Inspiration
I was a policy fan early on. I originally took a National Institute on Drug Abuse postdoc fellowship on the molecular basis of opiate addiction, but subsequently was awarded a Pew Health Policy Fellowship that allowed me to really explore, at an international level, the drivers of policy decisions. It became clear to me that we needed to be more systematic in using research and the evidence that it creates to drive policy. I began researching both the evidence to improve prescribing, and the influence of the pharmaceutical industry on drug research. Of course, this landed me right in the topics around tobacco, and the arguments at that time; what is evidence, whose evidence? I began researching methods for assessing bias and quality of research and scientific publications, and the dissemination and policy implications of research. Those topics are pretty universal, and really informed the work that I do in national and international committees, which I have really stayed engaged in since my Pew Fellowship.
Impact
The Cigarette Papers changed public awareness of industry manipulations, and brrought that conversation to every health focused committee. I was active in the struggle to end cigarette sales in San Francisco Pharmacies, (Ordinance 194-08) which was enacted in 2008. My work on this was recognized with the Harold S. Luft Award for Mentoring in Health Services and Health Policy Research in 2009. In 2010, the exemption for 'bigbox' stores was removed. Internationally, I have served on the WHO Essential Medicines Committee since 2005, and am current Chair. I also serve as a member of the Pan American Health Organization's (WHO Regional Office for the Americas) Advisory Committee for Health Research since 2008.
Strategies
I serve on several national and international committees related to conflicts of interest and research, and chaired the UCSF Chancellor’s Advisory Committee on Conflicts of Interest for 11 years. I worked to develop and validate methods for assessing bias in research and scientific publication and measure influences on the quality of research, including university-industry relations. This type of research can tell us which evidence to trust and what must be done to improve future research.
- Publish in professional journals -document conflicts in interest in research funding
- Served as an expert consultant to the WHO: Executive Summary: The Selection and Use of Essential Medicines 2015
- Served as advisory board member or provided testimony for legislative bodies
- Served on editorial boards and professional organizations
- Senior editor of Cochrane Public Health and Health Systems
- Write and publish public facing articles in news organizations
The Journey
In 1988, I was awarded a Pew Health Policy Fellowship that really set the tone for my research career; I looked at interventions to improve prescribing, and at the factors that bias research. I joined UCSF in 1991, and immediately started looking at publication bias and public health policy, which led to my work with the tobacco papers. In 1994 remember, UCSF was fighting for the right to publish the documents that now make up the Tobacco center. In 1996, we published the Cigarette papers.
After that, it became a process of identifying policies that could be addressed to impact health in the context of tobacco, policies to reverse the adoption of cigars, the rights of nonsmokers in the workplace, or government buildings. Understanding how industry fostered pushback groups, calling to "get government off our back"
In 2014 I began to publish on the WHO essential medicines process, where the evidence to policy pathway was different, and sometimes the same. Industry involvement in science policy is real at every level. Identifying and addressing conflicts of interest can be challenging. However, it is a real necessary part of understanding evidence that is used in policymaking. My work on international committees has taught me to dig a little deeper, in everything from systematic reviews to conference sponsorships.
Learn More
- News - The University of Sydney: Are pharma payments to nurses impacting your healthcare?
- U.S. Medicaid Drug Lists Cost More, Deliver Less (June 17, 2011)
- The BMJ (blog): Lisa Bero: More journals should have conflict of interest
- The Conversation AU: When big companies fund academic research, the truth often comes last
- The Conversation AU: Influential doctors aren't disclosing their drug company ties
- Science Magazine: Three percent of NIH grants involved a direct financial conflict
- The Guardian: Self-regulation by the pharmaceutical industry isn't working, say experts