G. "Scientists Often Mum About Ties to Industry" New York Times April 25, 2001


22. Cho, M.K. Shohara R. Schissel A. Rennie, D. Policies on faculty conflicts of interest at US universities
JAMA 284:2209-14 (2000)


23. Okie, S. "A Stand for Scientific Independence" Washington Post, Aug 5, 2001


24. Webster, K. "Study Criticizes Media Drug Coverage" Associated Press May 31, 2000.


Additional sources:


Chalmers, I., “Underreporting Research is Scientific Misconduct,” J.A.M.A 263: 1405 (1990)
Campbell, E., Louis, K.S., & Blumenthal, D., “Looking a Gift Horse in the Mouth: Corporate Gifts
Supporting Life Sciences Research,” J.A.M.A. 279: 995 (1998)

Korn D. Conflicts of interest in biomedical research.JAMA. 2000;284:2234-2237.
Kennedy, Donald, “Science and Secrecy,” Science, Aug 4, 2000. p. 724.
Rampton, S. and J. Stauber. Trust us, we're experts. Penguin Putnum Press, New York, 2001
Rothman, K.J., “Conflict of Interest: The New McCarthyism in Science,” J.A.M.A. 269:2782 (1993)


Center for Science in the Public Interest (CSPI), Integrity in Science,
http://www.cspinet.org/integrity/database.html



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