Carl Elliott responds to Rob MacDougall: The goal is not to achieve perfect impartiality.

________________________________________________________________________________

In 2010, about a decade after some of the country’s most prominent bioethicists began joining forces with drug companies, the pharmaceutical industry reached a milestone: it surpassed the defense industry as the leading defrauder of the United States government. 

Over a twenty year period, the pharmaceutical industry paid $19.8 billion in federal penalties, with a sharp increase coming in the mid-2000s.  As documents have been unsealed in litigation, the scope and creativity of the fraud have become clear.  Pharmaceutical companies have paid bribes and kickbacks to high-prescribing physicians.  They have bullied academic critics.  They have buried unfavorable research results; they have marketed drugs with phony studies (“seeding” trials); they have promoted their products through sales events disguised as Continuing Medical Education.   Not only have pharmaceutical companies made it a routine practice to pay academic physicians to sign articles written by professional ghostwriters, but in at least one case, they have collaborated with a scientific publisher to produce entirely fake journals.

And of course, these massive fraud penalties do not even touch the stunning pattern of research misconduct resulting in the deaths of human subjects in cases such as Pfizer’s Trovan trial, AstraZeneca’s CAFÉ study, Eli Lilly’s Phase I Cymbalta trial, and the recently uncovered scandals in India.

If I understand Rob MacDougall’s argument correctly, it is a mistake to worry about the fact that academic bioethicists have been working as paid consultants for the drug industry.   Why?  Because taking a moral position in exchange for cash is no different from taking a moral position because your conscience demands it.  Partiality is partiality, regardless of your motives.  Some people defend the weak and vulnerable for conscientious reasons at great personal cost; others defend powerful organizations because that’s what they are paid to do.  After all, felons need ethicists too.

Wait.  Did I actually say that out loud?  Sorry.  What I meant say is that every multinational corporation deserves adequate “bioethics representation.”  As MacDougall points out, working as a corporate bioethicist is very much like being a public interest attorney.  Just as public interest attorneys defend impoverished clients who are unable to pay for representation in a court of law, corporate bioethicists defend multi-billion dollar global corporations who are unable to justify their actions in the court of public opinion.   It would be unfair for bioethicists to discriminate against the rich and powerful just to compensate for their “excessively guilty feelings about coming from a background of privilege.”

Just think of it this way. Pharmaceutical companies fund professional medical bodies, patient advocacy groups, academic medical journals, and university CME offices.  They maintain one of the most powerful lobbies in Washington.  They even fund the Food and Drug Administration.  Why shouldn’t bioethicists get a cut of the action?

Look, I’ll confess: it’s not easy for me to take MacDougall’s argument seriously.  The goal of financial conflict of interest rules is not to achieve an ideal of perfect impartiality.  The goal is to prevent a person’s financial interests from compromising his or her professional duties.  To say that we should scrap financial conflict of interest rules because we’ll never be perfectly impartial is like saying that we should stop taking showers because we’ll never be perfectly clean.

MacDougall is right about one thing: what counts as a financial conflict of interest depends on the professional roles and duties of the job in question.  But you don’t have to think of bioethicists as judges to be troubled by the corrupting influence of the pharmaceutical industry.  You don’t even have to compare them to journalists, who are prohibited from taking money from the businesses they cover.  You can simply think of them as scholars.  Does anybody really think that, say, scientists funded by the tobacco industry have produced reliable, balanced data about health effects of smoking?  Or that students of international relations would be better educated if their professors worked for Lockheed Martin and General Dynamics?  In the documentary “Inside Job,” when the academic economists paid to consult for the financial industry were grilled about the role that their spectacularly bad advice played in the global financial collapse, they could do little more than bluster and snarl.   It is hard to imagine anyone watching these economists squirm under the klieg lights and thinking: “Yes, that’s exactly the future I want for my academic field.”

Carl Elliott is Professor, Center for Bioethics; Professor, Department of Pediatrics, University of Minnesota Medical School; Professor, Department of Philosophy, College of Liberal Arts,