Community Hospital Oversight of Clinical Investigators' Financial Relationships (In the Field) (Report‪)‬

In response to growing concerns over conflicts of interest in clinical research, considerable attention has been paid in recent years to clinical investigators' financial interests in the studies they conduct. To date, most of this attention has focused on research that takes place in academic medical settings. For instance, both the Association of American Medical Colleges and the Association of American Universities have issued reports and recommendations directed to university-based research settings. (1) In addition, the Government Accountability Office's investigation of conflicts of interest in the research setting focused on universities. (2) And most of the analyses in leading medical journals of conflicts of interest in research focus on academic settings, (3) as do many of the empirical studies of these issues. (4) The primary focus on academic research centers is at first glance understandable, since these centers and their affiliated research institutes account for the bulk of federally funded clinical research. However, focusing on conflicts of interest at academic institutions may not capture the full range of research settings in which conflicts can occur. For instance, when taking into account clinical trials funded by pharmaceutical and medical device companies, the majority of clinical research is conducted in community hospitals and ordinary clinical practices, rather than in academic medical settings. (5) Of note, this privately funded research is the very type that is most likely to entail certain financial relationships such as recruitment incentives, consulting, or stock ownership.