To reiterate, a conflict of interest is a situation in which there is a potential for conflict between one’s personal or financial interests and one’s academic and professional responsibilities. The potential to benefit financially from the outcome of one’s own clinical trial represents just such a conflict; and hence may require full disclosure and complete prohibition. Those who conceal such conflicts of interest must do so because they sense that the conflicts may be perceived as violating the trust that the patient, the hospital and the university have in the physician and the investigator to do only that which is in the best interest of the patient and scientific process.
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The third type of interaction between academia and industry, and the one with potential for the most egregious conflicts of interest, is that in which the relation between a pharmaceutical firm and an investigator is both direct and personal; the individual stands to personally profit from the interaction. An increasingly common example of this type of conflict of interest is that which arises when an investigator (or family member) holds equity or stock options in, or serves as a consultant or board member for, a commercial firm whose business interests are closely related to the investigator’s research activities. flovent inhaler
The defence of drug company-sponsored lunches through unrestricted educational grants is not intended to imply that such lunches do not create any potential conflicts of interest; but rather to point out that such conflicts, if present, are probably at an acceptably low level, because the sponsorship is indirect and nonpersonal. Furthermore, unless one invokes the ‘slippery slope’ hypothesis, such activities, per se, are unlikely to lead to more flagrant conflicts of interest. It is one thing for a student or resident to eat a drug company-sponsored sandwich at rounds. It is quite another thing for the student or resident to accept books, travel or other gifts that are directed explicitly to the individual in question. I am confident that our students and postgraduate trainees are perfectly capable of distinguishing the two scenarios and appreciating their differences. buy asthma inhaler
In considering situations that constitute potential or real conflicts of interest, it is worth noting that the relations between faculty members and industry encompass many types of interaction, with varying potential for conflicts of interest. For the purpose of this discussion, however, it is useful to consider three types of interaction that are particularly relevant to members of clinical departments: indirect, nonpersonal interactions; direct, nonpersonal interactions; and direct, personal interactions. Beginning with indirect, nonpersonal interactions, perhaps the best example in this category is the widespread practice in our teaching hospitals of having lunch at noon rounds and seminars sponsored by pharmaceutical manufacturers. While it is always a subject of debate in the medical literature (and perhaps one that we should revisit within the department), the topic has again hit the headlines because of a recent opinion piece on the subject of medical professionalism, written by a distinguished medical historian . In this article, Rothman stated that medical schools and teaching hospitals should categorically prohibit drug company sponsorship of lunches for housestaff (and presumably attending staff).
Perhaps the easiest relations to understand are those that are not only unethical, but for the most part, are also illegal. Included in this category is the concept of finder’s fees; that is, monetary or other rewards offered to physicians for referring their patients for clinical trials. As discussed in MediNews , it is neither illegal nor unethical for a physician (with the patient’s consent) to provide a patient’s name to an investigator involved in a clinical trial; but the practice becomes both illegal and unethical, whatever the circumstances, the moment the physician is paid or rewarded for doing so. buy asthma inhalers
As the relations between academia and industry become increasingly complex, so too does the potential for conflicts of interest arising from these relations become increasingly frequent. In response, universities, granting agencies and medical journals have attempted to establish guidelines for appropriate relations between investigators and industry, and to design policies to prevent or deal with conflicts of interest. Despite these initiatives and the widespread attention given to issues of conflict of interest in leading medical journals , faculty members, even with the best of intentions, may at times not realize that they are in a potential conflict of interest situation. However, because “ignorance of the law” is no defence, it is important that all faculty members, and clinical investigators in particular, be familiar with the principles of conflict of interest, and don’t inadvertently allow themselves to be party to such conflicts. buy antibiotics online