Conflict of interest and cost-effectiveness analysis.

M ORETHAN 30YEARSAGO, BRONOWSKI, WHO SPOKE so poetically about the ethos of science, wrote that “the body of scientists is trained to avoid and organized to resist every form of persuasion but the fact.” The values of science, he argued, are “inescapable conditions for its practice." But the practice of science, especially the biomedical sciences, has changed significantly since Bronowski made his observations. Increasingly, academic biomedicine has become commingled with corporate interests. Spurred by the burgeoning commercial opportunities of new discoveries such as those in genetics, the growth in academic-industry collaborations has created uneasiness among some observers who suspect that conditions beyond the pure facts of science can influence its outcome. During the mid-l980s, several medical journals, including JAMA, adopted policies on conflict of interest. According to 1 survey conducted in 1994-1995, nearly 50% of US medical journals with a circulation greater than 1000 had written policies regarding conflicts of interest. Those who support policies on author disclosure of financial interests in scientific publications generally do not assume that such policies will improve the quality of science. They recognize that transparency of interests is not an antidote to bias or misconduct in science but believe it can foster public trust. Others, skeptical of the emphasis given to financial interests as opposed to other potential sources of conflicts of interest, see no justification for requirements that raise suspicions without contributing to the scientific agenda.As noted by Rothman, conflict-of-interest policies are “ethically questionable, because they impugn authors with the implied accusation of wrongdoingwithout evidence andwithout recourse."Thus, without an empirically established connection between conflict of interest and scientific outcome, many scientists and journal editors who favor financial disclosure are inclined to view it as sound public relations or as a gesture of moral correctness. The journal Nature explained in an editorial that until there is evidence that “undeclared interests led to any