PHILADELPHIA -- Conflict of interest rules for academic scholars' relationships with private industry have become so expansive they inhibit important national policy development tasks, according to the head of the National Institutes of Health's Bioethics Department.
In a video interview at the University of Pennsylvania's Leonard Davis Institute of Health Economics (LDI), NIH ethics chief Dr. Ezekiel Emanuel said the implementation of health care reform required new ways of thinking about scholarship and corporate enterprise.
'The wrong shot' He emphasized that conflict of interest is a serious issue that needs even more management and prohibitions in some areas but said current efforts to regulate it overall have "taken the wrong shot."
"We keep talking about 'disclosure,'" he said. "But there's lots of evidence that disclosure is not a good protection and leads to bad incentive structures."
Emanuel's comments came in response to questions from Dr. Arthur Caplan, Director of the Center for Bioethics and LDI Senior Fellow. The video session was part of LDI's ongoing series of interviews and seminars with national authorities in the field of health policy research.
Vitriol and angst The conflict-of-interest issue has exploded in political vitriol and institutional angst in recent years. Senator Chuck Grassley's Congressional investigations have targeted staffers at Harvard and Stanford. Pharmaceutical companies' speaking fees and other gratuities have become public relations nightmares for universities across the country. Leading organizations like the Institute of Medicine of the National Academies have railed against the "troubling interactions between industry and physicians, researchers and medical institutions."
Even the recent movie "Inside Job" is credited with raising the public's sensitivity and ire about the financial connections between academia and private corporations.
Public sensitivity These high-profile controversies have driven various universities and professional organizations to adopt stronger conflict-of-interest protocols.
Emanuel, a physician and ethicist who has served as a special advisor on health to the White House Office of Management and Budget, is rare in his willingness to publicly question whether conflict-of-interest attitudes and rules have gone too far.
"One of the things that's quite clear to me from the policy world is that we can't ignore these people in the private sector," he said. "We have to work with them willy-nilly and I think to some degree we've created a situation where close collaborations with the for-profit sector is seen as (only) a bad thing."
Health care reform "Just take something like health reform," he continued. "You're going to have to work with the insurance companies. There are for-profit hospitals, there are drug-device manufacturers, there are all sorts of other profit-making entities that have to be worked with. And to say, 'I'm holier than thou and I'm not going to work with you; I'm not going to take your money to sponsor conferences and things,' I think is a mistake. We have to bring these perspectives together," he said.
"Four or five years ago there was a big article in JAMA about if you offer advice to a hedge fund you're in a conflict of interest," he said. "Well, in my view that article was just wrong and didn't understand what a conflict of interest is. And so we've gotten to the point where any relationship with anyone who's making money is a conflict of interest. That's false. We need to be a little more subtle about it and a little more realistic about the fact that we need to intersect with (industry). It can't simply be that every time you have a financial relationship you can't be objective."
"It would be a lot more interesting for us to think of different kinds of relationships where scholarly work could be done to influence policy without incurring the taint," he said. "We just haven't done that."
