Intended for healthcare professionals

Rapid response to:

Analysis

Web of industry, advocacy, and academia in the management of osteoporosis

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3170 (Published 21 July 2015) Cite this as: BMJ 2015;351:h3170

Rapid Response:

Medical schools should prohibit financial ties between individual academics and industry

The web of financial interests involving industry, advocacy and academia in the management of osteoporosis described by Grey and Bolland,1 is paradigmatic of a situation characterising many medical specialties.2 However, the ethical implications regarding each component of this web seem different. Industry is a private enterprise, its goal is profit, and its managers are accountable to shareholders. Advocacy organisations are morally accountable to patients, but are supported mainly with private funds.3 Conversely, most European academics are public employees paid with citizens' taxes and are accountable to society at large. Academics appears to have here by far the highest ethical liability, as without their compliance neither industry nor advocacy organisations could alone catch medicine so effectively in this web of interests.
Academics influence prescription practices and, hence, impact on citizens' health and healthcare resources. Therefore, citizens not only should have the right to know which academics are paid by whom and how much, but should also be allowed to decide whether these financial ties are permissible. Collaboration between industry and academics is necessary, but should not imply payments to individual investigators. Money deriving from industry-supported research could be centralised in anonymous institutional funds. Academics have the moral duty of educating young generations according to the highest ethical standards. The possibility that teachers do not enable their medical students to objectively appraise the evidence must be prevented, also because students are intellectually vulnerable. Thus, universities should prohibit the establishment of financial ties between academics and private enterprises, including medical communication companies.4
In his last published words, Arnold Relman warned: "now, more than ever, it is important that leaders in academic medical centers set an example for students and faculty by concentrating on advancing the non-for-profit social purposes of these institutions. They cannot do this if they also have ties to pharmaceutical businesses".

1. Grey A, Bolland M. Web of industry, advocacy, and academia in the management of osteoporosis. BMJ 205;351:h3170.
2. Kassirer JP. Professional societies and industry support: what is the quid pro quo? Perspect Biol Med 2007;50:7-17.
3. Lenzer J. Many US medical associations and disease awareness groups depend heavily on funding by drug manufacturers. BMJ 2011;342:d2929.
4. Schwartz LM, Woloshin S. Medical communication companies and continuing medical education: clouding the sunshine? JAMA 2013;310:2507-2508.
5. Relman AS. Potential conflicts of interest for academic medical center leaders. JAMA 2014;312:558.

Competing interests: No competing interests

26 July 2015
Paolo Vercellini
Associate Professor of Obstetrics and Gynaecology
Department of Clinical Sciences and Community Health, Università degli Studi di Milano, and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
Via Commenda 12 - 20122 Milano, Italy