Treating cancer is one of the most difficult medical challenges of our time. In addition to requiring effective therapies and compassionate clinicians and caregivers, it demands trustworthy and transparent communication. A report in JAMA Internal Medicine that summarized payments from the drug and device industry to directors of National Cancer Institute-designated cancer centers underscores the need to develop more rigorous strategies for reporting and monitoring.
Though the report showed that slightly more than half of the directors did not receive industry payments in 2017, slightly less than half did. While most were under $5,000, the NCI’s threshold for significant financial interest, one-third of all directors received payments for research and consulting well above that limit.
Trust is the pillar upon which the field of medicine is predicated. Patients following their doctors’ recommendations and advice, physicians’ willingness to act on researchers’ data, and numerous other elements that compose this enterprise are rooted in the reality that we depend on the honest, impartial work of others to ensure the health and well-being of our patients and our practices. Compromising trust compromises effective care, without exception.
As director of one of the NCI centers, the Sidney Kimmel Cancer Center at Jefferson, and president-elect of the Association of American Cancer Institutes (AACI), I believe that medical professionals and institutions should carefully navigate potential conflicts of interest and funding in gray areas with pharmaceutical companies, staying above the fray and safeguarding patient trust: I believe disclosure and management of executive-donor relationships are key to that process.
Financial ties and financial interests complicate relationships between physicians and researchers and the pharmaceutical and device companies. But that doesn’t mean these relationships can or should be severed. The relationship between academia and pharma is an invaluable component of the scientific process. By integrating theoretical research and practical application, this type of collaboration has allowed for major advancements in cancer detection and management. NCI-designated cancer centers meet rigorous standards for cancer research and scientific leadership, and are major hubs of discovery that provide the basis for these advances.
That said, the success of those relationships should not be the sole basis for their continuance. Any relationship with industry, whether with a center director or any other member of the scientific or medical community, must be honest. But that quality can be difficult to quantify.
To address the issue, the AACI convened a task force to examine conflict of interest policies and conflict management at the association’s member centers and provide guidelines for institutional transparency. I had the honor of co-chairing the task force with Dr. Leonidas C. Platanias, director of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.
The final recommendations of the task force boil down to clear disclosure and impartial management of professional relationships with industry. These are strong and essential starting points.
Another recommendation was to require the disclosure of all contributions, from long-term project funding to more ubiquitous requests like speaking engagements and webinars, whether or not they were accredited for continuing medical education. Further, the report recommended including all dollar amounts and affiliations with any foreign institutions and laboratories in these reports, with duties to disclose extending to at least researchers’ immediate family members.
Granted, disclosure procedures are already mandated through the Open Payments program, managed by the Centers for Medicare and Medicaid Services. It publishes financial relationships between health care providers and industry. But merely publishing these relationships is not enough. These reports need to be accessible: Many of them may be difficult to interpret by patients or their families. In addition, the disclosing process is complicated and current reporting standards typically involve too many steps, with many users reporting disclosures on multiple sites, each overseen by a different organization or agency. The separation and unique requirements of different databases make it difficult for the public to both locate and understand the information it needs.
A central registry for disclosures would address many of these concerns. Having a simple, accessible outlet through which physicians and academic researchers can comprehensively detail their financial and institutional affiliations would help patients seek care uninfluenced by clinics’ financial ties.
Patients in NCI centers have many concerns, but the objectivity of their medical professionals should not be one of them. Clinicians and cancer centers alike should share a singular mission: to treat patients and understand their needs. The scientific process necessitates clinical objectivity and complete impartiality, and cancer centers should demonstrate those virtues. Patients want to know that the information they receive will be objective, free of undue influence, and do the most good possible. The establishment of a centralized database for clinicians’ financial disclosures would do much to restore trust in the often-criticized medical field.
Karen E. Knudsen, Ph.D., is the executive vice president for oncology services at Jefferson Health, enterprise director for the Sidney Kimmel Cancer Center at Jefferson, and professor and chair of cancer biology at Thomas Jefferson University. She reports having received research support from Celgene, CellCentric, Novartis, and Sanofi, and has advised or consulted for Atrin, Celgene, CellCentric, Genentech, and Sanofi.