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[sSRI-Research] Pharma Buys a Conscience

 

http://www.phen.ab.ca/materials/intouch/vol4/intouch4-09.html

 

Provincial Health Ethics Network

Volume 4, Issue 09 - December 2001

 

Pharma Buys a Conscience

 

The following are excerpts from an article published in The American

Prospect (Volume 12, Issue 12, 2001). Reproduced here with permission from

the publisher.

 

I was raised in a house filled with drug-industry trinkets. My father has

been a family doctor for more than 40 years, and drug representatives

bearing gifts have visited him throughout his career. My brothers and I grew

up tossing Abbott Frisbees and Upjohn Nerf balls. We took down messages on

Inderal notepads, wrote with Erythromycin pens, carried Progestin umbrellas.

We constructed weird Halloween costumes from models of the human hand and

brain supplied by Parke-Davis and Merck. My father was no great fan of

" detail men, " as drug reps were called then. (These days, if you're a male

physician, your detail man is likely to be an attractive young woman.) Nor

did he take part in the drug industry's more outrageous marketing efforts,

such as frequent-flier miles in exchange for drug prescriptions. But he saw

no great harm in accepting drug samples for his patients or toys for his

children. Like virtually all doctors, he did not think that the gifts

influenced him in any way.

 

Why pharmaceutical companies want the goodwill of doctors is no great

mystery. The surprise is why they want the goodwill of someone like me. I am

a philosophy professor, and I work at a bioethics center. While I do happen

to have a degree in medicine, that degree is largely decorative: The only

prescriptions I write these days are moral ones. Despite this difference (or

maybe because of it), the pharmaceutical and biotechnological industries are

funneling more and more cash into the pockets of academics who teach and

study ethics. Some of it goes straight to individuals, in the form of

consulting fees, contracts, honoraria, and salaries. Some of it--such as

gifts to bioethics centers--is less direct. Many corporations are putting

bioethicists on their scientific advisory boards or setting up special

bioethics panels to provide in-house advice. While I have not yet been

offered Frisbees or Nerf balls, I suspect that it is only a matter of time.

 

The issue of corporate money has become something of an embarrassment within

the bioethics community. Bioethicists have written for years about conflicts

of interest in scientific research or patient care yet have paid little

attention to the ones that might compromise bioethics itself. Arthur Caplan,

the director of the University of Pennsylvania Center for Bioethics,

counsels doctors against accepting gifts from the drug industry. " The more

you yield to economics, " Caplan said last January, " the more you're falling

to a business model that undercuts arguments for professionalism. " Yet

Caplan himself consults for the drug and biotech industries, recently

coauthored an article with scientists for Advanced Cell Technology, and

heads a bioethics center supported by Monsanto, de Code Genetics, Millennium

Pharmaceuticals, Geron Corporation, Pfizer, AstraZeneca Pharmaceuticals,

E.I. du Pont de Nemours and Company, Human Genome Sciences, and the

Schering-Plough Corporation.

 

By no means does Caplan's center stand alone in its coziness with industry.

The University of Toronto houses the Sun Life Chair in Bioethics; the

Stanford University Center for Biomedical Ethics has a program in genetics

funded by a $1-million gift from SmithKline Beecham Corporation; the Merck

Company Foundation has financed a string of international ethics centers in

cities from Ankara, Turkey, to Pretoria, South Africa. Last year the Midwest

Bioethics Center announced a new $587,870 initiative funded by the Aventis

Pharmaceuticals Foundation. That endeavor is titled, apparently without

irony, the Research Integrity Project.

 

Bioethics appears set to borrow a funding model popular in the realm of

business ethics. This model embraces partnership and collaboration with

corporate sponsors as long as outright conflicts of interest can be managed.

It is the model that allows the nonprofit Ethics Resource Center in

Washington, D.C., to sponsor ethics and leadership programs funded by such

weapons manufacturers as General Dynamics, United Technologies Corporation,

and Raytheon. It also permits the former president of Princeton University,

Harold Shapiro, to draw an annual director's salary from Dow Chemical

Company while serving as chair of the National Bioethics Advisory

Commission. Dow, of course, has been the defendant in a highly publicized

lawsuit over the Dow Corning silicone breast implants as well as in numerous

legal actions involving disposal of hazardous waste.

 

Part of the problem is aesthetic. It is unseemly for ethicists to share in

the profits of arms dealers, industrial polluters, or multinationals that

exploit the developing world. But credibility also is an issue. How can

bioethicists continue to be taken seriously if they are on the payroll of

the very corporations whose practices they are expected to assess?

 

Listening to Eli Lilly

Last year some colleagues and I helped put together " Prozac, Alienation, and

the Self, " a special issue of The Hastings Center Report, a bioethics

journal. Some of the papers that we published, including one by me,

expressed worries about the extent to which antidepressants are being

prescribed, especially for patients who are not clinically depressed. One

paper in particular - " Good Science or Good Business? " - was especially

critical of the drug industry. Its author, David Healy, is a

psychopharmacologist and a historian of psychiatry at the University of

Wales.

 

Shortly after these Prozac essays were published, Eli Lilly and Company,

which manufactures Prozac, withdrew its annual gift to the Hastings Center,

citing the special issue as its reason. Lilly's yearly check for $25,000 was

not especially large by industry standards, but it was the Hastings Center's

largest annual corporate donation. Lilly's letter to the organization was

especially critical of Healy's article. Healy had previously published

research indicating that some patients, particularly those who are not

clinically depressed, may be more likely to commit suicide while taking

antidepressants. He has also testified as an expert witness against Lilly

and other drug manufacturers in lawsuits brought by family members of

patients who killed themselves or others after taking antidepressants. In

" Good Science or Good Business? " Healy argued that manufacturers of

antidepressants have gone into the business of selling psychiatric illnesses

in order to sell psychiatric drugs. Apparently, this was not the kind of

bioethics scholarship that Lilly had in mind when it donated money to the

Hastings Center.

 

The reaction of bioethicists to all of this is emblematic of the

difficulties raised by corporate money. Some were encouraged by the response

of the Hastings Center staff -particularly by the Report's editors, who

published the special issue without regard to Lilly's reaction. We are never

hostage to corporate money, these scholars say. We can always turn it down,

resign our posts, and do the right thing despite enticements to the

contrary. For others, however, the fact that the Report's editors faced such

incentives is precisely the problem. Given enough cases where bioethicists

must choose between scholarship and their corporate funders, the funders

will eventually win out. In the long run, money conquers all.

 

But the Hastings Center episode was only the first chapter of the Healy

affair. In November 2000, Healy gave a talk on the history of

psychopharmacology at the University of Toronto's Center for Addiction and

Mental Health (CAMH), where he was scheduled to take up a new position as

director of the Mood Disorders Program. In that lecture, Healy mentioned his

worries about Prozac and suicide. Shortly thereafter, the center rescinded

his appointment. He was given no reason but merely informed by e-mail that

CAMH did not feel that his " approach was compatible with the goals for

development of the academic and clinical resource " of the clinic. CAMH

officials insist that the Eli Lilly Corporation had nothing to do with the

decision; yet the center is the recipient of a $1.5-million gift from Lilly.

The Mood Disorders Program, which Healy was to direct, gets 52 percent of

its funding from corporate sources.

 

Whether Lilly or any other corporate funder had anything to do with Healy's

dismissal is impossible to know. Even so, the trouble CAMH has had in

convincing the public that industry sources were not involved points to the

difficulty of discerning financial influence. Would CAMH have dismissed

Healy if it had no ties to Lilly whatsoever? Does fear of being unable to

attract future corporate money count as influence? Does fear of angering

powerful industry-tied psychiatrists?

 

" Doctors fear drug companies like bookies fear the mob, " says Harold

Elliott, a psychiatrist at Wake Forest University. Corporate money is so

crucial to the way that university medical centers are funded today that no

threats or offers need actually be made in order for a company to exert its

influence. The mere presence of corporate money is enough.

 

And researchers are probably right to be afraid. The University of Toronto

itself has seen two other public scandals erupt over pharmaceutical-company

funding in recent years. The most visible one involved Nancy Olivieri, a

researcher at the university's Hospital for Sick Children,

" How can bioethicists continue to be taken seriously if they are on the

payroll of the very corporations whose practices they are expected to

assess? " who was conducting clinical trials of deferiprone, a thalassemia

drug, for the generic-drug manufacturer Apotex. When Olivieri became

concerned about possible side effects of deferiprone, she broke her

confidentiality agreement with Apotex and went public with her concerns. In

response, Apotex threatened her with legal action. Rather than backing

Olivieri against Apotex, the Hospital for Sick Children attempted to dismiss

her. News headlines had hardly faded when Apotex promised the University of

Toronto $20 million (about $13 million in U.S. dollars) in funding for

molecular biology, then threatened to withdraw it if the school's

then-president, Robert Prichard, did not lobby the federal government to

change its drug-patent regulations. Apotex wanted rules that would be more

favorable to generic-drug manufacturers. The president did as he was asked

and was later forced to apologize publicly when the story broke.

 

Industry-sponsored bioethics programs face problems that parallel those

encountered by industry-sponsored medical researchers. What do you do when

your scholarly work conflicts with the goals of your industry sponsor? No

one is forcing industry money on bioethics programs, but many of them are

located in academic health centers, where faculty members are expected to

generate money to fund their research either by seeing patients or by

obtaining grants. If bioethics is seen as an activity that can attract

industry sponsorship, university administrators strapped for cash will

inevitably look to industry as a financial solution. All that remains is for

bioethicists themselves to dispense with the ethical roadblocks...

 

Still, we can all take heart: Help may be on the way. The American Medical

Association's Council on Ethical and Judicial Affairs is planning a $590,000

initiative to educate doctors about the ethical problems involved in

accepting gifts from the drug industry. That initiative is funded by gifts

from Eli Lilly and Company, GlaxoSmithKline, Inc., Pfizer, U.S.

Pharmaceutical Group, AstraZeneca Pharmaceuticals, Bayer Corporation,

Procter and Gamble Company, and Wyeth-Ayerst Pharmaceutical.

Guest Writer Profile:

Carl Elliott

Carl Elliott, MD PhD, is an associate professor at the University of

Minnesota Center for Bioethics and the author of A Philosophical Disease:

Bioethics, Culture and Identity. He is Associate Professor and Co-Director

of Graduate Studies in the Center for Bioethics. He was educated at Davidson

College in North Carolina and Glasgow University in Scotland, where he

received his PhD in philosophy. He received his MD from the Medical

University of South Carolina.

 

He joined the faculty at the University of Minnesota in July 1997 after four

years at McGill University in Montreal, where he held appointments in the

Biomedical Ethics Unit and the Montreal Children's Hospital and directed the

Master's degree

 

 

 

 

 

 

 

 

 

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