Ahmed Rashid: Should junior doctors accept pharma support for clinical research training?

ahmed_rashidJunior clinical researchers know that there’s really only one way for them to comprehensively get on the academic ladder and prove their credibility. Those three letters that contain years of effort and soul searching that make all the difference. The essential and the impossible. The mountain. The PhD.

But, of course, once you’ve made the brave decision to take on this beast, you must then find the support to do so. And the particular support needed to tackle this beast is money. Unless you’re able to support yourself by other means, and dramatically reduce your income by enrolling as an independent postgraduate student, a clinical research fellowship may be the only option.

Generally speaking, there are two options available to achieve this. Firstly, you can write a doctoral research grant proposal and apply competitively with clinicians across all specialties to get an award from a national funding council or a charity. These awards are excellent, in that they recognise that safeguarding the future of clinical research relies not only on projects and institutions, but also on individuals. They’re not easy to win though, and as one might imagine, the opportunities are fiercely fought for.

The other option is to “piggyback” onto an existing programme of work and apply for a clinical research fellowship that has already been funded. Typically, an established and senior researcher will already have secured the necessary funding and you simply slot in and join the research team. You avoid having to write a research proposal and, as long as you meet the project plan, you have a golden ticket to completing a clinically funded PhD.

Although I know that these “off the shelf” projects are typically laboratory based and unlikely to satisfy my population health interests, I still can’t help but take an envious look at ads for them. Recently, I came across one such post advertised through BMJ Careers that took my eye. Not because of the institute, research title, or supervisor, but rather because it was named, boldly and proudly, after the pharmaceutical company that sponsored it.

My thoughts immediately turned to the recent controversy around Oxford professor and eminent public health scientist Susan Jebb and her involvement in research that was funded, or part funded, by industry. The BBC Radio 4 debate between Jebb and The BMJ’s editor in chief, Fiona Godlee, was enthralling and had the medical world listening intently. Unfortunately, there were no answers to the difficult questions about how clinical research could fairly be funded by industry—although perhaps the recognition that we urgently need debate was an important step in itself.

What the BMJ-Jebb affair does tell us is that getting involved with industry raises suspicions, and has the potential to affect even the most senior academics at the most prestigious institutions. Junior clinical researchers looking for a golden ticket to a clinically supported doctorate are a vulnerable target, and may not appreciate that accepting an industry fellowship could be a move they come to regret later in their academic careers.

Although the medical world doesn’t seem to have figured out just how acceptable it is to be involved in clinical research with industry sponsorship, it seems likely that it will increasingly be seen as a blemish, and will generally be avoided in order to maintain professional credibility. With that in mind, I know I certainly don’t want to devote my time, energy, and soul to complete a doctorate that has any ties to industry funding. Moreover, if BMJ are committed to leading the important drive to limit the influence of industry, it must surely stop advertising such fellowships and being complicit in leading junior clinicians down this potentially dark alley.

Ahmed Rashid is an academic clinical fellow at the University of Cambridge. You can follow him on Twitter @Dr_A_Rashid

I declare that I have read and understood BMJ policy on declaration of interests and I hereby declare the following interests: None.

Read The BMJ‘s editorial: Medical journals and industry ties

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  • susanne stevens

    Somebody has to do it. But would a junior have the confidence to probe or likely to be in a position to discover anything ‘dodgy’ about such projects? Be able to weigh up the pros and cons before participating in research.?Or the opposite….be rather impressed by how ethical some of them are?. If asking too many questions beforehand it is probably unlikely a junior would be given a post so could these positions be evaluated according to ethical criteria before being advertised by BMJ etc. There could also be an invitation to people to openly post their experience of working with pharmaceutical companies rather than be seen to mainly to be’investigated’ or have suspicion raised – so that those interested in working for pharmaceutical companies or wishing to study in such teams for good reasons will not need to worry that the only judgment will likely be negative or detrimental to careers.

  • David Levine

    Ahmed

    I applaud your principled stance but I’m not sure about all the reasoning and I wonder if you might be unecessarily denying yourself a chance to pursue this PhD.

    I know it’s fashionable to demonise everything about ‘big pharma’ (where I now live in retirement the bigger risk is from the similarly sounding characters who drive tractors slowly on narrow lanes for miles) but, although Pharma have gone badly wrong on occasions, the reality has to be more balanced and there are much greater corporate threats to fight.

    I think I’m right in saying that your own, excellent, department mentions links to industry and even a named pharmaceutical company on its website. I presume any potential ethical conflicts are handled with great care. Surely any department capable of supervising PhDs and any person capable of undertaking one can devise watertight ways to protect the integrity of the work and publications.

    Even If you choose (hypothetically!) to work with NICE you might have to be prepared for some challenging discussions about the frequency of potentially conflicting industry interests amongst its experts.

    The fact is that the Health Service and the Pharmaceutical (plus other) industries must and can work closely and ethically together because we can’t do without them.

  • Robyn Toomath

    Requiring doctors to acquire a PhD is crazy – most of the ‘research’ generated is rubbish and a huge waste of money as we delay the time before expensively trained people start properly working. Research should be left to the true scientists and if drug company money dries up it may be a good thing.