Conflict of interest in academic oncology: moving beyond the blame game and forging a path forward

The management of financial conflict of interest (COI) in academic medicine has again been thrust in the spotlight, with some writers contending that current COI policies—largely a mandate to disclose conflicts, and, on rare occasion, recusal from academic opportunities or divestiture of the conflict—may perversely stifle biomedical innovation. Others have argued in opposition, noting that loss of innovation is speculative, that historical breaches of trust led to current policies, and that the bias of financial COI may be subtle. Although there are clearly many types of conflict—consistency with prior views, desire for success, preference for friends or family, organizational and professional allegiances—financial conflicts have been highlighted over the last three decades in part because they are objectively measurable, have documented associations with favorable and positive results and in part because they are unidirectional—while other conflicts sometimes point for or against some treatment or diagnostic test—financial conflicts are nearly always aligned with more care. The role financial COI plays in oncology, especially in the United States, has not been discussed. Interactions between academic investigators and the biopharmaceutical industry are particularly important in oncology for three reasons: (1) many treatment decisions in oncology are based on ‘expert’ interpretation of suboptimal data, (2) a considerable amount of therapy involves off-label use of highly expensive treatments and (3) the majority of new drug approvals now occur in oncology, and interactions are common. For these reasons, we believe the nature and appropriate management of oncology COI deserves special consideration. At the same time, we acknowledge the considerations here apply to other fields or subfields with similar advances in therapeutics and large industry presence, and our solutions may extend outside of oncology.