Research, innovation, and safety: Doing the right thing

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Nina Totenberg
Legal Affairs Correspondent, National Public Radio, Washington, DC

Panelists
Philip A. Pizzo, MD
Dean and Professor of Pediatrics and of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA

Thomas P. Stossel, MD
Professor of Medicine, Harvard Medical School, Boston, MA

P. Roy Vagelos, MD
Chairman, Regeneron Pharmaceuticals, Inc.; Chairman, Theravance, Inc.; Former CEO, Merck & Co., Inc.

Dr. Stossel reported that he has ownership interests in ZymeQuest, Inc., and in Critical Biologics Corp.; has intellectual property rights in Critical Biologics Corp.; has received consulting/advisory fees from Merck, Inc.; has received honoraria from Pfizer, Inc.; and has received royalties from Lippincott Williams & Wilkins.

All other participants reported that they have no financial interests, relationships, or affiliations that pose a potential conflict of interest with this article.

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Nina Totenberg
Legal Affairs Correspondent, National Public Radio, Washington, DC

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Philip A. Pizzo, MD
Dean and Professor of Pediatrics and of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA

Thomas P. Stossel, MD
Professor of Medicine, Harvard Medical School, Boston, MA

P. Roy Vagelos, MD
Chairman, Regeneron Pharmaceuticals, Inc.; Chairman, Theravance, Inc.; Former CEO, Merck & Co., Inc.

Dr. Stossel reported that he has ownership interests in ZymeQuest, Inc., and in Critical Biologics Corp.; has intellectual property rights in Critical Biologics Corp.; has received consulting/advisory fees from Merck, Inc.; has received honoraria from Pfizer, Inc.; and has received royalties from Lippincott Williams & Wilkins.

All other participants reported that they have no financial interests, relationships, or affiliations that pose a potential conflict of interest with this article.

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Moderator
Nina Totenberg
Legal Affairs Correspondent, National Public Radio, Washington, DC

Panelists
Philip A. Pizzo, MD
Dean and Professor of Pediatrics and of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA

Thomas P. Stossel, MD
Professor of Medicine, Harvard Medical School, Boston, MA

P. Roy Vagelos, MD
Chairman, Regeneron Pharmaceuticals, Inc.; Chairman, Theravance, Inc.; Former CEO, Merck & Co., Inc.

Dr. Stossel reported that he has ownership interests in ZymeQuest, Inc., and in Critical Biologics Corp.; has intellectual property rights in Critical Biologics Corp.; has received consulting/advisory fees from Merck, Inc.; has received honoraria from Pfizer, Inc.; and has received royalties from Lippincott Williams & Wilkins.

All other participants reported that they have no financial interests, relationships, or affiliations that pose a potential conflict of interest with this article.

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Medical devices and conflict of interest: Unique issues and an industry code to address them

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Paul A. LaViolette, MBA
Chief Operating Officer, Boston Scientific Corporation, Natick, MA; Member, Board of Directors, and Chairman, Special Committee on Codes of Ethics, AdvaMed

Correspondence: Paul A. LaViolette, Chief Operating Officer, Boston Scientific Corporation, One Boston Scientific Place, Natick, MA 01760; [email protected]

Acknowledgment: The author is indebted to two individuals for their contributions to concepts discussed in this article: Donald S. Baim, MD, of Boston Scientific, and Christopher L. White of AdvaMed. Dr. Baim has coauthored a manuscript on this topic entitled “Medical Device Development: A Balanced Approach to Managing Conflicts of Interest Encountered by Physicians,” resulting in part from the 3rd Dartmouth Device Development Symposium (3D3), October 27 and 28, 2005.

Mr. LaViolette reported that he has no financial interests, relationships, or affiliations that pose a potential conflict of interest with this article apart from his employment with Boston Scientific Corp., from which he receives a salary and in which he holds ownership interest.

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Correspondence: Paul A. LaViolette, Chief Operating Officer, Boston Scientific Corporation, One Boston Scientific Place, Natick, MA 01760; [email protected]

Acknowledgment: The author is indebted to two individuals for their contributions to concepts discussed in this article: Donald S. Baim, MD, of Boston Scientific, and Christopher L. White of AdvaMed. Dr. Baim has coauthored a manuscript on this topic entitled “Medical Device Development: A Balanced Approach to Managing Conflicts of Interest Encountered by Physicians,” resulting in part from the 3rd Dartmouth Device Development Symposium (3D3), October 27 and 28, 2005.

Mr. LaViolette reported that he has no financial interests, relationships, or affiliations that pose a potential conflict of interest with this article apart from his employment with Boston Scientific Corp., from which he receives a salary and in which he holds ownership interest.

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Paul A. LaViolette, MBA
Chief Operating Officer, Boston Scientific Corporation, Natick, MA; Member, Board of Directors, and Chairman, Special Committee on Codes of Ethics, AdvaMed

Correspondence: Paul A. LaViolette, Chief Operating Officer, Boston Scientific Corporation, One Boston Scientific Place, Natick, MA 01760; [email protected]

Acknowledgment: The author is indebted to two individuals for their contributions to concepts discussed in this article: Donald S. Baim, MD, of Boston Scientific, and Christopher L. White of AdvaMed. Dr. Baim has coauthored a manuscript on this topic entitled “Medical Device Development: A Balanced Approach to Managing Conflicts of Interest Encountered by Physicians,” resulting in part from the 3rd Dartmouth Device Development Symposium (3D3), October 27 and 28, 2005.

Mr. LaViolette reported that he has no financial interests, relationships, or affiliations that pose a potential conflict of interest with this article apart from his employment with Boston Scientific Corp., from which he receives a salary and in which he holds ownership interest.

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Guiding principles: Where are we headed?

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Nina Totenberg

Legal Affairs Correspondent, National Public Radio, Washington, DC

Panelists
Darrell G. Kirch, MD

President and CEO, Association of American Medical Colleges, Washington, DC

Paul A. LaViolette, MBA
Chief Operating Officer, Boston Scientific Corporation, Natick, MA; Member, Board of Directors, and Chairman, Special Committee on Codes of Ethics, AdvaMed

Norka Ruiz Bravo, PhD
Deputy Director for Extramural Research, National Institutes of Health, Bethesda, MD

Mr. LaViolette reported that he has no financial interests or relationships that pose a potential conflict of interest with this article apart from his employment with Boston Scientific Corp., from which he receives a salary and in which he holds ownership interest.

All other participants reported that they have no financial interests, relationships, or affiliations that pose a potential conflict of interest with this article.

 

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Nina Totenberg

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Darrell G. Kirch, MD

President and CEO, Association of American Medical Colleges, Washington, DC

Paul A. LaViolette, MBA
Chief Operating Officer, Boston Scientific Corporation, Natick, MA; Member, Board of Directors, and Chairman, Special Committee on Codes of Ethics, AdvaMed

Norka Ruiz Bravo, PhD
Deputy Director for Extramural Research, National Institutes of Health, Bethesda, MD

Mr. LaViolette reported that he has no financial interests or relationships that pose a potential conflict of interest with this article apart from his employment with Boston Scientific Corp., from which he receives a salary and in which he holds ownership interest.

All other participants reported that they have no financial interests, relationships, or affiliations that pose a potential conflict of interest with this article.

 

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Nina Totenberg

Legal Affairs Correspondent, National Public Radio, Washington, DC

Panelists
Darrell G. Kirch, MD

President and CEO, Association of American Medical Colleges, Washington, DC

Paul A. LaViolette, MBA
Chief Operating Officer, Boston Scientific Corporation, Natick, MA; Member, Board of Directors, and Chairman, Special Committee on Codes of Ethics, AdvaMed

Norka Ruiz Bravo, PhD
Deputy Director for Extramural Research, National Institutes of Health, Bethesda, MD

Mr. LaViolette reported that he has no financial interests or relationships that pose a potential conflict of interest with this article apart from his employment with Boston Scientific Corp., from which he receives a salary and in which he holds ownership interest.

All other participants reported that they have no financial interests, relationships, or affiliations that pose a potential conflict of interest with this article.

 

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Applications in the real world: Case studies in defining boundaries and managing innovation

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Executive Associate Dean, Administration and Faculty Affairs, Emory University School of Medicine, Atlanta, GA

Author of Case Study 1
Michael J. Meehan, Esq

Senior Counsel and Corporate Assistant Secretary, Cleveland Clinic, Cleveland, OH

Panelists
Gail H. Cassell, PhD, DSc (hon)

Vice President, Scientific Affairs, and Distinguished Lilly Research Scholar for Infectious Diseases, Eli Lilly and Company, Indianapolis, IN

Jeffrey P. Kahn, PhD, MPH
Maas Family Chair in Bioethics and Director, Center for Bioethics, University of Minnesota, Minneapolis, MN

Philip A. Pizzo, MD
Dean and Professor of Pediatrics and of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA

Thomas P. Stossel, MD
Professor of Medicine, Harvard Medical School, Boston, MA

Dr. Cassell reported that she receives a salary, grant/research support, and stock options through her employment with Eli Lilly and Company.

Dr. Stossel reported that he has ownership interests in ZymeQuest, Inc., and in Critical Biologics Corp.; has intellectual property rights in Critical Biologics Corp.; has received consulting/advisory fees from Merck, Inc.; has received honoraria from Pfizer, Inc.; and has received royalties from Lippincott Williams & Wilkins.

All other participants reported that they have no financial interests, relationships, or affiliations that pose a potential conflict of interest with this article.

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Executive Associate Dean, Administration and Faculty Affairs, Emory University School of Medicine, Atlanta, GA

Author of Case Study 1
Michael J. Meehan, Esq

Senior Counsel and Corporate Assistant Secretary, Cleveland Clinic, Cleveland, OH

Panelists
Gail H. Cassell, PhD, DSc (hon)

Vice President, Scientific Affairs, and Distinguished Lilly Research Scholar for Infectious Diseases, Eli Lilly and Company, Indianapolis, IN

Jeffrey P. Kahn, PhD, MPH
Maas Family Chair in Bioethics and Director, Center for Bioethics, University of Minnesota, Minneapolis, MN

Philip A. Pizzo, MD
Dean and Professor of Pediatrics and of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA

Thomas P. Stossel, MD
Professor of Medicine, Harvard Medical School, Boston, MA

Dr. Cassell reported that she receives a salary, grant/research support, and stock options through her employment with Eli Lilly and Company.

Dr. Stossel reported that he has ownership interests in ZymeQuest, Inc., and in Critical Biologics Corp.; has intellectual property rights in Critical Biologics Corp.; has received consulting/advisory fees from Merck, Inc.; has received honoraria from Pfizer, Inc.; and has received royalties from Lippincott Williams & Wilkins.

All other participants reported that they have no financial interests, relationships, or affiliations that pose a potential conflict of interest with this article.

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Claudia R. Adkison, JD, PhD

Executive Associate Dean, Administration and Faculty Affairs, Emory University School of Medicine, Atlanta, GA

Author of Case Study 1
Michael J. Meehan, Esq

Senior Counsel and Corporate Assistant Secretary, Cleveland Clinic, Cleveland, OH

Panelists
Gail H. Cassell, PhD, DSc (hon)

Vice President, Scientific Affairs, and Distinguished Lilly Research Scholar for Infectious Diseases, Eli Lilly and Company, Indianapolis, IN

Jeffrey P. Kahn, PhD, MPH
Maas Family Chair in Bioethics and Director, Center for Bioethics, University of Minnesota, Minneapolis, MN

Philip A. Pizzo, MD
Dean and Professor of Pediatrics and of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA

Thomas P. Stossel, MD
Professor of Medicine, Harvard Medical School, Boston, MA

Dr. Cassell reported that she receives a salary, grant/research support, and stock options through her employment with Eli Lilly and Company.

Dr. Stossel reported that he has ownership interests in ZymeQuest, Inc., and in Critical Biologics Corp.; has intellectual property rights in Critical Biologics Corp.; has received consulting/advisory fees from Merck, Inc.; has received honoraria from Pfizer, Inc.; and has received royalties from Lippincott Williams & Wilkins.

All other participants reported that they have no financial interests, relationships, or affiliations that pose a potential conflict of interest with this article.

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Conflicts, compliance, and enforcement: Government priorities and initiatives

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Jeffrey P. Kahn, PhD, MPH

Maas Family Chair in Bioethics and Director, Center for Bioethics, University of Minnesota, Minneapolis, MN

Panelists
Bernard A. Schwetz, DVM, PhD

Director, Office for Human Research Protections, US Department of Health and Human Services, Washington, DC

James G. Sheehan
Associate US Attorney, US Attorney’s Office, US Department of Justice, Philadelphia, PA

Drs. Kahn and Schwetz reported that they have no financial interests, relationships, or affiliations that pose a potential conflict of interest with this article.

Mr. Sheehan reported no such interests, relationships, or affiliations apart from his salary from the US Department of Justice.

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Maas Family Chair in Bioethics and Director, Center for Bioethics, University of Minnesota, Minneapolis, MN

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Bernard A. Schwetz, DVM, PhD

Director, Office for Human Research Protections, US Department of Health and Human Services, Washington, DC

James G. Sheehan
Associate US Attorney, US Attorney’s Office, US Department of Justice, Philadelphia, PA

Drs. Kahn and Schwetz reported that they have no financial interests, relationships, or affiliations that pose a potential conflict of interest with this article.

Mr. Sheehan reported no such interests, relationships, or affiliations apart from his salary from the US Department of Justice.

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Jeffrey P. Kahn, PhD, MPH

Maas Family Chair in Bioethics and Director, Center for Bioethics, University of Minnesota, Minneapolis, MN

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Bernard A. Schwetz, DVM, PhD

Director, Office for Human Research Protections, US Department of Health and Human Services, Washington, DC

James G. Sheehan
Associate US Attorney, US Attorney’s Office, US Department of Justice, Philadelphia, PA

Drs. Kahn and Schwetz reported that they have no financial interests, relationships, or affiliations that pose a potential conflict of interest with this article.

Mr. Sheehan reported no such interests, relationships, or affiliations apart from his salary from the US Department of Justice.

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Proceedings of A National Dialogue on Biomedical Conflicts of Interest and Innovation Management

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Proceedings of a National Dialogue on Biomedical Conflicts of Interest and Innovation Management

Supplement Editor:
Guy M. Chisolm III, PhD

Contents

From the editor
The rapidly changing landscape of biomedical conflicts of interest
Guy M. Chisolm III, PhD, Vice Chairman, Lerner Research Institute, and Professor, Department of Cell Biology, Cleveland Clinic

Opening comments
The mandate of innovation management
Delos M. Cosgrove, MD, CEO and President, Cleveland Clinic

Research, Innovation, and Safety: Doing the Right Thing
Prologue: A case study in biomedical conflicts
Nina Totenberg, Legal Affairs Correspondent, National Public Radio

Fostering innovation without compromising integrity
Philip A. Pizzo, MD, Dean and Professor of Pediatrics and of Microbiology and Immunology, Stanford University School of Medicine

Innovation and industry-academia interactions:Where conflicts arise and measures to avoid them
P. Roy Vagelos, MD, Chairman, Regeneron Pharmaceuticals, Inc.; Chairman, Theravance, Inc.; Former CEO, Merck & Co., Inc.

Overregulation of conflicts hinders medical progress
Thomas P. Stossel, MD, Professor of Medicine, Harvard Medical School

Panel discussion: Research, innovation, and safety: Doing the right thing
Moderated by Nina Totenberg, Legal Affairs Correspondent, National Public Radio
Panelists: Philip A. Pizzo, MD; Thomas P. Stossel, MD; and P. Roy Vagelos, MD

Guiding Principles:Where Are We Headed?
Conflict-of-interest management: Efforts and insights from the Association of American Medical Colleges
Darrell G. Kirch, MD, President and CEO, Association of American Medical Colleges

Medical devices and conflict of interest: Unique issues and an industry code to address them
Paul A. LaViolette, MBA, Chief Operating Officer, Boston Scientific Corporation; Member, Board of Directors, and Chairman, Special Committee on Codes of Ethics, AdvaMed

The challenge for NIH ethics policies: Preserving public trust and biomedical progress
Norka Ruiz Bravo, PhD, Deputy Director for Extramural Research, National Institutes of Health

Panel discussion: Guiding principles:Where are we headed?
Moderated by Nina Totenberg, Legal Affairs Correspondent, National Public Radio
Panelists: Darrell G. Kirch, MD; Paul A. LaViolette, MBA; and Norka Ruiz Bravo, PhD

Keynote Address
Building and retaining trust in the biomedical community
Dick Thornburgh, Counsel, K & L Gates; Former Governor of Pennsylvania; Former Attorney General of the United States

Applications in the Real World: Defining Boundaries and Managing Innovation
Interactions of the public and private sectors in drug development: Boundaries to protect scientific values while preserving innovation
Gail H. Cassell, PhD, DSc (hon), Vice President, Scientific Affairs, and Distinguished Lilly Research Scholar for Infectious Diseases, Eli Lilly and Company

Beyond disclosure: The necessity of trust in biomedical research
Jeffrey P. Kahn, PhD, MPH, Maas Family Chair in Bioethics and Director, Center for Bioethics, University of Minnesota

Panel discussion: Applications in the real world: Case studies in defining boundaries and managing innovation
Moderated by Claudia R. Adkison, JD, PhD, Executive Associate Dean, Administration and Faculty Affairs, Emory University School of Medicine
Case studies submitted by Michael J. Meehan, Esq., Senior Counsel and Corporate Assistant Secretary, Cleveland Clinic, and Claudia R. Adkison, JD, PhD
Panelists: Gail H. Cassell, PhD, DSc (hon); Jeffrey P. Kahn, PhD, MPH; Philip A. Pizzo, MD; and Thomas P. Stossel, MD

Conflicts, Compliance, and Enforcement: Government Priorities and Initiatives
Protecting subjects without hampering research progress: Guidance from the Office for Human Research Protections
Bernard A. Schwetz, DVM, PhD, Director, Office for Human Research Protections, US Department of Health and Human Services

Fraud, conflict of interest, and other enforcement issues in clinical research
James G. Sheehan, Associate US Attorney, US Attorney’s Office, US Department of Justice

Panel discussion: Conflicts, compliance, and enforcement: Government priorities and initiatives
Moderated by Jeffrey P. Kahn, PhD, MPH, Maas Family Chair in Bioethics and Director, Center for Bioethics, University of Minnesota
Panelists: Bernard A. Schwetz, DVM, PhD, and James G. Sheehan

Guidelines and Performance: Creating a Culture of Ethics
Creating an institutional conflict-of-interest policy at Johns Hopkins: Progress and lessons learned
Edward D. Miller, MD, Dean of the Medical Faculty, Johns Hopkins School of Medicine; CEO, Johns Hopkins Medicine

Managing ethical performance in organizations: Insights from the corporate world
Edward Soule, CPA, PhD, Associate Professor, McDonough School of Business, Georgetown University

Panel discussion: Guidelines and performance: Creating a culture of ethics
Moderated by Susan H. Ehringhaus, JD, Associate General Counsel for Regulatory Affairs, Association of American Medical Colleges
Panelists: Edward D. Miller, MD, and Edward Soule, CPA, PhD

Articles in these proceedings were developed by the Cleveland Clinic Journal of Medicine staff from transcripts of audiotaped presentations at the “National Dialogue on Biomedical Conflicts of Interest and Innovation Management” and then reviewed and revised by the respective speakers.

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Cleveland Clinic Journal of Medicine - 74(3)
Publications
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S1-S80
Sections
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Article PDF

Supplement Editor:
Guy M. Chisolm III, PhD

Contents

From the editor
The rapidly changing landscape of biomedical conflicts of interest
Guy M. Chisolm III, PhD, Vice Chairman, Lerner Research Institute, and Professor, Department of Cell Biology, Cleveland Clinic

Opening comments
The mandate of innovation management
Delos M. Cosgrove, MD, CEO and President, Cleveland Clinic

Research, Innovation, and Safety: Doing the Right Thing
Prologue: A case study in biomedical conflicts
Nina Totenberg, Legal Affairs Correspondent, National Public Radio

Fostering innovation without compromising integrity
Philip A. Pizzo, MD, Dean and Professor of Pediatrics and of Microbiology and Immunology, Stanford University School of Medicine

Innovation and industry-academia interactions:Where conflicts arise and measures to avoid them
P. Roy Vagelos, MD, Chairman, Regeneron Pharmaceuticals, Inc.; Chairman, Theravance, Inc.; Former CEO, Merck & Co., Inc.

Overregulation of conflicts hinders medical progress
Thomas P. Stossel, MD, Professor of Medicine, Harvard Medical School

Panel discussion: Research, innovation, and safety: Doing the right thing
Moderated by Nina Totenberg, Legal Affairs Correspondent, National Public Radio
Panelists: Philip A. Pizzo, MD; Thomas P. Stossel, MD; and P. Roy Vagelos, MD

Guiding Principles:Where Are We Headed?
Conflict-of-interest management: Efforts and insights from the Association of American Medical Colleges
Darrell G. Kirch, MD, President and CEO, Association of American Medical Colleges

Medical devices and conflict of interest: Unique issues and an industry code to address them
Paul A. LaViolette, MBA, Chief Operating Officer, Boston Scientific Corporation; Member, Board of Directors, and Chairman, Special Committee on Codes of Ethics, AdvaMed

The challenge for NIH ethics policies: Preserving public trust and biomedical progress
Norka Ruiz Bravo, PhD, Deputy Director for Extramural Research, National Institutes of Health

Panel discussion: Guiding principles:Where are we headed?
Moderated by Nina Totenberg, Legal Affairs Correspondent, National Public Radio
Panelists: Darrell G. Kirch, MD; Paul A. LaViolette, MBA; and Norka Ruiz Bravo, PhD

Keynote Address
Building and retaining trust in the biomedical community
Dick Thornburgh, Counsel, K & L Gates; Former Governor of Pennsylvania; Former Attorney General of the United States

Applications in the Real World: Defining Boundaries and Managing Innovation
Interactions of the public and private sectors in drug development: Boundaries to protect scientific values while preserving innovation
Gail H. Cassell, PhD, DSc (hon), Vice President, Scientific Affairs, and Distinguished Lilly Research Scholar for Infectious Diseases, Eli Lilly and Company

Beyond disclosure: The necessity of trust in biomedical research
Jeffrey P. Kahn, PhD, MPH, Maas Family Chair in Bioethics and Director, Center for Bioethics, University of Minnesota

Panel discussion: Applications in the real world: Case studies in defining boundaries and managing innovation
Moderated by Claudia R. Adkison, JD, PhD, Executive Associate Dean, Administration and Faculty Affairs, Emory University School of Medicine
Case studies submitted by Michael J. Meehan, Esq., Senior Counsel and Corporate Assistant Secretary, Cleveland Clinic, and Claudia R. Adkison, JD, PhD
Panelists: Gail H. Cassell, PhD, DSc (hon); Jeffrey P. Kahn, PhD, MPH; Philip A. Pizzo, MD; and Thomas P. Stossel, MD

Conflicts, Compliance, and Enforcement: Government Priorities and Initiatives
Protecting subjects without hampering research progress: Guidance from the Office for Human Research Protections
Bernard A. Schwetz, DVM, PhD, Director, Office for Human Research Protections, US Department of Health and Human Services

Fraud, conflict of interest, and other enforcement issues in clinical research
James G. Sheehan, Associate US Attorney, US Attorney’s Office, US Department of Justice

Panel discussion: Conflicts, compliance, and enforcement: Government priorities and initiatives
Moderated by Jeffrey P. Kahn, PhD, MPH, Maas Family Chair in Bioethics and Director, Center for Bioethics, University of Minnesota
Panelists: Bernard A. Schwetz, DVM, PhD, and James G. Sheehan

Guidelines and Performance: Creating a Culture of Ethics
Creating an institutional conflict-of-interest policy at Johns Hopkins: Progress and lessons learned
Edward D. Miller, MD, Dean of the Medical Faculty, Johns Hopkins School of Medicine; CEO, Johns Hopkins Medicine

Managing ethical performance in organizations: Insights from the corporate world
Edward Soule, CPA, PhD, Associate Professor, McDonough School of Business, Georgetown University

Panel discussion: Guidelines and performance: Creating a culture of ethics
Moderated by Susan H. Ehringhaus, JD, Associate General Counsel for Regulatory Affairs, Association of American Medical Colleges
Panelists: Edward D. Miller, MD, and Edward Soule, CPA, PhD

Articles in these proceedings were developed by the Cleveland Clinic Journal of Medicine staff from transcripts of audiotaped presentations at the “National Dialogue on Biomedical Conflicts of Interest and Innovation Management” and then reviewed and revised by the respective speakers.

Supplement Editor:
Guy M. Chisolm III, PhD

Contents

From the editor
The rapidly changing landscape of biomedical conflicts of interest
Guy M. Chisolm III, PhD, Vice Chairman, Lerner Research Institute, and Professor, Department of Cell Biology, Cleveland Clinic

Opening comments
The mandate of innovation management
Delos M. Cosgrove, MD, CEO and President, Cleveland Clinic

Research, Innovation, and Safety: Doing the Right Thing
Prologue: A case study in biomedical conflicts
Nina Totenberg, Legal Affairs Correspondent, National Public Radio

Fostering innovation without compromising integrity
Philip A. Pizzo, MD, Dean and Professor of Pediatrics and of Microbiology and Immunology, Stanford University School of Medicine

Innovation and industry-academia interactions:Where conflicts arise and measures to avoid them
P. Roy Vagelos, MD, Chairman, Regeneron Pharmaceuticals, Inc.; Chairman, Theravance, Inc.; Former CEO, Merck & Co., Inc.

Overregulation of conflicts hinders medical progress
Thomas P. Stossel, MD, Professor of Medicine, Harvard Medical School

Panel discussion: Research, innovation, and safety: Doing the right thing
Moderated by Nina Totenberg, Legal Affairs Correspondent, National Public Radio
Panelists: Philip A. Pizzo, MD; Thomas P. Stossel, MD; and P. Roy Vagelos, MD

Guiding Principles:Where Are We Headed?
Conflict-of-interest management: Efforts and insights from the Association of American Medical Colleges
Darrell G. Kirch, MD, President and CEO, Association of American Medical Colleges

Medical devices and conflict of interest: Unique issues and an industry code to address them
Paul A. LaViolette, MBA, Chief Operating Officer, Boston Scientific Corporation; Member, Board of Directors, and Chairman, Special Committee on Codes of Ethics, AdvaMed

The challenge for NIH ethics policies: Preserving public trust and biomedical progress
Norka Ruiz Bravo, PhD, Deputy Director for Extramural Research, National Institutes of Health

Panel discussion: Guiding principles:Where are we headed?
Moderated by Nina Totenberg, Legal Affairs Correspondent, National Public Radio
Panelists: Darrell G. Kirch, MD; Paul A. LaViolette, MBA; and Norka Ruiz Bravo, PhD

Keynote Address
Building and retaining trust in the biomedical community
Dick Thornburgh, Counsel, K & L Gates; Former Governor of Pennsylvania; Former Attorney General of the United States

Applications in the Real World: Defining Boundaries and Managing Innovation
Interactions of the public and private sectors in drug development: Boundaries to protect scientific values while preserving innovation
Gail H. Cassell, PhD, DSc (hon), Vice President, Scientific Affairs, and Distinguished Lilly Research Scholar for Infectious Diseases, Eli Lilly and Company

Beyond disclosure: The necessity of trust in biomedical research
Jeffrey P. Kahn, PhD, MPH, Maas Family Chair in Bioethics and Director, Center for Bioethics, University of Minnesota

Panel discussion: Applications in the real world: Case studies in defining boundaries and managing innovation
Moderated by Claudia R. Adkison, JD, PhD, Executive Associate Dean, Administration and Faculty Affairs, Emory University School of Medicine
Case studies submitted by Michael J. Meehan, Esq., Senior Counsel and Corporate Assistant Secretary, Cleveland Clinic, and Claudia R. Adkison, JD, PhD
Panelists: Gail H. Cassell, PhD, DSc (hon); Jeffrey P. Kahn, PhD, MPH; Philip A. Pizzo, MD; and Thomas P. Stossel, MD

Conflicts, Compliance, and Enforcement: Government Priorities and Initiatives
Protecting subjects without hampering research progress: Guidance from the Office for Human Research Protections
Bernard A. Schwetz, DVM, PhD, Director, Office for Human Research Protections, US Department of Health and Human Services

Fraud, conflict of interest, and other enforcement issues in clinical research
James G. Sheehan, Associate US Attorney, US Attorney’s Office, US Department of Justice

Panel discussion: Conflicts, compliance, and enforcement: Government priorities and initiatives
Moderated by Jeffrey P. Kahn, PhD, MPH, Maas Family Chair in Bioethics and Director, Center for Bioethics, University of Minnesota
Panelists: Bernard A. Schwetz, DVM, PhD, and James G. Sheehan

Guidelines and Performance: Creating a Culture of Ethics
Creating an institutional conflict-of-interest policy at Johns Hopkins: Progress and lessons learned
Edward D. Miller, MD, Dean of the Medical Faculty, Johns Hopkins School of Medicine; CEO, Johns Hopkins Medicine

Managing ethical performance in organizations: Insights from the corporate world
Edward Soule, CPA, PhD, Associate Professor, McDonough School of Business, Georgetown University

Panel discussion: Guidelines and performance: Creating a culture of ethics
Moderated by Susan H. Ehringhaus, JD, Associate General Counsel for Regulatory Affairs, Association of American Medical Colleges
Panelists: Edward D. Miller, MD, and Edward Soule, CPA, PhD

Articles in these proceedings were developed by the Cleveland Clinic Journal of Medicine staff from transcripts of audiotaped presentations at the “National Dialogue on Biomedical Conflicts of Interest and Innovation Management” and then reviewed and revised by the respective speakers.

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Guidelines and performance: Creating a culture of ethics

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Dean of the Medical Faculty, Johns Hopkins School of Medicine, and CEO, Johns Hopkins Medicine, Baltimore, MD

Edward Soule, CPA, PhD
Associate Professor, McDonough School of Business, Georgetown University,Washington, DC

All participants reported that they have no financial interests, relationships, or affiliations that pose a potential conflict of interest with this article.

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Dean of the Medical Faculty, Johns Hopkins School of Medicine, and CEO, Johns Hopkins Medicine, Baltimore, MD

Edward Soule, CPA, PhD
Associate Professor, McDonough School of Business, Georgetown University,Washington, DC

All participants reported that they have no financial interests, relationships, or affiliations that pose a potential conflict of interest with this article.

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Associate General Counsel for Regulatory Affairs, Association of American Medical Colleges, Washington, DC

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Dean of the Medical Faculty, Johns Hopkins School of Medicine, and CEO, Johns Hopkins Medicine, Baltimore, MD

Edward Soule, CPA, PhD
Associate Professor, McDonough School of Business, Georgetown University,Washington, DC

All participants reported that they have no financial interests, relationships, or affiliations that pose a potential conflict of interest with this article.

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Raising hemoglobin levels to normal range for chronic kidney failure patients may be too risky

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Hemoglobin concentrations in the high normal range in patients with anemia due to chronic kidney disease result in an excess risk of major adverse events, reported Arintaya Phrommintikul, MD, and colleagues from Monash University, Melbourne, Australia.

Adverse events include death, arteriovenous access thrombosis, and poorly controlled hypertension.

The investigators conducted a meta-analysis of 9 randomized controlled studies that enrolled 5143 patients treated with recombinant human erythropoietin.

Patients in the group targeted for a higher hemoglobin level (120-160 g/L) had a higher risk for all-cause mortality than patients in the lower hemoglobin target group (< 120 g/L) (risk ratio 1.17, P = 0.031).

There was also a higher risk for arteriovenous access thrombosis (risk ratio 1.34, P=0.0001) as well as a significantly higher risk of poorly controlled blood pressure (risk ratio 1.27, P=0.004) in the higher hemoglobin target group. The incidence of myocardial infarction was similar in the two groups.

Current guidelines recommend the maintenance of hemoglobin concentrations at 110 g/L or higher, based mainly on evidence of benefit in quality-of-life measures.

Current guidelines do not include an upper limit for the target hemoglobin concentration. The authors suggest that an upper limit should be added in future revisions of guideline recommendations.

The study was published in the 3 February 2007 issue of Lancet

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Hemoglobin concentrations in the high normal range in patients with anemia due to chronic kidney disease result in an excess risk of major adverse events, reported Arintaya Phrommintikul, MD, and colleagues from Monash University, Melbourne, Australia.

Adverse events include death, arteriovenous access thrombosis, and poorly controlled hypertension.

The investigators conducted a meta-analysis of 9 randomized controlled studies that enrolled 5143 patients treated with recombinant human erythropoietin.

Patients in the group targeted for a higher hemoglobin level (120-160 g/L) had a higher risk for all-cause mortality than patients in the lower hemoglobin target group (< 120 g/L) (risk ratio 1.17, P = 0.031).

There was also a higher risk for arteriovenous access thrombosis (risk ratio 1.34, P=0.0001) as well as a significantly higher risk of poorly controlled blood pressure (risk ratio 1.27, P=0.004) in the higher hemoglobin target group. The incidence of myocardial infarction was similar in the two groups.

Current guidelines recommend the maintenance of hemoglobin concentrations at 110 g/L or higher, based mainly on evidence of benefit in quality-of-life measures.

Current guidelines do not include an upper limit for the target hemoglobin concentration. The authors suggest that an upper limit should be added in future revisions of guideline recommendations.

The study was published in the 3 February 2007 issue of Lancet

Hemoglobin concentrations in the high normal range in patients with anemia due to chronic kidney disease result in an excess risk of major adverse events, reported Arintaya Phrommintikul, MD, and colleagues from Monash University, Melbourne, Australia.

Adverse events include death, arteriovenous access thrombosis, and poorly controlled hypertension.

The investigators conducted a meta-analysis of 9 randomized controlled studies that enrolled 5143 patients treated with recombinant human erythropoietin.

Patients in the group targeted for a higher hemoglobin level (120-160 g/L) had a higher risk for all-cause mortality than patients in the lower hemoglobin target group (< 120 g/L) (risk ratio 1.17, P = 0.031).

There was also a higher risk for arteriovenous access thrombosis (risk ratio 1.34, P=0.0001) as well as a significantly higher risk of poorly controlled blood pressure (risk ratio 1.27, P=0.004) in the higher hemoglobin target group. The incidence of myocardial infarction was similar in the two groups.

Current guidelines recommend the maintenance of hemoglobin concentrations at 110 g/L or higher, based mainly on evidence of benefit in quality-of-life measures.

Current guidelines do not include an upper limit for the target hemoglobin concentration. The authors suggest that an upper limit should be added in future revisions of guideline recommendations.

The study was published in the 3 February 2007 issue of Lancet

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Isosorbide dinitrate-hydralazine improves outcomes in African Americans with heart failure

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Interpreting the African American Heart Failure Trial (A-HeFT)
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Monica Colvin-Adams, MD
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Anne L. Taylor, MD
Professor of Medicine/Cardiology and Associate Dean for Faculty Affairs, University of Minnesota Medical School; Codirector, University of Minnesota National Center of Excellence in Women’s Health; Chair, Steering Committee, African-American Heart Failure Trial (A-HeFT)

Address: Anne L. Taylor, MD, University of Minnesota Medical School, C694 Mayo Memorial Building, Mayo Mail Code 293, 420 Delaware Street, S.E., Minneapolis, MN 55455; e-mail: [email protected]

Dr. Taylor has indicated that she has received research support and consulting fees from the NitroMed corporation, which also sponsored the African-American Heart Failure Trial.

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Monica Colvin-Adams, MD
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Anne L. Taylor, MD
Professor of Medicine/Cardiology and Associate Dean for Faculty Affairs, University of Minnesota Medical School; Codirector, University of Minnesota National Center of Excellence in Women’s Health; Chair, Steering Committee, African-American Heart Failure Trial (A-HeFT)

Address: Anne L. Taylor, MD, University of Minnesota Medical School, C694 Mayo Memorial Building, Mayo Mail Code 293, 420 Delaware Street, S.E., Minneapolis, MN 55455; e-mail: [email protected]

Dr. Taylor has indicated that she has received research support and consulting fees from the NitroMed corporation, which also sponsored the African-American Heart Failure Trial.

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Monica Colvin-Adams, MD
Assistant Professor of Medicine/Cardiology; Medical Director, Cardiac Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN

Anne L. Taylor, MD
Professor of Medicine/Cardiology and Associate Dean for Faculty Affairs, University of Minnesota Medical School; Codirector, University of Minnesota National Center of Excellence in Women’s Health; Chair, Steering Committee, African-American Heart Failure Trial (A-HeFT)

Address: Anne L. Taylor, MD, University of Minnesota Medical School, C694 Mayo Memorial Building, Mayo Mail Code 293, 420 Delaware Street, S.E., Minneapolis, MN 55455; e-mail: [email protected]

Dr. Taylor has indicated that she has received research support and consulting fees from the NitroMed corporation, which also sponsored the African-American Heart Failure Trial.

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Interpreting the African American Heart Failure Trial (A-HeFT)
Interpreting the African American Heart Failure Trial (A-HeFT)
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If you have celiac disease

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