More support and encouragement for researchers who avoid conflicts of interest would help to ward off growing threats to the preservation of intellectual freedom in clinical medicine, an Italian academic claims.

In an editorial for Psychotherapy and Psychosomatics, Giovanni Fava, from the Department of Psychology at the University of Bologna, cites a number of factors that have led to increasing concern about the independence of academic medicine. These include “self-selected academic oligarchies”, rooted in corporate interests, that direct the flow of clinical and scientific information.

These special interest groups are not just “the easily recognisable prodigal experts who move from one meeting to another to illustrate the wonderful properties of the drugs to be launched, who have their slides prepared and checked by the companies, who sign ghost-written papers and are promptly substituted if they do not have [an] impact on prescriptions”, Fava says.

They are also “the gatekeepers of corporate interest in scientific information”, acting as editors, reviewers and consultants for medical journals, scientific meetings and non-profit research organisations. Their task is “systematically” to prevent “the dissemination of data that may be in conflict with the special interest they represent”, whether through careful selection of the published literature or manipulation of clinical trial data, Fava contends.

Independent investigators who feel a “moral obligation to tell the truth” may face retaliation from these groups in the form of exclusion from symposia, removal from academic appointments or blocked access to research funding, he warns.

Modes of censorship

Censorship may come directly from a pharmaceutical company, exercising “its power as an advertiser in medical journals, a supporter of meetings and the owner of the data”, or from “trusted opinion leaders”. But there are also more subtle forms of repression, Fava notes.

One is the introduction of financial thresholds for the publication of research findings. “In recent years, there has been a progressive demand for the free availability of resources on the internet and for centralising medical information,” he points out. “Public access to medical journals means that the authors will have to pay at least part of the expenses” – a significant barrier for young and unsupported researchers who are “the lifeblood of science”.

What may have the most dangerous impact, though, is deliberate self-censorship. “The typical example is the intervention of an established investigator in a drug-sponsored symposium,” Fava writes. “He or she refrains from making promotional statements, leaving the dirty job to someone else in the symposium. However, he or she does not comment on unsubstantiated and commercial statements from other speakers in the panel.”

An uncensored exchange of scientific data is not necessarily the answer, Fava believes. “The challenge is to preserve pluralism, critical thinking and intellectual freedom in a setting more and more characterised by conformism, political appropriateness and the cult of mediocrity”, he says.

That underlines the value of researchers who stay clear of any substantial conflicts of interest, such as being employed by a private company, acting as a regular consultant for a company or sitting on its board of directors, owning shares in a company operating in a related field of research, or owning a patent directly linked to published work.

This kind of researcher needs support, including “priority for obtaining grants from public agencies supported by taxpayers’ money” and for securing “key positions in scientific societies and journal editorships”, Fava argues, adding that only these investigators should be drawing up clinical practice guidelines.

“Taxpayers and members of professional societies deserve scientific leadership by those researchers who opt to be devoid of substantial conflicts of interest, and may counteract the feudal lords of medicine and the artificial boundaries that the game of power has built in the medical system,” he comments.