College and university researchers today are more dependent than ever on corporate sponsorship. In the United States in 2015, spending on health-related research and development totaled $158.7 billion. Of that, industry spent $102.7 billion, while federal agencies spent just $35.9 billion. The current administration attempted to further decrease NIH funding, but those efforts were unsuccessful.
Increased reliance on industry money not only limits the scope of research that is done; it weakens researchers’ ability to act as independent critics, an effect illustrated in current pharmaceutical-policy debates. ProPublica reports that an army of economists and health-care experts from the nation’s top universities have been deployed in a “lobbying blitz” to argue the societal benefits of the industry’s high drug prices. Founders of Precision Health Economics, the company behind the initiative, include a professor at the University of Southern California and an economist at the University of Chicago. The company allows drugmakers to review articles by its academics prior to their publication in academic journals. Dana Goldman, one of the founders, says he and other academics at the company disclose their ties to the pharmaceutical industry “whenever appropriate.”
As universities find themselves increasingly forced to court industry dollars, their need for private-sector partners may corrode their ethical boundaries. Experts have proposed some guidelines.
Disclosure of funding sources is necessary but not sufficient. Fifteen years ago, in Science in the Private Interest, Sheldon Krimsky argued that a relatively new focus on technology transfer and industry contracts in American universities was putting at risk the university’s primary value: socially useful critical inquiry. Disclosure was not an antidote to this threat, Krimsky concluded: Conflicts of interest had to be prevented or prohibited, and not just “subtly managed.”
The problems that can arise from those conflicts of interest have been shown by investigators who study the effects of industry ties on research. They have found that pharmaceutical companies study, fund, publish, and promote studies favorable to marketing goals and suppress or attack research that threatens market share. One study found that industry-sponsored studies were more likely than non-industry-sponsored studies to conclude that a therapy was beneficial and less likely to find harms.
That is true in both preclinical and clinical studies. For example, both basic and clinical studies of a drug that stimulates the production of red blood cells reported fewer adverse effects when they were industry-funded. In 34 cellular-level studies by non-industry-funded researchers, 32 (or 94 percent) found that the drug had the potential to promote malignancy. Among the 10 researchers who were funded or employed by the drug’s manufacturers, however, none reported those effects.
Academic researchers are trapped in this system, but they are not without power.
Perhaps most troubling is that if the final results of a study do not support commercial goals, the full study may never be published. In general, industry-funded studies are less likely to be published than non-industry-funded ones. And contrary to expectations, the reason negative studies are unpublished is not because journals rejected them, but because they were never submitted for publication.
Although many universities frown on agreements that give funders the right to suppress the publication of findings, policies regarding publishing are not uniform across colleges and universities. In any case, enforcement is nil: Colleges can’t force researchers to publish studies. Industry insiders tell us that when company representatives fail to prevent a researcher from publishing unfavorable results on a drug, they may attempt to persuade the researcher to “bury” the paper in an obscure journal. Or, under the guise of reviewing a manuscript for “accuracy,” a company may soften statements or insert subtle marketing messages into the article to mitigate harm to its marketing goals.
We don’t know the extent to which industry funding distorts biomedical literature — and clinical decision-making — but a substantial body of evidence now shows that allowing industry to choose what scientific questions should be asked, and how findings should be analyzed, interpreted, and disseminated, has public-health costs. We need strategies to minimize industry influence on scientific questions, and the resulting impact on policies and medical practice.
One strategy is for scientists to vocalize their tough predicament. The commercialization of science and the university is now entrenched. Academic researchers are trapped in this system, but they are not without power. Kelly Holloway, a postdoctoral fellow at the University of Toronto who studies the commercialization of academic research, found that researchers understand the paradoxes and problems inherent in commercialization. Narratives gain traction when they are widely discussed, and Holloway challenges scientists to openly articulate and interrogate the contradictions, challenges, and tensions they experience in their daily work.
Another strategy comes from Joel Lexchin, a professor emeritus in the School of Health Policy and Management at York University, in Toronto. He suggests erecting “a firewall between the money and the people doing the research and the data analysis,” or developing “an entirely separate funding source that is independent of the pharmaceutical industry.”
Academic researchers and their institutions could do more to effect change. Researchers should refuse any input from sponsors into the design or analysis of a study. Sponsors should have no input into the writing, editing, or reviewing of a manuscript before it is published, and no say in whether or where a study is published. Colleges should provide researchers access to statisticians, manuscript-preparation assistance, and other services. They should create enforceable policies that prevent researchers from agreeing to any input from sponsors on the design or analysis of a study, or on the manuscript or any part of the submission process. The sponsors should see the study when it is published. If they don’t like it, they can write a letter to the journal like anyone else.
Finally, researchers and academic institutions should become politically involved as advocates for more federal funding of scientific research. Scientists generally shy away from politics, but we have reached a crisis point in which corporations are capturing not only academic institutions but scientific direction. Without more government funding, the role of science will increasingly be one that puts the interests of corporations before the interest of public health. No one can make that dire case better than the researchers doing the work.
Sharon Batt is an adjunct professor in the departments of bioethics and political science at Dalhousie University, in Canada, and the author of Health Advocacy Inc.: How Pharmaceutical Funding Changed the Breast Cancer Movement (UBC Press, 2017). Adriane Fugh-Berman is a professor in the departments of pharmacology and physiology and family medicine at the Georgetown University Medical Center. She directs PharmedOut, a project that examines pharmaceutical marketing practices.
Correction (3/5/2018, 3:35 p.m.): An earlier version of this essay said that last year’s budget for the National Institutes of Health had been reduced by 18 percent, with the Fogarty International Center scheduled for elimination. Those were the recommendations from the president’s budget, but Congress did not enact them. The text has been updated.
