One piece of news in the oncology news today was a celebratory announcement by Merck that they will be collaborating with researchers at the Dana-Farber Cancer Center, part of the Harvard medical system and one of the most influential cancer centers in the world, in drug development. As part of this agreement of developing a team approach, “Merck will provide up-front and research support funding to [the Dana Farber Cancer Center} as well as milestone and royalty payments upon market approval.”
Umm…great. Merck is happy to have buy-in of one of the world’s leading research institutions. Stockholders are happy, too: the stock went up $1.22 (2.69%). Woohoo!
Now I’m not anti-business, and I’m certainly not against advancing the cancer field, but I’m just taking a moment here because we’re rightly focusing on potential conflict of interest among researchers and speakers. I just wrote a post (here) in which I’m trying to convey that we’re struggling with even the perception of conflict of interest in having an educational grant with no strings attached that would be provided to GRACE from a pharmaceutical company. When I give a talk to oncology colleagues, I consistently report that in the past two years certain companies have paid me to speak on their behalf or consult with them (and this information will also be available on the GRACE website for every board member and faculty writer). So I’m just wondering, shouldn’t we maybe be a bit concerned if our academic centers are becoming the Research and Development Division for the world’s largest pharmaceutical companies?
The argument for this is that it’s hard to bring new cancer drugs through clinical trials and into commercial use: I appreciate this and have also written about this in past posts. But personally, I would be a little concerned if my oncologist, let alone the entire department or institution in which s/he practices, had systematic incentives to develop novel drug X for a company that is in ongoing collaboration and providing large amounts of research funds and then potential royalties to our academic institutions that are also receiving our support. I’m not saying Merck is alone here, either. There are many other academic-industry collaborations that are uncomfortably friendly.
I’m not trying to be sanctimonious here: I work closely with industry and have made money consulting with and speaking for various companies. And I don’t want to hold up progress. But I’m troubled if we have wild double standards of tarring and feathering individual investigators who made $1500 for speaking on behalf of one company, while congratulating a revered institution that may compromise its credibility in the name of a systematic “partnership” with another company. Do people not mind their oncologist earning royalties from Merck (or even if the royalties go to the cancer center, are we confident that there would be no influence on management habits?)? Are people at all concerned that this may influence patient care in a detrimental way?
posted by Dr. West @ 4:25 pm link to this post
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February 12th, 2008 at 5:59 pm
I’m with you on this one, I think. And I’m not sure that disclosure is enough. I assume (I’m at a loss for specifics) that there will be situations (if not in lung cancer then somewhere else) where a Dana-Farber doctor will have to choose between two treatments for a patient that are a close call, and where one of those treatments provides revenue to Merck and one doesn’t. For a confused cancer patient (that’s probably redundant), that adds another element that probably crosses the acceptability line.
And I do think that’s different from the situation you’re posing regarding funding for GRACE. You already have biases (most of which you openly acknowlege) and disclosing one more to people who are not your patients and to whom you’re not making recommendations is not as overwhelming an issue.–Neil
February 12th, 2008 at 7:59 pm
Dr. West,
While your concerns about conflicts of interest are valid and need to be sorted out, cancer research funding from public sector has been on a steep decline over the last 10 years. May be, such new strategic models between private sector and leading research institutions may help create substitute funding sources for research. Won’t that be a good thing?
Prem
February 12th, 2008 at 8:43 pm
Prem,
I just want to open the dialogue here. I agree that your point is th best counter-argument. What I really think is problematic is a double standard of proclaiming the evils of confict of interest a doc uses a pen that says “Tarceva” on it (and I’ll admit, I’ve done it, but I give equal time to pens with names of other drugs — there, I’ve confessed!), but it’s a boon to the world if the Dana Farber Cancer Center and Merck are now officially in business together.
-Dr. West
February 15th, 2008 at 9:11 am
This answers one of my questions that I posed in a previous post, concerning what current public detriments are occurring as a result of the lack of cancer funding by the government.
I guess this is path the we will be following as a result of inadequate funding for cancer research from the federal government.
We have reached that slippery slope now I’m afraid. There will be more to come.
Jim
February 19th, 2008 at 4:46 pm
Dr. West-
As a result of your post, I contacted Dr. Lynda Chin, who will be Dana-Farber’s senior investigator in the Center for Applied Cancer Science(CACS)-Merck alliance. Below is her response:
(she also cc’d Ronald DePinho, MD, of the CACS and Bill Schaller DFCI’s Director of Media Relations)
Dear Ms. ,
Thank you for alerting us to some of the issues being raised about Dana-Farber’s research agreement with Merck.
The agreement does not diminish our ability, or responsibility, to conduct independent research. Rather, it enables us to have access to Merck’s vast chemistry resources and to be able to determine through pre-clinical research if any of these compounds hold promise as cancer therapies. We would not have access to these compounds without this agreement.
Separately, we’re hopeful that the collaboration we’ve created will serve as a model to enhance the communication between academia and industry, two critical partners in the drug development process. Better communications may lead to greater clinical trial success rates.
Last year, Dana-Farber offered its patients access to more than 600 publicly and privately financed clinical trials. It is important to note that the agreement with Merck does not preclude or limit us from collaborating on clinical trials sponsored by other companies. Nor does it prevent our own investigators from pursuing or testing any promising leads they may find on their own. Dana-Farber will continue to work with a vast and wide array of collaborators, including those at other academic institutions, publicly-funded organizations, and private companies, to further the field of cancer research and care.
I hope this information is helpful to you.
Sincerely
Lynda
Lynda Chin, MD, Associate Professor
Harvard Medical School
Dana-Farber Cancer Institute
web: http://genomic.dfci.harvard.edu
February 20th, 2008 at 8:54 am
Wendy,
Thanks for that info. That was a very proactive and constructive way to move forward. The issue, though, is that we still presume bias if an individual has any financial relationship with a company. They aren’t exonerated if they say “although I have spoken for company X, I can still prescribe any anti-cancer treatments I’d like to patients”. Even though that’s true, they still are considered to have a conflict of interest that needs to be reported. My point is that I don’t think there’s a real distinction between relationships with industry for either individuals or institutions. And I personally am fine with many of those relationships, as I have several myself, but I need to be transparent about them and be evidence-based to show how I make my decisions. I also expect that an institution should follow the same rules of transparency and allow the public to decide if their actions are guided by the best evidence or potentially by conflicts of interest.
Thanks for taking initiative, Wendy.
-Dr. West