In the grip of the python: conflicts at the university-industry interface

A systematic review of the relationship between plastic surgery and the medical industry

BACKGROUND

The nature and extent of medicine's relationship with the medical industry is currently a heated issue in medicine. Although the ethical implications of this relationship have been widely discussed in medical journals and the popular media, it is unknown how the current interest in industry issues has affected plastic surgery. The aim of this systematic review was to characterize the literature of the past two decades that examines plastic surgery's relationship with the medical industry.

METHODS

Three medical databases were searched using plastic surgery and industry-related search terms. The quality of selected articles was assessed by two reviewers. The specific data abstracted included the venue of the industry interaction discussed within the article: (1) physician education programs, (2) research partnerships, and (3) clinical settings. Within each of these categories, a comprehensive taxonomy was created to categorize the thematic content of the articles' discussions.

RESULTS

Of the 465 articles gleaned by the search, 21 met the inclusion and exclusion criteria and were included in the final review. All 21 articles were of a review or editorial nature, and the majority (57 percent) discussed the nature or effects of industry's presence within the clinical setting.

CONCLUSIONS

This systematic review revealed the literature's cursory analysis of plastic surgery's relationship with the medical industry. This project highlighted the need for plastic surgery to examine the ethical implications of industry's support and engagement within the field. Improving this literature is necessary for plastic surgeons to understand and adhere to current standards on acceptable practices.

Debunking myths in physician-industry conflicts of interest

PURPOSE

To call attention to the myths that surround physician-industry conflicts of interest, to refute their validity, and to propose ways to address them so as to insure that physicians make medical practice decisions in the best interest of their patients.

DESIGN

Perspective.

METHODS

Review, analysis, and discussion of the implications of selected pertinent literature.

RESULTS

Physicians often have voluntary financial relationships with industry based on behaviors and motivations that include entitlement, recognition, belonging, and money. The pharmaceutical and device industry spends billions of dollars annually in marketing to physicians. The sophisticated marketing plan seeks access to physicians through gifting mechanisms to ingratiate them and to influence them to prescribe industry's drugs and to purchase its products. Despite widely accepted studies that demonstrate that industry's marketing activities influence physicians' medical practice behavior to the detriment of patients and the public, physicians persist in voicing myths to justify their partaking of industry's largesse. Many physicians believe that their voluntary financial conflicts of interest with industry can be managed by simply disclosing them and by "being honest." Yet there is no support from well-conducted studies to support the effectiveness of this approach.

CONCLUSIONS

Medical organizations and academic institutions are the ones to take the lead in recognizing that these voluntary financial conflicts of interest are unacceptable and should be stopped. Such conflicts mainly relate to the acceptance of gifts and money that are designed to influence behavior and are a form of financial coercion.

The contract research organization and the commercialization of scientific research

The early 1980s constituted a watershed in science, mainly concerning the extent and nature of globalization and commercialization of scientific research, and its impact upon the university. Considerable debate has arisen about the sources of this transition, but aside from a few lone voices, the scholarly literature has neglected the concurrent rise of the contract research organization (CRO) and its role int he commercialization of scientific research. The CRO warrants wider attention as a modern paradigm of privatized science in the biopharmaceutical sector. In discussing the CRO's technologies, the purposes they pursue, and the legal and policy initiatives that have fostered their rapid rise, we confront the wider implications of the modern regime of commercialized science for the future conduct of scientific research. We identify five areas of innovation: treatment of human subjects, control of disclosure, subjection of research tools to commercialization, redefinition of authorship, and re-engineering the goals of research.

Intellectual property and the commercialization of research and development

Concern about the commercialization of research is rising, notably in testing new drugs. The problem involves oversimplified, polarizing assumptions about research and development (R&D) and intellectual property (IP). To address this problem this paper sets forth a more complex three phase RT&D process, involving Scientific Research (R), Technological Innovation (T), and Commercial Product Development (D) or the RT&D process. Scientific research and innovation testing involve costly intellectual work and do not produce free goods, but rather require IP regulation. RT&D processes involve an unrecognized IP shift from a common IP right in public goods like information and knowledge to private IP in products and other hard assets. The question then is, what kind of IP right: private or common? Since scientific research and innovation testing require openness about adverse findings, and wide, low cost diffusion of results, they require a common, inclusive IP right. Common IP is appropriate to both sharing knowledge goods and recovering the cost of production. Research is furthermore compatible with commercialization and support by other social interests. On the other hand it is incompatible with the exclusionary private IP rights that permit restrictive publication or total suppression of information. Private IP rather than commercialization conflicts with the openness requirements of scientific research and innovation testing. Commercial funding, however, is in principle compatible with research and testing, especially when regulated by a common IP right. This reflects a pragmatic view of the fundamental interconnections of knowledge and other social interests.

Ethical issues at the university-industry interface: a way forward?

This paper forms an introduction to this issue, the contents of which arose directly or indirectly from a conference in May 2001 on Corruption of scientific integrity?--The commercialisation of academic science. The introduction, in recent decades, of business culture and values into universities and research institutions is incompatible with the openness which scientific and all academic pursuit traditionally require. It has given rise to a web of problems over intellectual property and conflict of interest which has even led to corporate sponsors' suppressing unfavourable results of clinical trials, to the detriment of patients' health. Although there are those who see the norms of science developing to recognise the importance of instrumental science aiming at specific goals and of knowledge judged by its value in a context of application, none justifies the covert manipulation of results by vested interest. Public awareness of these problems is growing and creating a climate of opinion where they may be addressed. We suggest a way forward by the introduction of nationally and internationally-accepted guidelines for industrial collaboration which contain proper protections of the core purposes of universities and of the independence of their research. Some codes suggested for this purpose are discussed. We note that some universities are moving to adopt such codes of conduct, but argue the need for strong support from the government through its funding bodies.