The December 1, 2010, seminar was presented by Lisa Cosgrove, Edmond J. Safra Lab Fellow and Associate Professor in the Department of Counseling and School Psychology at University of Massachusetts, Boston. Lisa's research deals with institutional corruption in the field of psychiatry. This is a particularly vulnerable area because, unlike most other fields in medicine, there are no biological markers, leaving more room for interpretation and abuse. Lisa's presentation explored the ways that industry influence may distort psychiatric taxonomy, research, clinical practice guidelines, and informed consent practices. Of particular concern are the DSM panel members, who make decisions regarding the inclusion and expansion of disorders in the DSM.
Following the presentation, seminar participants discussed the pitfalls of transparency and disclosure as methods for counteracting the effects with financial conflicts of interest. They examined how the structure of the university encourages relationships between industry and physicians, and the necessity of convincing others that the current system creates enough harm to justify making significant changes to it.
While transparency--or simply disclosure of one's financial ties to industry--is often mentioned as something that may alleviate the problem, it was pointed out that there is little evidence to suggest that merely being transparent about one's financial conflicts of interest produces much of an effect. People may either become habituated to the disclosures, or their awareness of them leads them to dismiss otherwise legitimate findings. Neither of these reactions is particularly helpful.
Some participants wondered about using reputation as a lever to convince physicians not to take industry funding. However, it was pointed out how deeply ingrained this practice is--so much, in fact, that there isn't a reputation cost to engaging in it. Discussants then considered whether the university is in many ways responsible for not creating an environment in which such behavior would have more significant costs. As it is, the university seems to be structured precisely to encourage people to have industry ties. Given that many medical schools require their faculty to raise their own salary, the university has created a situation that makes professors vulnerable to industry influence.
However, in order to convince people that something needs to change, several participants pointed out how necessary it is to demonstrate that the current system is inflicting some harm. Others pointed out that this is an issue for all of the institutions we have been examining. At this point, there doesn't appear to be an intellectual framework in place to think about and measure the harm that results from institutional corruption. However, such a framework is necessary to launch a convincing argument for reform.
In summary, seminar participants discussed the hazards of relying on disclosure as a solution to the problem of financial conflicts of interest. They considered the role that the structure of the university plays in encouraging professors to forge ties with industry, and the necessity of developing some way to measure the harm that occurs as a result of those ties.