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Integrity
in the face of conflict
Last year Emory’s $525 million profit from the marketing rights
to the HIV drug Emtriva brought into clear focus some of the potential
“dividends” of academic/industry collaboration in health-related
research, product development, and health care. In fact, the Emtriva partnership
is a classic case study in translational research: moving vital discoveries
efficiently from the scientific bench to the bedside by drawing on the
strengths of both the academy and industry. Yet relationships between
health professionals and institutions in the nonprofit sector and partners
and sponsors in the private sector are fraught with difficulties. An important
factor we must recognize and manage at every step is conflict of interest
(COI). COI can exist where the primary interests of an individual or institution
(for example, the pursuit of knowledge or the education of students) run
up against significant secondary interests (such as pecuniary gain).
As
a university and health system, we have special obligations to ensure
the integrity of everything we do. The reliance of students and trainees
on their teachers and mentors requires the commitment of educators to
the best interests of their students. The pursuit of knowledge and new
discoveries requires scientific integrity, collaboration, and free sharing
of information. Human vulnerability in light of disease and injury creates
a moral imperative for the integrity of caregivers. Even the appearance
of COI can undermine a patient’s, a student’s, or the public’s
trust in our vital work.
COI is not new. Longstanding sources of
conflicts requiring management within academia and health care include
hubris, the desire for academic promotion, competition for sponsored research
support and “interesting cases,” the push to be the first
to publish discoveries, an aspiration for higher pay and revenues, and
other competing secondary interests. The recent growth of collaboration
with private industry is only the latest challenge in earning and maintaining
public trust in the integrity of research, training, and clinical care.
It is vitally important for everyone in
our community to understand COI and be proactive in identifying and managing
conflicts. COI policy and its enforcement have evolved quickly during
the past several years, but they are still works in progress. Often the
issues are complex and far from straightforward or clear-cut. New ground
is broken regularly. Therefore, informed voices from a variety of perspectives
and a continuous and healthy dialogue are necessary, as is complete compliance
in areas where policies are clear and settled. As always, I hope and expect
that you will find in the pages of Momentum good and useful information
that keeps us moving forward in managing COI and in all of our work together.
Michael M E Johns
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