Knowledge is just one more commodity to be traded.
The dependence of universities on biomedical research funding from big business is leading to a disastrous decline in scientific ethics and on the public perception of science. This is the message of a new book by Sheldon Krimsky, 1 reviewed by Richard Horton, editor of The Lancet in March 2004.2
Professor Krimsky’s position is already known. ‘The new symbiosis between academia and commerce, amply nurtured by public policies, is forcing a critical examination of research ethics on issues such as sharing of information, commodification of knowledge, conflicts of interest held by scientists and their institutions, and the mingling of medicine and business in clinical trials’.3 Not only are scientific ethics corrupted, but the very way in which science is supposed to work is inhibited. The drive to be first with the patent means that scientists can no longer talk to one another about their research. Wasteful duplication is an inevitable consequence.
A particular danger.
The Pharmaceutical industry is not the only threat to scientific ethics. The desire of some scientists for recognition (which, pace Shaplin) has always existed, and the influence of lawyers in a ‘blame culture’ society cannot be discounted. However, there are serious grounds for alarm concerning the relationship which has developed between universities and industry.
From the early 1980s, the emerging biotechnical industry, based on scientific advances in biology has been the principal agent in driving academia and industry ever closer. In the USA, this project has been supported by the Federal Government, in spite of protests by some academics who perceived the dangers.4
Scientists who declined to toe the corporate line, for example, David Healy, who pointed out the suicide risks of a certain antidepressant 5, and Nancy Olivieri, who wished to publish the shortcomings of a drug for treating thalassemia have experienced victimisation. Along with the threat to the academic freedom of researchers, came the damaging effects on science itself. Derek Bok, a former president of Harvard University, has pointed out that research is now skewed towards answering questions which are the concerns of industry.
In a recent JAMA article Justin E. Bekelman and his co-authors concluded ‘Financial relationships among industry, scientific investigators, and academic institutions are widespread. Conflicts of interest arising from these ties can influence biomedical research in important ways’. 6
A clash of cultures.
Professor A. M. Gale of Bristol University summarises the dilemma for researchers as follows: ‘Expert clinicians, valued for their academic status and independence, are used by the pharmaceutical industry for advice, for contract research, and as a means of conveying their message to other clinicians. Both academics and industry depend upon this interaction, but there is a fundamental clash of cultures at the interface between the two. Independence cannot be marketed for a fee, opinion too easily shades into advocacy, and secrecy and science do not mix’.7
Promotion through science.
Nonetheless, the pharmaceutical industry has succeeded in suborning large sections of the scientific community to serve its ends. ‘Scientific conferences’ are promoted. But the conference will include a large trade exhibition at which the sponsors are free to market their products to the delegates, who have already been softened up by an ‘extraordinary culture of gift giving’. Conference participants attend the event on an all expenses paid basis and depart loaded with gifts and golden opinions.
Taking over the journals.
The practice of ‘encouraging’ doctors to endorse research articles written by ghostwriters has already been described on this website.8 Drug companies also work to influence the scientific journals themselves to the point where, in Horton’s opinion, the scientific press, far from being ‘neutral arbiters of quality’ has been reduced to an ‘under recognised obstacle to scientific truth-telling’. Clearly the journals are vulnerable to pressure from companies who spend heavily on advertising. More insidiously, a company will host a symposium with speakers carefully selected for their ‘positive’ views on the product to be promoted. The resulting papers will be offered, with the inevitable cash inducement to a compliant journal. In return, the sponsor gets a journal supplement carrying the credibility conferred by a respected imprint.
An article from New England Journal of Medicine of 1992 opens, ‘An increasing proportion of spending by the pharmaceutical industry has gone to funding symposiums that are published by peer-reviewed medical journals.’ The subsequent study concluded, ‘Symposiums sponsored by drug companies often have promotional attributes and are not peer-reviewed. Financial relations … should be completely disclosed, symposiums should be clearly identified, and journal editors should maintain editorial control over contributions from symposiums’.9
In 1994, Paula Rochon and collaborators found, ‘…randomized control trials published in journal supplements are generally of inferior quality compared with articles published in the parent journal’.10
What can be done?
Some universities have tried to confront the problem. The University of Pennsylvania has published a Financial Disclosure Policy for Research and Sponsored Projects, which begins,’An essential aspect of the University is the ability of the faculty to pursue all areas of academic inquiry with freedom from inappropriate external bias’. 11 It is one thing to publish a policy, and another to maintain it in the face of financial inducements like the $25 million deal with the University of California at Berkeley reported in Krimsky’s book.
Professor Gale thinks that it is up to individual researchers, ‘Formal guidelines and declarations of interest are inadequate as a means of policing an interface where undisclosed amounts of money change hands so freely. In the absence of effective sanctions, each of us must seek a personal solution to the professional and ethical issues involved’. 12 We saw what happened to Healy and Olivieri. Any volunteers?
Krimsky himself believes that there should be a ‘sharp separation between knowledge producers and wealth creators’, an admirable sentiment which may or may not be achievable.
John Ziman proposes that what he calls ‘non-instrumental’ science, could be fenced off from ‘post-academic’ science, which seeks an economic payoff.13 Pure science should be quarantined away from financial interests by having funding decisions determined by ‘disinterested’ scientists. First catch your disinterested scientist.
Prospects for success.
The chances of turning back the commercial tide are not promising. Krimsky reports that in the USA, federal advisory committees give preference in awarding funds to private over public interests.
In the UK, Shapin’s abode of gentlemanly science, prospects took a turn for the worse with the Government welcome for the Lambert Report. ‘Increased collaboration between business and university research departments will bring significant economic benefits to the UK … but concerted action by business, universities, and government will be required in order to grasp the opportunities for the UK economy’. 14 Alternatively, increased involvement with business will relieve the Treasury of the need to finance academic research – never mind the ethics, feel the balance sheet. No wonder Chancellor Gordon Brown welcomed the report.
Meanwhile, Prime Minister Blair routinely bemoans the loss of public confidence in science.
But as Ogden Nash put it, “To the man in the street, who, I’m sorry to say, is a close observer of life, it looks as though the man in the street is right to be suspicious.”
1. Sheldon Krimsky, Science in the Public Interest: Has the Lure of Profits Corrupted Biomedical Research?, Rowman and Littlefield
2. Richard Horton, The Dawn of McScience, New York Review of Books, March 11, 2004.
3. Sheldon Krimsky, Reforming Research Ethics in an Age of Multivested Science, Buying in or Selling Out, ed Donald G Stein, Rutgers University Press, 2004
4. William F Raube, ‘The Emerging Partnerships Among the National Institutes of Health, Academic Health Centers and Industry’ Preparing for Science in the 21st Century , Association of Academic Health Centers, 1991
5. Jim Blair ‘Ghostwritten Research Papers’, 4th December 2003
6. Justin E. Bekelman, Yan Li, Cary P. Gross, Scope and Impact of Financial Conflicts of Interest in Biomedical Research: A Systematic Review JAMA. 2003;289:454-465.
7. Edwin A, M, Gale, Between two cultures: the expert clinician and the pharmaceutical industry’ Clin Med 2003;3:538-41
8. Drug Companies “Hoodwink” the Medical Journals
9. L A Bero, A Galbraith, and D Rennie ‘The publication of sponsored symposiums in medical journals’ New England Journal of Medicine October 15, 1992 pp 1135-1140
10. Paula A Rochon et al Evaluating the quality of articles published in journal supplements compared with the quality of those published in the parent journal, JAMA, July 13th 1994, pp 108 – 103
11. Financial Disclosure Policy for Research and Sponsored Projects, University of Pennsylvania Almanac, Febuary 6, 2001, Volume 47, Number 21
12. Edwin A. M. Gale op cit
13. John Ziman, ‘Non-instrumental Roles of Science’, Science and Engineering Ethics, Vol 9, 2003, pp 17-27
14. Government Welcomes Business-University Collaboration Review, HM Treasury December 2003.