Pharma Owns Bioethics [and Other Fables]

Writes Carl Elliot in this coming week's Lancet:

North American bioethics has a growing credibility problem. As the influence of bioethics has grown, so has the willingness of bioethicists to seek out funding from the pharmaceutical and biotechnology industries. These industries have begun to fund bioethics centres, lectureships, consultants, advisory panels, conferences, and private regulatory boards.1, 2 and 3 The results of this industry-funded work are now making their way into peer-reviewed academic journals. Readers of the medical and bioethics literature have recently seen articles on the ethics of recruiting homeless individuals for research, funded by Eli Lilly;4 on the ethics of biotechnology and the developing world, funded by Glaxo, Merck, and Pfizer;5 on the ethics of stem-cell research, funded by Geron;6 and the ethics of placebo-controlled trials for mood-altering drugs, funded by antidepressant manufacturers.7 They have also seen pharma-funded university bioethicists collaborating on ethics articles with biotech entrepreneurs8 and a medical ethics and humanities journal issue funded by a pharmaceutical lobbying organisation.9 The authors of these articles have disclosed their industry ties, but readers are left to wonder: is an industry-funded bioethicist a bioethicist that we can trust?

Even discussions of conflict of interest have become tainted by questions of conflict of interest—or at least the perception of a potential conflict. The American Journal of Bioethics recently published an article on the ethics of taking gifts from the pharmaceutical industry which was itself funded by Pfizer, while the American Medical Association's Council on Ethics and Judicial Affairs launched an educational project on industry gifts that was funded by a US$675 000 gift from the pharmaceutical industry.10 and 11 When the US National Institute of Health (NIH) commissioned a so-called blue-ribbon panel to investigate their conflict-of-interest scandal, in which researchers were found to have undisclosed financial ties to private industry, the blue-ribbon panel included an insurance executive, the vice-president of a for-profit health-care company, the chief executive officer of a leading weapons manufacturer, and the director of the Ethics Resource Center, Washington DC, an ethics institute funded by Merck.12 One can see the reasoning behind appointing these panellists, but they are hardly likely to inspire trust in observers worried that the NIH has become too close to private industry.

I'm sure Pfizer is just thrilled with the "ethics of taking gifts" publication in AJOB that Elliot lambasts (here and elsewhere). What pharmaceutical company doesn't want to be identified as funding a study that finds that pharma's most frequent marketing practice, one in which it itself engages, is pervasive and unethical, and then to see that publication in a major journal and splashed all over most U.S. newspapers?

It is becoming clear that Dr. Elliot is trying to cause rather than report on a scandal about industry funding of bioethics. There is a scandal to report on - bioethics is being compromised - but the powerful who are taking over bioethics are not in the world of industry but in politics. There is a well developed neoconservative bioethics "movement" now, a virtually unadulterated tool of the Bush administration that has most recently busied itself with apologetics for the Bush administration position on stem cell research.

Meanwhile, there is no evidence whatsoever that bioethics is becoming a "thought leader" tool for industry. Elliot's lists of who is taking what money are just horrendous - they lack any context and show a genuine disregard for the truth of the matter. I for one have tired of reading one accusation after another about the way in which my colleagues are bought by industry, while Elliot utterly ignores the way in which pharma funds virtually every institution in which bioethics is practiced - and more important ignores the bigger threat to "buying bioethics" that comes almost exclusively from the right wing. I for one am very proud of the work I and others in bioethics have done in the context of funding by industry, and I am convinced that much of it was possible - and that it was possible for my colleagues and I to challenge industry so pointedly - exactly because we had that funding. It is insulting to me that Elliot simply reviews sources of funding without reviewing the papers attached to that funding. And the notion that in taking funding from industry I or my colleagues became tools of industry is mean spirited inuendo and nothing more, no matter how it is spun in the clever rhetoric of this editorial or other nearly identical versions of it in other publications.

Elliot makes innumerable claims that strain credibility about the erosion of bioethics' integrity among the general public, and the biggest problem with them is the assertion that there is a growing wariness about industry bioethics. However, to the extent that it is true that there is wariness about bioethics and industry, that wariness is almost certainly a product of Elliot's own well-placed articles in which he alleges it to be true. For example, in speeches Elliot has taken to describing a speech at Minnesota by Alan Milstein, the attorney who has built a major practice in litigating against institutions (including Penn) that have been alleged to be involved in research misconduct. Milstein, Elliot says, mentioned in his talk that he was proud of having sued bioethicists (by which he meant that he named one bioethicist, Arthur Caplan, in the lawsuit against Penn involving the gene therapy case of Jessie Gelsinger). The big punchline in Carl's talk about how bioethics is actually beginning to show signs of losing credibility is that, amazingly, the crowd broke out into applause at that suggestion. With embarrassment, Elliot says it: people are beginning to clap when they hear that we bioethicists are being sued, because we're all bought out, tools of industry.

The only problem with this story is that, like the general argument that bioethics is being bought out by industry, it is not exactly as reported. Take a listen. Shortly after 1:13, you'll find the punchline by Milstein, then laughter and one person heartily clapping as he laughs. Maybe the rousing ovation is in the Spanish version of the soundtrack?

The point is that while the cautionary tale Elliot spins in the Lancet, enough to inspire an early online publication of this article, and tons of media interest, is interesting and grounded in an important concern about academic integrity, it isn't as simple as Elliot makes it out to be. Elliot, whose hard money position at Minnesota is funded in large part (as are most bioethics positions in major medical centers) by dollars from pharmaceutical companies directly to those medical schools, is searching for a monastic cleanliness of funding that simply doesn't exist. Many of the most revered institutions of bioethics, such as the Hastings Center, receive significant contributions from industry as a matter of simple live-or-die economics.

There are big issues here that deserve to be treated with much more subtlety and far less conspiracy theory. The notion that bioethics is losing its credibility has become a self-fulfilling crusade for Elliot, who seems to be waging an almost single handed campaign to convince a broad audience that bioethics is less than credible, rather than (as he claims) reporting on the evolving demise of the field.

The reporters are calling. They keep asking the same question: is industry funding changing the claims or orientation or bearing or credibility of bioethics. I try again and again to think of a single point at which that might even seem to have happened. But, nope, none appear. Except for that one, glaring set of examples: huge funding from the religious right to keep a PVS patient in Florida alive at all costs - bioethics paid for by the right wing of the Republican Party. But hey, that Schiavo thing had no real impact - let's focus on a dozen small grants to two or three bioethics centers from which it is difficult to identify any papers that would fit the category "bought."

I'm sympathetic to the quest - my own resignation as chair of the ethics advisory board of Advanced Cell Technology started this mess in the media in the first place. But those of us who are worried about the dangers of corporate influence on ethics need to direct our attention at best practices rather than identifying villains. And the scandal/scare tactics in this and other iterations of the Elliot mantra are shameful. It is time for those who claim to want a better bioethics to abandon their McCarthyism.