Should there be more focus on the financial relationship itself rather than its disclosure?
The literature has shown that disclosure does not prevent a conflict of interest or bias. The main concern about conflict of interest is that it leads to biased reporting and, clearly, biased reporting can occur if there is financial reward. There is potential for bias when researchers are reporting the results of pharmaceutically sponsored studies or writing editorials that comment on pharmaceutically sponsored studies.
I don’t think that most scientists or academic clinicians writing these papers or editorials are purposely introducing bias, but if you’re receiving payments from a company, you tend to avoid biting the hand that’s feeding you. Very commonly, people frame things in a way that is more favorable to people from whom they are receiving funds. There is also intrinsic bias, meaning researchers have written reports of their studies to make them look positive. However, the desire to make your study look good may be greater if you are receiving financial reward.
The U.S.’s Sunshine Act makes things a bit more transparent, but it doesn’t stop people from being biased. Bias can stop researchers from being the advocates of patients and from trying to improve access to drugs at a reasonable price.
I believe that receiving funds from pharmaceutical companies has an impact. On the other side, although my salary in Canada was very good and I could afford to go to a meeting, people from other parts of the world might say they would never have been able to attend an ASCO Annual Meeting, ESMO Congress or any other large meeting if they didn’t receive company funding to do so. There is a certain truth in that. People have said, “It’s easy for you to sit on your high horse and still be able to go to these meetings, but we can’t.”
I respect that, and I also respect that there are some oncologists who receive money from companies and who nevertheless are extremely straight in the way they present things. In general, though, if you’re receiving money from companies, there is a strong tendency to present data related to their drugs favorably.
This isn’t going to change overnight. But, there are some institutions that are not allowing their researchers to take personal money from companies. This is a step in the right direction.
Ian F. Tannock, PhD, FASCO, is emeritus professor of medicine and medical biophysics at Princess Margaret Cancer Centre and University of Toronto. He can be reached at firstname.lastname@example.org. Disclosure: Tannock reports no relevant financial disclosures.
Interactions between academic physician researchers and pharmaceutical companies, along with government support of cancer research through the NCI Cancer Therapy Evaluation Program or cooperative groups, are vital to progress in our field. Institutional transparency is essential; at Cleveland Clinic, we disclose these types of relationships to a conflicts of interest committee.
Relationships with pharmaceutical companies can be beneficial to patients and are necessary because they may lead to the development of better cancer therapies. Collaborations through advisory boards or consulting arrangements can result in better clinical trial design with proper endpoints, correlative studies or inclusion criteria to make the studies relevant.
Should the nature of these relationships be the focus of reporting instead of just the relationship? Not necessarily. There are those who look at any interaction with pharmaceutical companies as negative and will not likely be convinced otherwise, even with additional information about the relationship. I believe, though, that as government funding for research shrinks, these relationships — and their disclosures — are imperative.
Dale Shepard, MD, PhD, is director of the Cleveland Clinic Taussig Cancer Institute phase 1 and sarcoma programs. He can be reached at email@example.com. Disclosure: Shepard reports current research funding from Bristol-Myers Squibb, Corvus Pharmaceuticals, Leap Therapeutics, Loxo Oncology and Pfizer; research support from Amgen and Compugen; honoraria for educational talks with Celgene and Genentech; an advisory board role with Sanofi; and a consultant/advisory role with Harpoon Therapeutics.