The Stanford Program in Law, Science & Technology’s Center for Law and the Biosciences inaugurated its regular speaker series with an engaging talk by Dr. Ezekiel Emanuel, Chief of the Department of Clinical Bioethics at the National Institute of Health. Dr. Emanuel’s remarks focused on one of the more troubling aspects of medicine: financial conflicts of interest among researchers. Dr. Emanuel first described the current landscape of medical research, emphasizing that the potential for bias based on financial ties is significant. He noted that since the passing of the Bayh-Dole Act in 1980, there has been a dramatic increase in the amount of corporate funding of university research. Dr. Emanuel also cited studies showing that over a third of the articles published in leading scientific journals were written by lead authors with a financial interest in the result of their research. He stressed that money was only one form of reward which could bias researchers. According to Dr. Emanuel, nonmonetary gains such as publications, promotions, and peer recognition could also affect a researcher’s judgment.

Turning to an examination of the actual effect of financial ties between researchers and industry, Dr. Emanuel mentioned three main areas of concern: research design, data integrity, and patient safety. In all of these areas, Dr. Emanuel stated, it is important that there be some oversight to ensure proper conduct. He also pointed out that it is sometimes difficult to differentiate between biases based on conflict of interest and biases based on other factors. For instance, Dr. Emanuel cited studies indicating that industry-sponsored trials are less likely to be published if the results are negative. While this might reflect efforts by the private sector to prevent “bad” results from reaching the public, Dr. Emanuel offered that it might also reflect a general sentiment among journal editors that positive results are more interesting and worthy of publication.

One of the solutions proposed by some to these conflicts of interest is the full disclosure by researchers to their research subjects regarding any financial ties. While Dr. Emanuel agreed that disclosure is important, he cautioned that patients are often not in a position to fully understand complicated financial relationships. Also, there exist certain intangible conflicts of interest, such as fame, that researchers may have trouble articulating, in part because they may be unaware of such biases. Dr. Emanuel concluded these considerations by arguing that many patients will have little choice but to participate in research, even if they do possess reservations about conflicts of interest.

— Pablo Arredondo