Intended for healthcare professionals

Feature Essay

From the $80 hamburger to managing conflicts of interest with the pharmaceutical industry

BMJ 2019; 365 doi: (Published 03 May 2019) Cite this as: BMJ 2019;365:l1939

Linked BMJ Opinion

Reflections from a casualty of the food industry research funding debater

  1. Christopher M Booth, professor of medical oncology1 2,
  2. Allan S Detsky, professor of health policy, management and evaluation3 4
  1. 1Department of Oncology, Queen’s University, Kingston, Ontario, Canada
  2. 2Division of Cancer Care and Epidemiology, Queen’s Cancer Research Institute, Kingston
  3. 3Institute for Health Policy, Management, and Evaluation, and Department of Medicine, University of Toronto, Toronto, Ontario
  4. 4Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto
  1. adetsky{at}

Free lunches in medicine aren’t really free, mentor Allan Detsky taught mentee Christopher Booth. Their early conversations contributed to Booth’s opting to have no relationships with drug companies

We met in the summer of 1999, when one of us (CB), at the beginning of his third year of medical school, did a clinical elective with the other (AD), an experienced clinician and researcher. We have maintained the mentor-mentee relationship (and subsequent friendship) up to the present time. CB is now a mid-career clinician scientist and AD a senior faculty member.

One of our frequent conversations concerns the appropriate response to professional opportunities that create potential conflicts of interest: specifically, when to accept gifts, payments, employment, equity, or research support from the pharmaceutical industry. Here we provide our thoughts on this subject to other medical professionals, especially those near the beginning of their careers. We believe that only a minority of physicians share our views.

Hidden in full view?

Our personal opinions and interactions with the industry have evolved over time. During the 1980s and 1990s AD engaged with drug companies as a paid consultant and speaker at symposiums and advisory board meetings. The endeavour was intellectually and financially rewarding, and to him the conflict of interest seemed manageable. This changed in the late 1990s when he embarked on a programme of research that led to some of the earliest reports documenting how the drug industry influences the interpretation of medical evidence and guidelines.12 Since that time he has had no relationships with industry. Moreover, he now “sees” industry influence in almost all facets of patient care, medical education, clinical research, and even certification exams (in which the correct answers are based on pharmaceutical funded guidelines).

CB was a postgraduate resident in the early to mid 2000s. During that era he enjoyed …

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