The new chimaera: The industrialization of organ transplantation

Clinical organ transplantation has evolved through advances in patient care in parallel with investigations in associated biologies. It has developed from a cottage industry to an important medical specialty driven increasing ly by the availability of newer and more effective immunosuppressive drugs, and dependent on consistently close collaborations between university-base d clinical scientists and the pharmaceutical industry. Particularly during the past decade, however, this industry has undergone striking changes, con solidating into huge multi-national corporations, each competing for patien ts, their doctors, and for support of the allied hospitals, Because of the growth of "Big Pharma" the relationship between academia and industry has c hanged. There have been many advantages to such mutually dependent interact ions. A combination of university-based expertise and the specialized knowl edge and resources of industry have produced important scientific gains in drug development. Commercial sponsorship of applied research has been cruci al. The orchestration of multicenter controlled clinical drug trials has pr ovided invaluable information about the effectiveness of newer agents. But there are also disadvantages of increasing concern. Indeed, the power of "B ig Pharma" in many medical fields including transplantation is such that pr esentation of data can be delayed, adverse results withheld, and individual investigations hampered, Clinical trials may be protracted to stifle compe tition. Monetary considerations may transcend common sense. Several measure s to enhance the clinical relationship between the pharmaceutical industry and those involved with organ transplantation are suggested, particularly t he use of third party advisors in the production of clinical trials, suppor t for more basic research and in the dissemination of results. In this way, the increasingly problematic phenomenon of commercialization of the field of transplantation can be tempered and controlled.