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The newspaper of The Johns Hopkins University October 3, 2005 | Vol. 35 No. 5
Thinking Out Loud

William R. Brody

By William R. Brody

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.


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