Change in Washington and Elsewhere--Latest News

Several news items in the last 24 hours' worth of e-mail. Our friends at Integrity in Science Watch report on the reintroduction by Sens. Grassley and Kohl of their Physician Payment Sunshine Act in Congress, and mention in passing that several more academic medical centers appear to be moving in the direction of ordering fuller disclosure of faculty members' payments from the drug and device makers: Harvard joins Cleveland Clinic and Duke in pursuing more sunshine, as does a major health provider in Minnesota, Park Nicolett.

My recent mailing from the American Academy of Family Physicians urges me to write my congressman to support the Obama economic stimulus package, in part because it contains a number of health care investments friendly toward primary care-- one of which is said to be increasing the amount of research the Feds can conduct comparing drugs head to head to determine which is more effective.

Will It Never End? Wither the Nobel?

The e-mail lists have been abuzz with the latest allegations of pharmaceutically linked impropriety. I can't seem to get the full link to appear in this post for some reason (I am actually doing this from a hotel in Beijing--go figure) , but go to www.newsmax.com and search for "Nobel Prize bribery." The allegations are that AstraZeneca stands to gain a lot of sales for its human papillomavirus (HPV) vaccine as a result of the publicity of the discoverers of HPV winning the Nobel Prize, and so via a couple of intermediary PR organizations, it managed to exert financial influence over the prize committee. The Swedish authorities are investigating this as a possible criminal act, though according to the press account the Swedish media have been notably silent on the matter.

More on "Intellectual Conflict of Interest"

I previously posted on "Intellectual bias" as a red herring in the conflict-of-interest debate: http://brodyhooked.blogspot.com/2007/12/intellectual-bias-latest-salvo-from.html

Now, Peter Lurie of Public Citizen has put together a slide show (as his presentation before the new Institute of Medicine Committee on Conflict of Interest), which among other things nicely develops the notion of intellectual conflict of interest: http://www.citizen.org/publications/release.cfm?ID=7553&secID=1656&catID=126

What I say here is basically stolen from Slide 9 in Dr. Lurie's presentation. The discussion attached to that slide goes:

Frequently, one hears that there are both financial and intellectual conflicts of interest; somehow this argument is offered as evidence to downplay the importance of the financial conflicts. While intellectual conflicts are important, they can readily be distinguished from financial ones. Financial conflicts of interest are extrinsic to the scientific endeavor, whereas intellectual conflict is the very way science moves forward. Financial conflicts can occur at variable levels – some people have them, some people don’t – and they can be quantified, whereas intellectual conflicts are ubiquitous and not susceptible to quantification in the same way. Moreover, in the context of debate on an advisory committee, for example, it is unlikely that the financial conflict information will naturally emerge, whereas it is likely that any relevant intellectual one will. There are relatively straight-forward methods to alleviate financial conflicts, whereas it’s not nearly as clear how one should approach intellectual conflicts. Finally, our legal system has long recognized the distinctions between the two.

I believe that this is a wonderful, succinct explanation of why these two diffferent forms of conflict are quite different and should be handled as different in any public policy. It explains why intellectual conflict of interest is on the one hand much harder to eliminate (if it could be eliminated at all), and yet poses a much lesser threat to the integrity of science.