A group of researchers at Duke University scoured 746 studies on heart
stents published in medical journals over the course of a year and
were shocked to discover two huge omissions. First, 83% of the papers
failed to disclose whether any of the authors were paid consultants
for companies, even though many journals formally require that
information. And of those articles specifically describing clinical
trials, 72% didn't say who funded the research. When it comes to
policing their disclosure rules, says lead author Kevin Weinfurt of
the Duke Clinical Research Institute, "these journals should be doing
better."

Virtually every medical organization urges physicians to be up front
about their financial ties to industry. It's especially a concern when
doctors who publish studies about drugs and medical devices receive
funding from the companies that make those products. Over the past few
years, a spate of safety warnings and product recalls has left journal
editors fearful that company-paid researchers might be filtering their
results to highlight the positive. So the publications have toughened
up their disclosure policies, hoping that transparency by itself would
neutralize conflicts of interest.

The Duke study shows that even when authors do divulge their
connections, some statements are less than forthright. In all, 168
authors out of 2,985 made disclosures in the journal articles, which
were published in 2006. Through simple Internet searches, the Duke
team discovered that some physicians who said they had no conflicts of
interest in fact served on advisory boards of companies that make
stents. One person co-founded a stent company. (The Duke paper doesn't
name doctors.)

The report reveals just how deeply corporate interests have
infiltrated medical research. The top funding sources named in
disclosure statements were stentmakers Johnson & Johnson (JNJ), Boston
Scientific (BSX), and Medtronic (MDT), as well as drugmakers Bristol-
Myers Squibb (BMY) and Sanofi-Aventis (SNY). The last two co-market
the blood thinner Plavix, which is widely prescribed to stent
patients.

Contacted by BusinessWeek (MHP), spokespeople for Bristol-Myers
Squibb, Boston Scientific, and Sanofi said in e-mails that they
require authors to disclose all financial support from their
companies. (J&J and Medtronic did not respond by publication time.)
BUILT-IN LIMITATIONS

Some journal editors gripe that there's only so much they can do. Once
they issue disclosure rules, they have no choice but to trust authors
to follow them. "I'm not a cop. I'm not the FBI," says Dr. Catherine
DeAngelis, editor-in-chief of the Journal of the American Medical
Assn. With several thousand authors contributing every year to her
publication, DeAngelis says, she can't expect her editors to research
every disclosure to determine whether it's accurate. And she's
frustrated so many authors are resisting the call to disclose. "It
should be a no-brainer," DeAngelis says. "It doesn't mean the
worthiness of the paper is marred. But if they're not disclosing
because they think it's marred, then maybe it is."

Transparency has some built-in limitations. If all authors
consistently disclosed every possible conflict of interest, the world
would be awash in information that's hard to interpret. After all,
most disclosure statements don't say how much money the authors
receive, whether they're paid in cash and/or stock, or what services
they provide in return. "The whole system is pretty slipshod," says
Dr. Jerome P. Kassirer, former editor-in-chief of The New England
Journal of Medicine and author of On the Take: How Medicine's
Complicity with Big Business Can Endanger Your Health. "When you know
an author has a conflict of interest, you're still in the dark."

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