Ties That Bind

Abstract
Interactions between medical specialists and pharmaceutical manufacturers are important for the development and evaluation of new medicines. However, interaction with industry has the capacity to create conflicts of interest. While these risks are well recognized, studies have shown that physicians underestimate the potential for different interactions to cause problems. For instance, many do not consider that acceptance of small gifts creates an ethical dilemma.1-3 Interaction with industry in one area may lead to the development of other ties. The development of multiple ties may blur professional boundaries and responsibilities. Research collaboration, an important and growing area of engagement between industry and clinical researchers, may lead to other significant relationships, such as advisory panel membership, payment for consultation to the industry, and substantial recompense to attend international conferences.4-6 These ties may create a sense of collegiality, and the resulting obligation and need to reciprocate may not be consciously felt.2,7-9 The term “entanglement” has been used to describe this process, but there has been little direct research into the development of multiple ties.10,11