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Medical Experts: On Conflicts of Interest, Tell All

The best way to damp down concerns about doctors’ and researchers’ financial conflicts of interest is to require full disclosure, according to an expert report issued today. A panel of the National Academies' Institute of Medicine says faculty members at medical institutions should be required to report all industry money they receive from outside their institution—no matter how small the amount—to special committees that would keep track of the data and manage conflicts.

The policy recommended by IOM would be far more intrusive than current U.S. rules, which require only National Institutes of Health grantees to report to their own institutions outside income of more than $10,000 per year. But the IOM panel members say concerns are growing that academic researchers who take drug company payments are withholding data from publication or otherwise biasing results. And as part of an ongoing investigation, Senator Chuck Grassley (R–IA) has identified several psychiatrists who allegedly failed to disclose hundreds of thousands of dollars in consulting income.

Disclosure is "a critical but limited first step" toward addressing conflicts of interest, the IOM panel concludes. Besides urging that all industry income be reported to an investigator's institution, it endorses a proposal similar to one from Grassley to require that drug and device companies report payments to physicians and researchers in a public database.

Much of the IOM report echoes recommendations from the Association of American Medical Colleges, which also supports Grassley's proposed database. But not all schools have followed that group's advice. "We give a pretty clear warning," says panel chair Bernard Lo, a bioethicist at the University of California, San Francisco. "If the [institutions] don't get their act together, they're really inviting the legislators to step in." That, he warns, could lead to “very, very blunt” regulations and “a risk that valuable relationships will be curtailed in ways that will hurt patients."