Is it a conflict of interest for a bioethicist to work as a paid consultant for the pharmaceutical industry?
In recent weeks I have posted my conversation with Jenny Dyck Brian of Arizona State University, who wrote her doctoral dissertation on corporate bioethics boards. (See parts one, two and three.) Today we reach the final installment.
Q: A lot of people outside bioethics seem shocked when I tell them about academic bioethicists working for pharma. But within the field, I don’t see a lot of pushback.
A: Within the field there is little pushback. A lot of people said they themselves wouldn’t do it (or that an interesting opportunity has yet to present itself), but they think it’s a good thing that industry is getting some good advice, or at least seeking different perspectives. …
Do bioethicists make pharmaceutical companies more ethical?
This is a central question motivating my interview with Jenny Dyck Brian, an Arizona State University professor who wrote her doctoral dissertation on corporate bioethics boards. (See parts one and two of the interview.) Today we turn to Eli Lilly, a company that has had its share of ethical scandal: the recruitment of homeless alcoholics for drug-safety trials, the suicide of a healthy volunteer in a Cymbalta study, the company’s controversial promotion of Xigris, a sepsis drug that was later taken off the market, and most recently, a record-setting penalty for fraudulent marketing of its antipsychotic drug, Zyprexa. Throughout it all, Lilly has been guided by a group of bioethicists that includes some of the most prominent names in…
In the first part of my interview with Jenny Dyck Brian of Arizona State University about pharma’s bioethicists, we talked about whether or not ethicists could be used as public relations tools. Today we turn to a specific case. In the mid-1990s, SmithKline Beecham—a company that later became part of GlaxoSmithKline—set up its Ethics and Public Policy Board to look especially at issues in genomic science, an area in which the company was eager to become a leader. The board met three times a year for two-day meetings, and according to Brian, the membership was “all male, Caucasian, middle aged and highly distinguished.” The members were Ronald Dworkin, John Harris, Lawrence Gostin, David Weatherall, John Robertson, Hamilton Moses, Philip Reilly, Ian Kennedy, Gordon Dunstan, and
It is no secret that many academic physicians work for the pharmaceutical industry as speakers and consultants. Less widely known is that the pharmaceutical industry also employs academic bioethicists.
Beginning in the 1990s, a number of pharmaceutical and biotechnology companies began to set up bioethics advisory boards, ostensibly to obtain guidance about controversial ethical issues. Over the years, the ties between industry and bioethics have gradually grown closer, with companies setting up endowed chairs and hiring bioethics consultants. Yet very little is known about how bioethics advisory boards work. What exactly is their purpose? Do they prevent ethical wrongdoing, or do they provide ethical cover? How many bioethicists are involved and who are they?
“The Man With the Muck Rake,” courtesy of National Archives UK
Everyone knows how muckraking is supposed to work. An investigative reporter uncovers hidden wrongdoing; the public is outraged; and the authorities move quickly on behalf of justice and righteousness. There can be failure at any of these points, of course. Sometimes there is no outrage. The timing of the story may be poor, or the media outlet might be too small to get any real attention. If the target of the investigation has a skilled public relations team, it may be able to spin the story in a way that minimizes the damage. Often, the relevant authorities simply don’t take any action. And once the initial shock of the story has settled, the public demand for justice vanishes, like a bullet that has missed the target.
Geoffrey Wilkinson as Ben Gunn, courtesy of Aveleyman.com
I’m sitting in a pink plastic yard chair, feet up, glass in hand, looking out over the palm trees and the mangroves. Across the bay are the mountains of Viti Levu. I have never really been an enthusiast of tropical paradises, yet this is the third time I have found myself in the Fiji islands on my birthday. I suppose there are worse ways of dispelling the malaise. No phone, no Internet, just a bottle of Bounty Rum and a stack of hard-boiled crime novels. The monkey-faced fruit bat, I’m told, is one of only two mammalian species native to Fiji, and the further the sun sinks over the horizon, the closer the bats swoop down over our porch. They look like something out of a Hunter Thompson drug hallucination.
The first time we visited Fiji was almost accidental. Air…
Another spectacular winter morning in Dunedin, New Zealand. Clear blue sky, frost on the ground, lush green hills plunging into the South Pacific. It is hard to complain about the setting, still less about the kindness and decency of the inhabitants. It has been nearly 22 years since my wife and I first landed in Dunedin, in August of 1990, when I began a postdoctoral fellowship at the newly established Bioethics Centre at the University of Otago. I still wonder why we ever left.
It was an extraordinary time for bioethics in New Zealand. In 1990, the country was still reeling from the shock of a medical research scandal – the “unfortunate experiment” at the National Women’s Hospital in Auckland. In that study, which had begun in 1966 and continued for a…
Imagine for a moment that you are seriously injured in a medical research study and require expensive medical care. Imagine further that the study in which you are injured is scientifically worthless, deceptive and exploitative – sort of like the Tuskegee syphilis study, for example. Who ought to be responsible for paying for your medical care?
In the United States, the answer is: You are. There is no legal obligation for a research sponsor to pay for your medical care, even if the sponsor is directly responsible for your injury. In the United States, only 16 percent of academic health centers make it a policy to pay for the care of injured subjects, and none of them compensate subjects for lost wages or suffering. As a consequence, the risks of participating in medical research in America do not merely include illness, injury and death. They also include financial…
For years, those of us who worry about the way pharmaceutical industry money perverts medical practice have been told there is a simple solution to our concerns: disclosure. “Sunshine is the best disinfectant,” the advocates say in unison, like elementary school students reciting the Pledge of Allegiance. The Physician Payment Sunshine Act, the Pro Publica “Dollars for Docs” database, stricter disclosure rules for medical journals and continuing medical education events: Everyone believes the solution to conflicts of interest is transparency, and the more of it, the better. Even the pharmaceutical industry has jumped on board, posting their payments to physicians and medical groups on publicly accessible Web sites.
Wait. The pharmaceutical industry supports disclosure? If anything should have tipped us off that sunshine is not quite the disinfectant it is advertised to…
We’re on the road, my son Crawford and I. It’s time to visit colleges, and our schedule is brutal. Hot car, blinding sun, 12 colleges in 10 days, Ann Arbor to Sewanee. Onward we drive, Zevon on the stereo, afternoon into night, our mission fueled by gas-station coffee and Doritos. When we stop, it is for college admissions tours, barbecue, and, on one occasion, a broken alternator belt. I don’t even like to think about how far we have traveled.
The trip has revealed aspects of university life previously unfamiliar to me. Based on our extensive research, I am prepared to summarize the primary objective of the American university in two words: Lawn Care. Never have I seen such careful attention to landscaping. The clipped shimmer of the grass at…
In February, my colleague at the University of Minnesota, Leigh Turner, sent a letter to the FDA asking for an investigation of Celltex, the controversial adult-stem-cell company in Texas. In response, attorneys for Celltex fired off a letter to the president of the university claiming that the letter had created “real and permanent harm to Celltex’s reputation.” It asked what steps the University of Minnesota was taking to “disclaim sponsorship of the Turner letter” and remove it from the Internet. That effort at intimidation generated a vigorous debate in the world of bioethics, some of it on this blog. That debate followed controversy over the decision of Glenn McGee, the editor-in-chief of the American Journal of Bioethics, to become “president for ethics and strategic initiatives” at Celltex in December 2011. (McGee resigned in February.)
If your incoming flow of email spam looks anything like mine, it probably features a regular invitation to submit an article to a journal you have never heard of, or to be a part of its editorial board, or maybe even to edit the journal. The names of the publishers vary, but the invitations usually look something like this one, which arrived last week.
Deae Carl Elliott,
I am very pleasure that you can read this letter. Given the achievement you made in your research field, we sincerely invite you to join the Editorial Board for the Advances in Bioscience and Biotechnology (ABB). We are looking for Editorial Board members and Editor-in-Chief with renewal options.
Last week I posted the first half of my interview with Dr. Adriane Fugh-Berman, the director of the Pharmed Out project at Georgetown University Medical Center, which will be holding its 3rd annual conference on June 14-15. At the end of Part 1, we were discussing the need for informed consent in medical school when attending physicians remove the souls of medical students. We’ll pick up the conversation from there.
Can you think of any particularly bad moments that seem emblematic to you?
The interns discussing how we envied patients because they were lying in bed and eating and watching TV. It’s terrible looking back on how distorted our thinking was. One of my internship mates ended up in a mental institution; another intern attempted suicide. Standing in a supply cabinet looking…
In June, I will be returning to Washington for the annual Pharmed Out conference, a project located at Georgetown University Medical Center. It is one of my favorite events of the year, in part because of the wide array of academics, journalists, and activists who attend, but mainly because of its extraordinarily committed, outspoken director, Dr. Adriane Fugh-Berman, and her merry band of student volunteers. Adriane agreed to an interview by email. Part 1 appears below. I will post Part 2 next week.
Would it be fair to say that your project was funded by a felony?
Yes, we were funded by the Attorney General Consumer and Prescriber Grant program, a novel and never-to-be-repeated program that resulted from a settlement between Pfizer and all 50 states and the District of Columbia. We promised so much that before we got the grant, the grant administrators asked us to cut do…
From Wikipedia, a 1947 photograph of Wittgenstein by Ben Richards
“I first saw Wittgenstein in the Michaelmas term of 1938, my first term at Cambridge. At a meeting of the Moral Science Club, after the paper for the evening was read and the discussion started, someone began to stammer a remark. He had extreme difficulty in expressing himself and his words were unintelligible to me. I whispered to my neighbor: ‘Who is that?’: he replied, ‘Wittgenstein.’”
So begins Ludwig Wittgenstein: A Memoir, by Norman Malcolm, a student of Wittgenstein’s at Cambridge and his lifelong friend. It is a small book, published over half a century ago, but its influence would be hard to overstate. Not many philosophical books have created as many disciples. If philosophers were evangelists (and so…
Let’s start with a quiz. Can you tell which of these awards is real?
A) The Exxon Valdez Prize in Environmental Ethics
B) The Goldman Sachs Endowment in Business Ethics
C) The Richard Milhous Nixon Award for Ethics in Government
D) The Pfizer Fellowship in Bioethics
If you guessed D), you win. Yes, it is true that Pfizer has a rap sheet filled with felonies; yes, the company exploited Nigerian children in one of the deadliest research scandals in recent memory; and yes, in 2009 it paid out the (then) largest criminal fine in American history. But what better way to atone for past wrongdoing than a generous cash award to a bioethicist? The Pfizer Fellowship in Bioethics is a $100,000 grant that allows “researchers to explore ethical issues that arise in the everyday practice of contemporary medicine,” such as “conflicts of interest.” This year’s…
These are not happy times for the embattled drug maker AstraZeneca. The patent for Seroquel has expired; the company’s profits have plummeted; and its CEO, David Brennan, has just been escorted to the exit door. It seems like a good time to look back at sunnier days, when Seroquel, the ex-blockbuster antipsychotic, was a hot new drug for bipolar disorder.
As it happens, I recently got an email from “David Bronstein,” the medical ghostwriter who appears in my book, White Coat, Black Hat. Bronstein (a pseudonym) is a developmental biologist who provided some of the book’s best stories, especially his brutally hilarious accounts of his work for a “medical communications” company in the United Kingdom. He was writing to tell me about a branded AstraZeneca t-shirt he had acquired at a conference many years ago. It was designed to promote Seroquel. “Get yourself…
Everyone knows that some attorneys have a reputation for playing hardball. In fact, many of us even seek out attorneys who play hardball. But sometimes “playing hardball” becomes something entirely more disturbing, like a deranged major league pitcher hurling a 90 mile-an-hour fastball at the head of a Little Leaguer. What would you do if you discovered this was the behavior of attorneys representing your university?
This was the question I asked myself in 2008, when my employer, the University of Minnesota, sought $56,000 from a retired St. Paul woman named Mary Weiss. Why? Her mentally ill son had committed suicide in what many observers considered to be a stunningly corrupt, exploitative research study at the university, and Ms. Weiss had the audacity to sue. When her lawsuit was dismissed on statutory grounds, the University of Minnesota apparently decided to…
Like many people, I often like to relax after work with a cool drink and a vice-presidential speech on the stereo. And these days, the album getting the heaviest rotation on my playlist is Spiro T. Agnew Speaks Out. Call me nostalgic; call me a prisoner of the 1970s; but for my money, a better compilation of vice-presidential speeches has never been made.
I discovered the Agnew album at Hymie’s Vintage Records last week. It was in a bin marked “Difficult Listening,” along with other neglected classics such as Jim and Tammy Bakker present the PTL Singers, Deutscher Humor and The Sounds of Welsh Rugby. For those too young to remember Agnew: he was the Maryland ex-governor and Nixon vice-president who was unjustly driven out of the White House in 1973 after a series of financial misunderstandings. Hunter S. Thompson once characterized Agnew as a “flat-out,…