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学术界与产业界之间的联系。

The connection between academia and industry.

作者信息

Singh Ajai, Singh Shakuntala

出版信息

Mens Sana Monogr. 2005 Mar;3(1):5-35. doi: 10.4103/0973-1229.27876.

Abstract

The growing commercialization of research with its effect on the ethical conduct of researchers, and the advancement of scientific knowledge with its effect on the welfare or otherwise of patients, are areas of pressing concern today and need a serious, thorough study. Biomedical research, and its forward march, is becoming increasingly dependent on industry-academia proximity, both commercial and geographic. A realization of the commercial value of academic biomedical research coupled with its rapid and efficient utilization by industry is the major propelling force here. A number of well-intentioned writers in the field look to the whole development with optimism. But this partnership is a double-edged sword, for it carries with it the potential of an exciting future as much as the prospect of misappropriation and malevolence. Moreover, such partnerships have sometimes eroded public trust in the research enterprise itself.Connected to the growing clout of industry in institutions is concern about thecommercialization of research and resolving the 'patient or product' loyalty.There is ambivalence about industry funding and influence in academia, and a consequent 'approach-avoidance' conflict. If academia has to provide the patients and research talent, industry necessarily has to provide the finances and other facilities based on it. This is an invariable and essential agreement between the two parties that they can walk out of only at their own peril. The profound ethical concerns that industry funded research has brought center-stage need a close look, especially as they impact patients, research subjects, public trust, marketability of products, and research and professional credibility.How can the intermediate goal of industry (patient welfare) serve the purpose of the final goal of academia is the basic struggle for conscientious research institutions /associations. And how best the goal of maximizing profits can be best served, albeit suitably camouflaged as patient welfare throughout, is the concern of the pharmaceutical industry.A very great potential conflict of interest lies in the fact that academia needs the sophisticated instruments that only big funding can provide, while at the same time resists the attempts of the fund provider to set the agenda of research, protocol, design, publication, the works. Conflicts arise at many steps and levels of functioning, and are related to the expectations, competing interests, and conflicting priorities of the different entities involved, whether they are the academic medical centers, the funding agencies, the patients and their families, or the investors and venture capitalists.The public expects access to new treatments. Its appetite for innovation has been bolstered by the constant attention given by the press to new treatments and by the implicit promise from researchers of continuing advances. Similarly, patients demand privacy and control over information about themselves.It makes greater sense for genuine researchers to associate with large long-term industry players who have a track record of genuine hard-core discoveries, even if the process is slow (maybe), and the funding less (may not be).The element of control venture capitalists exert over the pharmaceutical industry is an under researched area for obvious reasons. But it needs further probing, for that will lay bare the pulls and pressures under which industry works.It makes sense for ethically minded researchers and institutions not to fall in the trap of stocks and equity investments in industry, howsoever attractive they appear, and get rid of them as soon as possible if they have them. If at all they want, it makes more sense to own stocks of larger well established concerns, for the stock upheavals being less, the pressure of the market-place, and of venture sharks, is likely to be lower too.While active participation by the researcher in the commercialization process may be greatly desired by industry, ostensibly in the name of creating value, academia must realize it is a bait it might find hard to swallow in the long run. It makes more sense for the researcher and institution to forego such temptations and/or walk out of such investments as soon as possible.While mainstream medicine and research are booming, as is connected industry, concerns about professional commitment to patient welfare are growing too. Increasing corporate influence is challenging certain long held and fundamental values of patient care, which will have far reaching implications for biomedical care and the future progress of mainstream medicine.

摘要

研究的日益商业化及其对研究人员道德行为的影响,以及科学知识的进步及其对患者福利或其他方面的影响,是当今迫切需要关注的领域,需要进行严肃、深入的研究。生物医学研究及其向前发展越来越依赖于产业与学术界在商业和地理上的接近。认识到学术生物医学研究的商业价值以及产业对其的快速有效利用是这里的主要推动力。该领域一些善意的作者对整个发展持乐观态度。但这种合作关系是一把双刃剑,因为它既带来了令人兴奋的未来潜力,也带来了挪用和恶意行为的可能性。此外,这种合作关系有时会侵蚀公众对研究事业本身的信任。

与产业在机构中日益增强的影响力相关的是对研究商业化以及解决“患者还是产品”忠诚度的担忧。对于产业在学术界的资金投入和影响存在矛盾心理,随之而来的是一种“趋近 - 回避”冲突。如果学术界必须提供患者和研究人才,那么产业必然要提供资金和其他基于此的设施。这是双方不可改变且至关重要的协议,任何一方违背都将自担风险。产业资助研究引发的深刻伦理问题已成为焦点,尤其当它们影响到患者、研究对象、公众信任、产品的市场适销性以及研究和专业信誉时。

产业的中间目标(患者福利)如何服务于学术界的最终目标,这是尽责的研究机构/协会面临的基本难题。而如何在始终巧妙伪装成患者福利的情况下,最好地实现利润最大化目标,则是制药行业所关心的。

一个非常大的潜在利益冲突在于,学术界需要只有大量资金才能提供的精密仪器,同时又抵制资金提供者试图设定研究议程、方案、设计、发表等各项事宜的企图。在运作的许多步骤和层面都会产生冲突,这些冲突与不同实体(无论是学术医疗中心、资助机构、患者及其家属,还是投资者和风险资本家)的期望、竞争利益和相互冲突 的优先事项有关。

公众期望能够获得新的治疗方法。媒体对新治疗方法的持续关注以及研究人员对持续进步的含蓄承诺,增强了公众对创新的渴望。同样,患者要求隐私并能掌控关于自己的信息。

对于真正的研究人员来说,与有真正重大发现记录的大型长期产业参与者合作更有意义,即便这个过程可能缓慢(也许),资金也可能较少(或许并非如此)。

风险资本家对制药行业施加控制的因素,由于明显原因是一个研究不足的领域。但它需要进一步探究,因为这将揭示产业运作背后的各种拉力和压力。

对于有道德意识的研究人员和机构来说,不要陷入对产业的股票和股权投资陷阱,无论它们看起来多么有吸引力,如果已经持有,应尽快脱手。如果他们确实想持有股票,持有大型成熟企业的股票更有意义,因为股票波动较小,来自市场和风险投资鲨鱼的压力可能也较低。

虽然产业表面上以创造价值之名非常希望研究人员积极参与商业化过程,但学术界必须意识到这可能是一个长期来看难以吞咽的诱饵。对研究人员和机构来说,放弃这种诱惑并尽快退出此类投资更有意义。

虽然主流医学和研究蓬勃发展,与之相关的产业也是如此,但对致力于患者福利的专业精神的担忧也在增加。企业影响力的不断增强正在挑战某些长期以来的基本患者护理价值观,这将对生物医学护理和主流医学的未来发展产生深远影响。

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