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June 28, 2006

Academic Medical Centers and Conflicts of Interest

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;295(24):2845-2849. doi:10.1001/jama.295.24.2845-a

To the Editor: In their Special Communication, Dr Brennan and colleagues1 have proposed policies to eliminate the conflicts of interest that create bias in medical decisions and threaten scientific integrity. However, incomplete safeguards that ignore important contributors to bias will never be effective.

This proposal focused solely on some conflicts of interest related to industry, ignoring other important factors that create bias. For example, scientific and educational meetings routinely require disclosure of conflicts related to industry but do not ask for disclosures related to clinical income or National Institutes of Health (NIH) grants, both of which are major factors for professional success and involve financial sums much greater than the small gifts that the authors strongly argue can influence the behavior of physicians and scientists. If small gifts can create bias, there may be an even greater effect from larger amounts of money from clinical income, NIH grants, advertisements in medical journals, or grants to academic medical centers (AMCs) and medical scientific societies. In addition, scientific misconduct may be ego-driven, rather than motivated by financial greed.