Is conflict of interest in our best interest?

Abstract

On 8 November 1895 Wilhelm Conrad Rontgen observed a special type of radiation that was created from an electric discharge passing through a vacuum tube. He labelled this radiation “X-rays” using the mathematical designation for something unknown. Through X-rays matter became transparent, as so vividly demonstrated by the well-known X-ray image of the hand of Rontgen’s wife. Rontgen, at the time of his groundbreaking discovery was the Chair of Physics at the University of Wurzburg (1888–1900). He had no financial affiliations with industry; instead he argued with them over the costs for the vacuum tubes he used for his experiments: “Ihre Rohren sind in der Tat sehr gut, aber fur meine Verhaltnisse zu theuer,...Ich mochte mir deshalb die Frage erlauben, ob Sie mir die Rohren nicht zu M[ark] 20 statt zu M[ark] 30 liefern konnten...Falls Sie auf meinen Vorschlag eingehen, bitte ich Sie mir fur die zwei bereits verbrauchten Rohren 4 andere gleicher Qualitat zu schicken...Hochachtungsvoll” (Your tubes are indeed very good but too expensive for me. ... Therefore, I would like to ask whether you could provide me with the tubes at a price of 20 Marks instead of 30 Marks ... Should you be agreeable, I like you to replace my two already used tubes with four other tubes of similar quality ... Sincerely) [1]. Soon after Rontgen’s invention, made solely in the realms of academic research, several manufacturers offered X-ray tubes and helped disseminate X-ray imaging technologies among medical professionals. Rontgen does not appear to have benefited financially from his invention. The discovery of the X-rays and their subsequent use in various, primarily medical set-ups paved the path to non-invasive diagnosis. Thus, the non-invasively invisible became visible and by that the world of medicine was changed forever. Taking X-ray imaging a step further, Godfrey Newbold Hounsfield prototyped a workable tomographic transmission imaging device in 1968 [2]. Unlike Rontgen, Hounsfield was an industry-paid expert working at the Central Research Laboratory for Electric and Musical Industry (EMI) Ltd. in the UK since 1951. Subsequent to his inhouse research the first CT system was installed in October 1971 at the Atkinson Morley’s Hospital and the first patient images were taken in 1972 [3]. Interestingly, the company EMI did not realize the potential commercial impact of the CT system and estimated a market need of 25 systems only. By 1974 already 60 EMI CT systems were installed and by 1979 more than 1,000 CT from over 20 manufacturers were installed and operational worldwide. Today the number of clinical CT systems has exceeded 50,000. One may ask, with Hounsfield’s roots in industry, is the value of his invention reduced? Next to CT other imaging modalities were developed at the same time. The beginning of modern PET, for example, dates back to the early 1970s, when Phelps and colleagues at Washington University and, independently, researchers at Brookhaven National Laboratories built the first prototypes of a ring design PET system [4, 5]. The first, and subsequently successful approach, in particular, was joined early on by EG&G ORTEC, an Oak Ridge-based spin-off from Oak Ridge National Laboratories. The EG&G ORTEC group provided expertise in detectors and coincidence electronics and some nuclear instrumentation modules. A prototype (PETT) was used in January 1974 for first PETT. Beyer (*) cmi-experts GmbH, Pestalozziststr 3, 8032 Zurich, Switzerland e-mail: thomas.beyer@cmi-experts.com