Inherent forces fomenting conflicts of interest
Several forces have coalesced to increase the incidence of conflicts of interest in the medical industry: the vertical integration of the pharmaceutical industry, the 1980 Bayh-Dole Act, and the rapidly accelerating need of the medical industry to conduct human experiments. Vertical integration of pharmaceutical industry. The pharmaceutical industry has become increasingly vertically integrated, giving drug companies control over the entire chain of production. Drug companies develop new products, hire university and private-sector researchers to conduct drug trials, contribute to the design and pay for the study, and control which study results get published. Drug companies also market prescription drugs directly to consumers and physicians, support medical journals and conferences through advertising and contributions, fund physician continuing education and medical symposia, pay consulting fees to physicians for giving presentations and serving on committees and boards, and have financial relationships with the authors of guidelines establishing standards for prescribing medicines. The 1980 Bayh-Dole Act. The second force contributing to the increase of conflicts of interest in the medical industry is the 1980 Bayh-Dole Act, which foments the commercialization of new medical products by creating a uniform patent policy among the many federal agencies funding research and giving academic researchers and their institutions the right to products developed with government money, permitting them to license the inventions to other parties, and thereby encouraging them to develop financial ties to the biotechnology or pharmaceutical industries. Doctors quickly learned that they could go into business while continuing to practice medicine. The rapidly accelerating need of the medical industry to conduct human experiments. The third force contributing to an increase in conflicts of interest in the medical industry is the rapidly accelerating need of the medical industry to conduct human experiments as part of the drug and medical device approval process. In the early 1990s, managed care squeezed drug prices, leaving drug companies with one option: increasing the number of drugs they were selling. When the drug companies tried to hasten drug development, the academic world was unable to adapt rapidly, and drug companies began to recruit private practice doctors to mine their patient base for research subjects. In short order, the medical industry changed providers of human subject experiments required as part of the approval process. In 1991, nearly 80% of human experiments were conducted by nonprofit academic medical centers; by 2000, 40% of the 60,000 human subject studies were conducted by nonprofit academic medical centers, and 60% were conducted by for-profit companies, moving more research to "private settings and even storefront clinics." Likewise, there has been a significant increase in private industry funding of medical research that takes place in U.S. universities. According to a New England Journal of Medicine study, private industry funds more than two-thirds of medical research at U.S. universities; two decades ago, the main contributor to medical research was the federal government.