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August
2003
You Get What They
Pay For
When
a health researcher submits a paper to a prestigious, peer-reviewed
scientific journal, she
may be asked to declare her “conflicts of interest” in
the final publication.
Scientists generally report at least a few federal grants when
asked about their funding, but an increasing number also reel off
a list of sponsors that looks like the NASDAQ ticker.
These public-private
collaborations have been fruitful partnerships in many cases,
but prominent implosions of trust — from hazy
tobacco research, the mass prescription of hormone replacement
therapy and the disastrous overuse of Fen-phen — have raised
fears that formerly independent clinical researchers have become
well-compensated cheerleaders for industry. Participants at a recent
Washington conference on “conflicted science” repeatedly
sounded this alarm, with many concluding that the only solution
is complete separation of public and private funding.
But if a clinical
researcher — the one trying to bring laboratory
discoveries to a patient’s bedside — wants to shed
the golden handcuffs of corporate money, who would pay for that
freedom? Applied clinical research, along with systematic research
reviews and studies of health outcomes, are funded at the barest
minimum at the federal level. Because this investment is so low,
the corporate world is likelier than ever to pay for trials that
might actually improve people’s health. And the rest of us
have to pay the price for that.
Clinical studies
are exactly what corporations are interested: They represent
the
final leg in the research relay and have implications
for a new treatment’s success or failure and the company’s
potential bottom line. So their money — and its complications — neatly
fill the void left by public funding.
Although the case of tobacco company corruption of research is
an extreme one, it is also a powerful one. University of California,
San Francisco researcher Lisa Bero has found that studies of the
health effects of secondhand smoke are 90 times more likely to
conclude that secondhand smoke does not pose a serious risk if
the studies are funded by a tobacco company.
Cynics will
be forgiven for their lack of surprise, but the astonishingly
high number
testifies to the myriad ways that clinical research
can be manipulated. Interested parties can handpick study populations,
design less rigorous studies, fund only “sure things” and
repress findings that conflict with a desired conclusion. Publicly
funded scientists can use the same tricks, of course, but they
risk their reputations for less reward if shoddy work slips through
a rigorous process of peer review, which does not even exist in
all corporate-sponsored research.
Certainly,
individuals and institutions should abide by ethical and professional
standards,
no matter where their money comes from.
But if we’re serious about scientific objectivity, we ought
to reshape the nation’s research portfolio as we would our
own financial portfolio: accept some risk from corporations, but
balance that with government-backed investments as well.
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