Straight talking and the myth of ‘independent’ research

Nature Medicine (14, 1006 – 1007; 2008) features a question and answer session with Senator Charles Grassley. “What would a trim 75-year-old grain farmer have to say about drug safety and the payments given to medical researchers by drug companies? Lots, if he happens to be Charles Grassley, who has represented the state of Iowa in the US Senate since 1980. As the senior Republican on the Senate’s finance and judiciary committees, he has carved out a role as a relentless watchdog who acts as a magnet for whistleblowers in government agencies ranging from the US Department of Defense to the FBI. In the last several years, Grassley has set his investigative sights on issues relating to medicine. A leading critic of the Food and Drug Administration since the surprise withdrawal from the market of Merck’s painkiller Vioxx in 2004, Grassley is now focusing on university researchers funded by the National Institutes of Health who haven’t been properly reporting income from drug companies. Meredith Wadman asked the senator what he hopes to achieve through his investigations.” Read on, at Nature Medicine.

Sen Grassley’s congressional investigation allegeing that some researchers have failed to report all the drug-company money that they have received — and that universities may have been too slow to police them is also subject of the leading Editorial in the current issue of Nature (Nature 455, 835; 16 October 2008, free to access online). A string of internal Emory University documents and e-mails made public last week after a hearing of the US Senate Committee on Finance, chaired by Sen Grassley, allege a web of consulting, lecturing and advisory-board relationships that Charles Nemeroff, chair of the psychiatry department at the University maintained with 16 pharmaceutical companies. According to Nature, Nemeroff is the seventh academic psychiatrist this year that Grassley has exposed as allegedly underreporting drug-company income. His office says that there are more revelations to come. Grassley has begun pressuring the NIH to mete out real punishment — as in pulling grants — to spur institutions to enforce proper reporting. Sen Grassley’s plan to make companies disclose in a publicly accessible database all payments of more than $500 that they make to physicians, and whether this would make it easier for universties to report such payments, is open for debate at the Nature Network Opinion forum.

Researchers and their institutions need to dispel a myth about ‘independent’ research before the media does it for them, according to the latest Nature Biotechnology Editorial (26, 1051; 2008). The great unspoken reality is that relationships between companies and researchers are not only becoming the norm, but they are also essential for medicine to progress. Without the exchange of expertise and knowledge between industry and academia, much of medical progress would falter.

This truth remains unspoken because researchers and their institutions like to maintain an aura of lily-white independence from the commercial world. Researchers may feel, and they may be absolutely right, that allowing companies to contribute to payments for trials or research or publications does not threaten their independence of thought or action.

However, that is not how the general public or individual patients see ‘independence’. For them, independence implies no financial ties, no associations, not a smidgeon of influence from commercial interests. This wholly unrealistic view of angelic independence is an impression that the academic world has fostered, if not actively, then at least through a persistent failure to counter it. And it is this view that the Sunshine Act and its database will blow wide open once and for all.

The way to prevent a public and media backlash is for physicians and researchers (and their institutions) to take immediate and active steps now to explain the interdependence of industrial and academic research. It must be the biomedical community that says “we have to talk to these companies” and “their money really helps push medicine forward.” We need to make plain that there can be a win-win-win outcome for doctors, companies and patients alike. That will give patients a better view of the integrated worlds of research and commerce within healthcare and disarm a million trivial investigations based on nothing more than administrative discrepancies.


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