Conflict of interest in the field of medicines – MEDICI

The project brings together specialists in the different questions and addressed fields, from a broad range of disciplines (sociology, political science, history, and law). It combines two levels of investigation: the first is a cross-cutting study of conflict of interest (CoI) in medical journals, health authorities, and in doctor-industry relationships, while the second addresses the question of CoI in a more detailed fashion, looking at specific therapeutic classes. A large range of data are used to address this complex and controversial topic and underpin our work:
- interviews (political/health officials, experts, doctors, scientists, members of non-governmental organizations, journalists, patients, etc.)
- archives (public archives, companies’ archives, personal archives of interviewees, etc.)
- prosopographical and career path analysis
- content and bibliometric analysis of publications
- Statistical analyses of the Transparence Santé database

Our analyses focus on both historical dynamics and current operational logics, with each aspect shedding light on the other.

The intermediate results of our research project underline that the category of conflict of interest (CoI) has emerged from the mid 50s in connection with status regulating the activities of US government officials. In the health sector, the promotion of CoI from the mid-1980s was linked to ongoing transformations of the regime of biomedical knowledge production. From the 2000s, several sanitary crises have politicized this category and its uses.

The category of COI carries a specific conception of the influence of economic actors (the influence is seen as individual and commensurable). The popularity of the CoI notion lies in the fact that it can designate a wide range of problematic situations without assigning them to notions that, as bribery or fraud, have unequivocal moral meaning and are legally well-defined. In fact the trajectory of the notion was directly linked to the enforcement of disclosure procedures (in medical journals, regulatory authorities or as concerns the relationships between industry actors and health care professionals) and these transparency policies often allow the persistence of the problematic interactions under consideration. It is therefore possible that such apparatuses actually stand in place of what could otherwise be more fundamental reform of the sector. Our research also underlines that actors experience difficulties in implementing policies regulating CoI.

However, our work also shows that the CoI notion has undoubtedly been for 30 years an effective tool to question the influence of pharmaceutical firms, and the huge amount of data and knowledge produced on their links with scientists and health professionals are increasingly used by watchdog organizations and investigative journalists.

Pharmaceutical products play an essential health-related, social, and economic role. However, they are also increasingly viewed as a source of risk and repeatedly subject to controversies surrounding potential conflicts of interest (CoI) among scientists, experts, or doctors. Today, public debate on the matter seems to be caught in a rut between, on the one hand, those who describe medicine as being corrupted by industry interests and, on the other hand, those who denounce the suspicion with which they are viewed and the problems that this ‘crusade against conflict of interest’ now creates.

Up until now, there has been little focus on the issue of CoI in the social sciences. The MEDICI project has therefore an opportunity to make a decisive contribution to our understanding of these dynamics, which have a profound effect on the construction of scientific knowledge, on innovation, on health care, and on faith in treatment, as well as on health authorities. The latter are subject to increasing attention from public authorities but, in order to evaluate policies for managing CoI, it is now indispensable to draw on empirical work focused on actors and their practices.

Our studies will allow us to provide systematic results for the field of medicines and also to open up comparisons with other fields affected by the question of CoI (chemicals, nuclear technology, air pollution, occupational health, etc.). Beyond the question of CoI, our project will also allow discussion about the framing of transparency as a key political issue and the social effects of increased possibilities for processing and disclosing information, whether related to decisions or to actors in a given area.

Publications

- Hélène Michel (2018) « Promesses et usages des dispositifs de transparence : entre approfondissement et redéfinition de la démocratie », Revue Française d’Administration Publique, n°165, 5-15.
- Boris Hauray (2018) « Dispositifs de transparence et régulation des conflits d’intérêts dans le domaine du médicament », Revue Française d’Administration Publique, n°165, 49-61.
- Hélène Michel (2018) « La transparence dans l’Union européenne : réalisation de la bonne gouvernance et redéfinition de la démocratie », Revue Française d’Administration Publique, n°168, 109-126.
- Boris Hauray (2019) « Une médecine détournée ? Influences industrielles et crise de confiance dans le domaine du médicament », Mouvements, n°98, à paraître.

Conférences organisées

- « Les conflits d’intérêts dans la recherche sur les OGM », Paris, 26 juin 2017
- « Intérêts agro-industriels et santé publique », Paris, 13 mai 2018
- « Des influences toxiques ? Industrie chimique et santé publique », Paris, 29 novembre 2018
- « Conflits d’intérêts et médicaments », Paris, 9 mai 2019
- Panel « Corporate Influence on Science and Regulation», 4S annual meeting, New Orleans, 4-7 septembre 2019

Communications

- Boris Hauray, Contrôler les conflits d’intérêts par la transparence ? Le cas du médicament, Congrès de l’AFSP, Montpellier, 10 juillet 2017.
- Boris Hauray, Conflict of Interest, Transparency and Medicines, Annual Meeting of the Society for Social Studies of Science, 31 août 2017.
- Boris Hauray, Transparency mechanisms and conflict of interest regulation. The case of pharmaceuticals, Conférence invitée Université de Tokyo, 20 juin 2018.
- Henri Boullier, Jean-Paul Gaudillière Boris Hauray, et Emmanuel Henry. Conceptualizing the Influence of Economic Interests on Public Health: Capture, Conflict of Interests, Making of Ignorance, Hegemony, Society for the Advancement of Socio-Economics, Kyoto, 25 juin 2018.

Over recent decades, the notion of ‘conflict of interest’ has become widespread as the lens through which to consider the pharmaceutical industry’s influence on the construction of scientific knowledge, on decisions taken by public authorities, and on prescription practices. However, despite the key role of medicines in health care and biomedical research, the strategic position of the pharmaceutical industry, and the increasing number of health crises, there has been little focus on this issue in the social sciences, unlike law and biomedical science.

Our multidisciplinary project (sociology, history, political science, and law) intends to analyse the problematisation of conflicts of interest in the pharmaceutical sector. We aim to understand how conflicts of interest have become a public problem and to analyse how the mechanisms used to manage them result from mobilisations, power relations, and compromises. Our intention is also to understand the effects (or lack of effects) that these dynamics have on the practices of actors in the sector (doctors, experts, officials from medicines agencies, firms, patient organisations, etc. ).

Our project is based on collaboration between teams from three research centres with complementary expertise. Six scientific tasks will be carried out, with a seventh devoted to comparison between studies but also between our field of inquiry and other sectors concerned by conflicts of interest. The first three scientific tasks will focus on different social spaces in which the problem of conflicts of interest has been raised (medical journals, regulatory authorities, and relationships between industry actors and doctors). The three other tasks will examine this work of problematisation looking at the specific ecosystems created by particularly controversial therapeutic classes offering a certain historical distance: appetite suppressants, hormone treatments and treatments for Alzheimer’s disease. Practice-focused empirical work is lacking in this area and our studies will therefore call upon a wide range of data (interviews, archives, prosopography and analysis of career paths, content and bibliometric analysis of publications, and virtual focus groups). The main focus of the project will be the French case. However, given the weight of the European Union in the legal regulation and evaluation of medicines, as well as the international nature of knowledge production in this field (with the United States playing a key role in this regard), our study will not be limited to France.

In a highly controversial context, our project aims to make an important contribution to the social science of health and to science studies, while also directly contributing to public debate and to the reflections developed on this topic within the field of medicines.