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LEADERSHIP Martin Convenes Leaders of Top Schools to Consider Conflict of Interest Policies On Monday and Tuesday following Thanksgiving a group of 17 senior leaders from academic medicine around the country met in Washington, D.C. to discuss options for unifying and tightening policies for when faculty are a little too thankful to industry. "The group arrived at consensus on many issues that could improve both the public perception and the internal reality that academic centers are properly managing potential conflicts of interest," said HMS dean Joseph Martin, who convened the group. "This level of consensus would have been quite surprising just a year or two ago." Last spring, after months of speculation that HMS was about to loosen its strict policies on conflict, newspapers around the country carried stories in May when Martin announced that not only was the School keeping its policies, but it was adding safeguards to protect students and trainees from being affected by industrial ties of faculty mentors. In the following weeks, Martin was encouraged by Secretary of Health and Human Services Donna Shalala and numerous academic leaders inside and outside Harvard to launch a national dialogue on the issue. The D.C. meeting was the result. The gathering started with a review by Martin of four recent research reviews of conflict of interest policies around the country. Two were published in the Nov. 1 JAMA, and two were scheduled to be published in the Nov. 30 New England Journal of Medicine later that week. All four used different samples and looked at different parameters, but all came to the same conclusion: while almost all schools have conflict policies, there is considerable variability in how conflicts get reported and managed, and the policies are often too vague to clearly interpret. Following a talk on a personal view of the topic by Harold Varmus, former head of NIH and now president of Memorial Sloan–Kettering Cancer Center, and a lively discussion among all the participants on the goals of the meeting, the attendees split into three working groups. One discussed general guidelines that any policy should include, another focused on issues around disclosure, and the third dealt with procedures for implementation and review. Each group arrived at a consensus on its issues that was presented to the group as a whole for further refinement. Notes from the entire discussion were edited by the dean's staff into a final draft that was sent to all attendees for final review Dec. 1. Over the next few weeks the group will decide next steps for the project. Jordan Cohen, president of the Association of American Medical Colleges, said he would like to use the proposals as a starting point to speed the process when the committee he is convening on this topic for the AAMC begins its work. "The group agreed that the protection of human research subjects and the overall integrity of biomedical research is of paramount importance to American medical schools, teaching hospitals, and research institutes," said Martin. "Any final document ought to set a very high bar for preventing conflicts related to clinical research and for disclosure to the institution and in all communication, both oral and written, when conclusions reached could possibly be impacted by a conflict." The deans of the 10 medical schools whose faculty get the most NIH funding were invited to attend. Deans or senior surrogates arrived from the University of Pennsylvania, UCSF, the University of Michigan, Columbia, Yale, Johns Hopkins, Washington University in St. Louis, and the University of Washington. Among the other leaders of academic medicine who joined them were Varmus; the AAMC's Cohen; and HMS academic deans Dennis Kasper and Eugene Braunwald. In a Sounding Board editorial in the Nov. 30 issue of NEJM, Martin and Kasper described the competing pressures of preventing conflicts and exploiting the opportunity to translate discovery into products to benefit patients. They closed by writing: "In answering the question 'In whose best interest?' our ultimate aim is to find a solution that creates the most just and prudent balance among the interests of academic science, industry, and most important, the public." —Don Gibbons