printable version5 Questions: DeAngelis on conflicts of interest
Catherine DeAngelis
As editor of the Journal of the American Medical Association, Catherine DeAngelis, MD, MPH, enforces what is arguably the most stringent policy of any medical journal regarding author disclosure of potential conflicts of interest. Earlier this year, when it was discovered that a number of authors had failed to inform JAMA of their financial ties to drug companies that could benefit from their findings, she reacted quickly to make the standards even tougher. With the medical center putting in place its new conflict-of-interest policy, Medical Center Report asked DeAngelis to share her thoughts about the need for such rigorous rules.
1. Since 1985, JAMA has taken steps to ensure disclosure of conflicts. So why are so many researchers still seemingly clueless about the need for transparency?
DeAngelis: I wish I knew. It might be that there is no integrated initiative by journals and others to require disclosure. Many journals have no requirement for disclosure and those that do have different requirements. Since authors submit their work to different journals over time, the lack of consistency might confuse some of them. However, there are a few authors who know what is required and deliberately ignore the rules. These few make it very hard on the honest but confused authors.
2. How concerned are you that negative press has eroded patients' perception of academic research integrity?
DeAngelis: I am very concerned about how patients and the public view the academic research community. This loss of confidence in the integrity of medical research can result in patients refusing to participate in research; young, bright individuals choosing fields other than medicine or medical research, and loss of the physician-patient trusting relationships, which are the foundation of medical care.
3. Critics such as Harvard's Thomas Stossel, MD, say that the rise of conflict-of-interest disclosures has become an obsession, creating an informant culture with vigilantes who distort evidence that doctors fail to disclose corporate ties in publications. How do you respond?
4. Do you hope you've said your piece on this issue for once and for all?
DeAngelis: I hope the editorial in the Aug. 23 issue of JAMA will set the record straight on this issue. I worked very hard on that editorial and the feedback I've received makes me hopeful that I've clearly made the important points, which I feel so deeply. However, I don't think this issue is resolved; therefore my JAMA team and other editors who share my opinion will have to keep on working at it.
5. The Stanford medical center just enacted a sweeping policy to limit the influence of pharmaceutical companies in relation to the clinical and educational activities of the institution. How important are such policies?
DeAngelis: Policies made by academic medical centers are vital to assuring that the medical profession and pharmaceutical companies work together in a way that will benefit all, including mostly patients. The legitimate interactions of medical scientists, physicians and administration of both academic and pharmaceutical institutions are the very foundation of new discoveries. Clear understanding of accepted behavior ideally should be promulgated by the academic medical centers, where the majority of clinical researchers are trained, where they work and where clinical research is performed.