NEW YORK – Conflicts of interest, whether reported or unreported, are just one component of a broken system that has misaligned incentives with meaningful advances in breast cancer research, agreed a panel of experts who participated in an evening program sponsored by SHARE, a breast cancer patient advocacy group.

Ted Bosworth/MDedge News Fran Visco

“The issue of disclosures, while it is important, is not really the key issue. The key issue for me is about the amazing amount of money that is changing hands,” said Fran Visco, president of the National Breast Cancer Coalition, Washington. She contended not enough money in breast cancer research is being applied to save women’s lives rather than driving profits for institutions, physicians, and the pharmaceutical industry.

The other two participants in this panel, called Conflicts of Interest in Research and Treatment: What Breast Cancer Patients Should Know, largely agreed. In turn, they each explained that major sums of money in play for physicians and institutions collaborating with industry are earmarked for generating income much more than improving outcomes.

“Most of where this money is going is for these little tiny improvements and there is no association between the outcome increment that you get and what you pay for that outcome increment,” said Robert Cook-Deegan, MD, a bioethicist and a professor at the School for Innovation in Society, Arizona State University, Tempe.

Ted Bosworth/MDedge News Dr. Robert Cook-Deegan

Leaving aside whether physician-scientists working at nonprofit research institutions can avoid conflicts of interest when money is funneled to them from start-up investment opportunities, pharmaceutical board memberships, and direct compensation deals for consultancies and other services, Dr. Cook-Deegan was referring to the bigger problem of misaligned incentives. Large financial rewards are available for any drug with market potential instead of being limited to those that save lives, he said.

Tracing the current system to the Bayh-Dole Act in 1980, which permitted researchers to claim patents for intellectual property developed with federal funding, Dr. Cook-Deegan described a system of minnows, fish, and sharks. Researchers, who are the minnows, seek potential new therapeutics to be developed by for-profit startups or other commercial entities, which are the fish. If the drug continues to show promise, it brings investors, who are the sharks.

