By Hannah Hoag
Money's No Object
Doctors' financial ties don't worry many cancer patients
By Hannah Hoag
Many people believe that money muddies the waters of medical research. Stock ownership, speaking or consulting fees, and royalty payments are often viewed as incentives that might compromise a physician’s commitment to the well-being of the patients enrolled in a clinical trial. But many cancer patients are unconcerned about the financial ties between researchers or institutions and drug companies, according to a study in the Nov. 30, 2006, New England Journal of Medicine (NEJM ).
Ezekiel Emanuel, a breast oncologist and chair of the Department of Clinical Bioethics at the National Institutes of Health, and his colleagues interviewed 253 patients with cancer who were enrolled in cancer research trials at five U.S. medical centers. Eighty percent said they weren’t worried whether the doctors running their trials had any financial interest in the company that made the experimental drug, and 82 percent said they would still have enrolled in the trial if they had known that the doctors running it received speaking fees from the drug company.
“It was a big surprise at first,” says Emanuel. “But when you think about it for a second … you realize it is not all that perplexing. Sick people focus on their illness. They need to trust the system on this because they are worrying about something much more acute.”
According to Margaret C. Kirk, the chief executive officer of the national breast cancer support organization Y-ME, financial conflict of interest is an important subject, but quality care and efficacious treatment may be more important to those with a life-threatening illness.
Nonetheless, patient advocates would like researchers to disclose financial interests to their institutions, to refrain from any proprietary interest in a product they are testing and to avoid receiving payment in company stock or stock options, says Elizabeth Thompson, the director of research, scientific and government affairs for the Pancreatic Cancer Action Network, a national nonprofit organization. Most doctors get involved in clinical research because they want to help patients, she says, but the financial relationships they have with pharmaceutical companies can run the risk of affecting judgment and behavior.
A separate study published in the same issue of the NEJM attempted to quantify some of those relationships. According to the study, which surveyed researchers who monitor clinical trials at 100 medical schools and independent research hospitals, 36 percent of the researchers had financial ties that could be construed as conflict of interest.
In 2000, the American Medical Association called for the full disclosure of such financial interests to patients during the informed consent process. But other researchers argue that this process can confuse patients, who may be in a poor position to fully assess any potential conflict of interest.
“Everyone is trying to do the right thing and make sure clinical trials are being conducted as ethically as they can,” says Frances Richmond, a research scientist at the University of Southern California in Los Angeles, who has an interest in regulatory issues and clinical trials. “None of us profits from bad behavior.”
Patients should be informed about conflicts of interest, she says. But the burden of untangling financial ties shouldn’t fall primarily on them. “I would like to see the onus placed on the system—our IRBs (Institutional Review Boards), universities, professional organizations and companies—to have gates in place to try to control this problem,” she says. “We can never make it 100 percent foolproof, but let’s not make this yet another job of the patient.”