The interaction between medical research and for-profit corporations
is not new, but it has expanded considerably in recent years. Some of the
recent trends may accelerate the research process, particularly when large
clinical trials are required. However, a renewed commitment to the application
of high ethical standards is essential to ensure that societal trust in research
is not eroded, subjects enrolled in trials do not become merely a means to
an end, and medical research is efficiently translated into clinical advances
that will benefit future patients. This article focuses on the analysis of
conflicts of interest in the conduct of clinical trials in both academic and
community-based settings. Specifically, it discusses how the roles of research
scientists and clinical practitioners differ and the importance of ensuring
that participants' consent to enroll in clinical trials is not the result
of confusion about the goals of an experimental treatment that may resemble
clinical care. The article also discusses the potential conflicts of interest
that can arise when clinicians stand to gain from enrolling their own patients
as subjects in clinical trials and examines various instances in which disclosure
of information regarding funding and compensation may serve to minimize such
conflicts. This article emphasizes that to preserve the integrity of research
and to protect the welfare of human subjects who enroll in trials, physicians
should have adequate training in the conduct of research and be familiar with
the ethics of research. When a physician has treated or continues to treat
a patient who is eligible to enroll as a subject in a clinical trial conducted
by the same physician, someone other than the treating physician should obtain
the participant's informed consent. Finally, the article addresses disclosure
of financial incentives and related funding issues.