New England Journal, Conflict of Interest and Amgen

Quite a battle has broken out over the decision of the NEJM not to publish an editorial by Robert Steinbrook MD which is highly critical of the ways in which Amgen's Epoetin is prescribed in the U.S. There are no agreed upon maximum levels for hemoglobin and it appears as if Epo is being over prescribed at bigger than necessary doses by the for-profit dialysis industry. Steinbrook's editorial was published in the Lancet. Questions also have arisen about why the Journal chose to have Julie Ingelfinger write an editorial to substitute for Steinbrook's when she has close ties to the NKF--an organization that receives a significant percentage of its funding from Amgen.

It is still very clear that the management of conflicts of interest for universities, journals, academic health centers and even bioethics centers remains conflicted with no consensus on mimimal rules or about what constitutes a conflict. The academic and journal communities would be well-served in the coming year to convene a blue-ribbon panel to write a report on COI that might serve as the starting point for addressing the complex questions involved. - Arthur Caplan