A recent study published in JAMA reveals that 49% of National Cancer Institute (NCI)-designated cancer center physician directors received payments from industry sponsors in 2017. 23% of these top physicians received over $5,000 defined by NCI as a “significant financial interest.” The study used open payments to examine industry payments.
There are critiques of industry payments but the NCI conflict of interest policy is silent on the matter. The authors were somewhat critical of the findings. For example, in an opinion piece in the Los Angeles Times, authors Carr and Welch articulated that it is a problem that most clinical trials and new products are funded by industry, giving them considerable input in design and conduct of research.
New drug research in America evolves and occurs in a complex, integrated ecosystem of value chains, networks of interest and institutions in the context of a specific economic, political and social/cultural systems. Industry is a key driving agency—spurring flows of capital, resources and probably most important—talent—to solve vexing problems.
Without industry, there would be few, if any, drugs. Academia and government are not set up to drive and commercialize innovative new therapies. The know-how, capability and competency isn’t there because of the way the system has evolved.
Imagine if the system was reorganized under some hypothetical political leadership that sought to remove all perceived conflicts of interest. Artificial divides would be set up—barriers and firewalls that would preclude the flow of talent, ideals and, yes, some money from critical participants in a dynamic ecosystem.
The Real Question
The real question of research like this should focus on outcomes. What money is producing what outcomes? Is industry influence (e.g. money) overall producing better or worse outcomes? What are the patterns of outcomes for industry-funded NCI cancer center programs versus non-industry ones. What is getting individuals and the collection of such individuals called society better results? Can we correlate those NCI-designated centers with industry funding with more approved drugs or not? Of the approved drugs, can we differentiate which ones are truly novel and pathbreaking versus just incremental improvements (of the type in non-inferiority trials, for example)? Is there emerging benchmarks we can utilize to assess the effectiveness of how our public monies are utilized in NCI-designated cancer center? This seems to be almost a more important issue—how is our tax money being spent?
Underlying all of this is the move toward value-based care in America. Payers increasingly expect evidence of value for example. Whole new models have emerged in the American health system—such as ACOs—to drive better outcomes at lower costs. The success of many of these initiatives is questionable but intense underlying drivers continuously pulsate—the overall costs are too high.
With a focus on clinical trials, sites and investigators, TrialSite News was established as part of this underlying and unfolding dynamic—the value-driven healthcare movement. It is now the individual (consumer of healthcare) that must become educated, knowledgeable and empowered about their own healthcare. The individual must take control of their healthcare destiny to the extent that they can. First and foremost, this means, as they are a consumer of healthcare, they must become educated as to how their life is impacted by the various health care products and services constantly coming up. We know that the more the individual (and by extension families and communities) takes control of their health, empowers themselves and participates in positive behavior, the overall healthcare outcomes will improve.
So, individuals (and collections of individuals embarking on research projects) should start questioning first and foremost how the tax monies are spent on their healthcare. And as we look at the research complex in America (and beyond), targeted, value-centric research programs will better help us understand what in the system works well and what needs improvement.