No Conflict, No Interest
Earlier this year, former Hopkins faculty member Elias
Zerhouni had his hands full at the National Institutes of
Health when a conflict-of-interest scandal arose from
decisions made long before he assumed his role as director.
Faced with disclosures in the media that NIH scientists and
administrators were receiving personal consulting payments
from industry, speaking honoraria and cash awards —
as well as allegations that in many instances these
payments represented serious conflicts of interest with the
scientists' responsibilities — the NIH was compelled
to tighten its policies on outside activity. Ultimately,
stringent conflict-of-interest rules were adopted and
published in the Federal Register on Aug. 31.
This matter, I should add, may not stop at the gates
of the NIH. A number of people in Congress and the media
have called for the adoption of similar restrictions for
anyone who is the recipient of NIH grants, and it's unclear
as to the effects of the new regulations on academic and
other extramural researchers.
Conflict of interest is a battle between the necessity
of maintaining our pristine "trusted agent" status for
society and the pressures to move discovery from the bench
to the marketplace. There are many issues involved, among
them:
Protecting the safety and welfare
of human research subjects
Safeguarding the integrity of
scientific research
Making sure that technology
developments and scientific discoveries move quickly from
the university to industry
Making sure that student training
is not subverted to the priorities of outside
corporations
Ensuring open communication among
physicians and scientists, unencumbered by consulting
arrangements
Assuring the reputational
integrity of the university
Maintaining the dedication of the
faculty to the aims of the university
There are no easy answers to these challenges. We have
debated them in the past and developed guidelines that have
for the most part served Hopkins well. Whenever
conflict-of-interest issues arise, rarely do both sides get
heard; the media and general public tend to gravitate
toward the belief that the "negative" pressures of outside
financial interests will trump any other societal gains
that might accrue from university/industry collaborations,
whatever their form. And, unfortunately, there are a number
of publicized examples where scientists have subverted
their unimpeachable judgment to outside financial
interests.
Conflict of interest is not new. What has changed?
While the percentage of funding for corporate-sponsored
research at universities has not increased, there appear to
be many more opportunities for faculty to become industry
consultants, to serve on corporate advisory boards and to
become shareholders in private venture capital-backed
companies. And the dollars passing hands can sometimes
dwarf a faculty member's salary.
In my mind, conflict of interest begins the day a
scientist has an idea. Even receiving NIH grant support
drives a certain mode of behavior that could compromise the
objectivity of that scientist. And licensing the idea to
outside interests adds additional conflicts. A surgeon who
develops a new clinical procedure will want to pursue the
development of that procedure — which means conflict,
hopefully positive — even without the involvement of
an outside company. If she invents a surgical device that
enables the operation and licenses that technology to an
outside company, the conflict becomes more apparent, even
though the conflict was no less real before any agreement
was signed. But it is probably impossible to erect a
firewall between the scientist and the supposed source of
the conflict. I know of few surgeons who would use a device
invented by someone else if that colleague, even for
reasons of conflict of interest, did not use that device
herself. As a venture capitalist once told me, "No
conflict, no interest."
While there are many types of conflicts of interest,
it is appropriate to focus specifically on financial
conflicts, as these are directly measurable and
quantifiable, and are subject to public regulation.
Financial rewards can produce conscious or unconscious bias
in scientific inquiry. Equally importantly, as opposed to
other types of conflicts, in many cases, financial ones are
optional.
Many financial conflicts can be managed; ones that
cannot should be prohibited. At Johns Hopkins, conflict of
interest management begins with disclosure. While this is a
necessary, but not sufficient, condition to eliminate the
potentially negative effects of the conflict, it serves to
alert the university of a situation that may require
further oversight, and it alerts our external audience
— other scientists, students, patients, research
subjects, corporations or governmental agencies — of
the potential for bias in the products of our
activities.

William R. Brody is president
of The Johns Hopkins University. A version of this essay
appeared previously in Change, a newsletter
published for the medical faculty.