Drawing on her own experiences as editor-in-chief of the Journal of the American Medical Association (JAMA) since 2000, DeAngelis pointed out the concerns for treating physicians that ultimately affect the well-being of the most important factor: the patient.
Subtitled “Facts and Friction”, the presentation began with DeAngelis addressing the high probability that representatives of pharmaceutical companies were present in the audience, attempting to take note of her comments and slides.
Citing the 1850 edition of the Merriam-Websters Collegiate Dictionary, she defined a conflict of interest as a “conflict between the private interests and the official responsibilities of a person in a position of trust.” DeAngelis pointed out that a physician is often in the greatest position of trust.
Marketing
The year 1989 was a watershed moment for the pharmaceutical industry, DeAngelis explained. Companies decided to invest increasingly in marketing and lobbying to the detriment of research and development. The health sector is the largest spender lobbying the United States Congress and Federal agencies in 2007, of which pharmaceutical and health care companies are the greatest contributor.
Dealing with interests of these large companies, and their agendas is a stark reality for urologists and physicians in general. As editor-in-chief of JAMA, DeAngelis cited some examples of pressure exerted on her and her editorial team. The placement of advertising in scientific publications can present problems.
For instance, a certain pharmaceutical company was very keen to publish a four-page centrefold advertisement in an upcoming issue of JAMA, and DeAngelis inferred that it had to do with the scientific coverage of the company’s product in that same edition. When the company declined to publish in any other edition, DeAngelis relented, but moved the impartial article to the next issue.
Public Concerns
Ghostwriting is another practice that needs to be made more transparent, she added. Companies might provide articles, paying renowned physicians to add their name to the authors’ list. DeAngelis went on to cite many instances of biased conclusions favouring the industry, inappropriate funding, suppressed or delayed publication of results, fabrication of results and even of hiding side effects.
“Whether warranted or not, the total result arouses public concerns and threatens the credibility of biomedical research,” DeAngelis concluded. “Proper guidelines on disclosure are essential and must ensure transparency. Managing conflicts of interest appropriately is essential to ensure the public’s trust.”
Optimism
Speaking to EUT after the fifth sub-plenary session, DeAngelis, remains optimistic: “As it stands, there is no government that I’m aware of that can invest sufficiently in these kinds of clinical research. Therefore, it makes sense for industries that stand to profit to invest into developing new products. The problem comes from the marketing side of things. There are no problems with the scientists who work for pharmaceutical companies, as they are among the best and brightest in the world.”
“We need to stress that the patient is the top priority. Guidelines are very important in this regard. If we keep that in mind, everything will work out.”
Note
The EAU supports a strict policy of statement of conflict of interest by all its members in scientific activities both at the EAU Congress and in other publications and meetings of the EAU. See www.uroweb.org/guidelines/conflict-of-interest-policy/
By Loek Keizer