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Conflict of Interest?

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I noticed that your book does not index the term “conflict of interest.” This seems to me to be an important consideration when examining the scientific and ethical decisions that determine whether or not a clinical research trial moves forward. A recent issue of the Journal of the American Medical Association (May 2, 2107) focused on issues of conflict of interest in medicine and research, but they seemed not to address issues you raised in “Lethal Decisions.”  JAMA articles discussed conflict of interest that focused on payments and other benefits that might be given to physicians and researchers from pharmaceutical companies and other commercial healthcare related sources. One article pointed out that, “Meta-research studies have shown that financial conflicts of interest, including commercial research sponsorship, are associated with publication of research outcomes that favor the financial interest. The association between financial conflicts of interest and favorable outcomes has also been established for meta-analyses, systematic reviews, editorials, and letters to the editor. The influence of financial ties on research outcomes appears to be due to a variety of types of biases. For example, research agendas can be influenced by funding sources.” But the JAMA articles implied that the financial sources were primarily industry related.

I believe you are trying to say that concern about conflict of interest can result from financial gain, whether direct or indirect, and should be considered no matter the funding sourceindustry, government, USPHS, NIH, charitable organizations.  


By B. Rush MD

Benjamin Rush was a Founding Father of the United States. Rush was a civic leader in Philadelphia, where he was a physician, politician, social reformer, educator and humanitarian, as well as the founder of Dickinson College.


  • Arthur Ammann Monday, 31 July 2017

    “Conflict of interest” should have been indexed.
    There exists a long-standing bias that conflict of interest originates solely when payments are made by industry to support research, conferences, consultancy agreements, academic presentations and secondary payments for travel reacted to professional development. It is true that the sums can be large amounting to billions of dollars each year as you quote from in the meta-analysis study, “Meta-research studies have shown that financial conflicts of interest, including commercial research sponsorship, are associated with publication of research outcomes that favor the financial interest.” But the annual payments to researchers and institutions from US government grants and grants from charitable organizations also amount to billions of dollars. While the Academy has been successful in pointing out the conflicts of interest associated with industry funding they have insisted that payments from government and other sources are not associated with conflict of interest. Yet the decisions on what research is given priority funding, what clinical research studies are conducted, and whether they are ethically and scientifically sound are made by individuals within the Academy who receive substantial financial support for salaries, benefits, and overhead costs for their institutions. Outside independent review of Academic policy of conflict of interest when funding is received from the US government or charitable organizations is neither encouraged nor required. As I concluded in Lethal Decisions, “Past ethical abuses, the potential for future abuses, and the continued denial by some clinical researchers and their institutions that unethical research has been and will continue to be conducted demand an examination of the ethical and scientific proficiency of academic IRB’S and a thorough review of existing ethical standards by experts and advocates who lack conflicts of interest and with the full participation of those most at risk of exploitation.” (Lethal Decisions. The Unnecessary Deaths of Women and Children from HIV/AIDS. Page 291.)

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