The Canadian Institutes of Health Research (CIHR) Governing Council (GC) has a new member:  Dr. Bernard Prigent, the Vice-President of Medical Affairs for Pfizer Canada.  CIHR President Alain Beaudet warmly welcomed Dr. Prigent's appointment as a sign of commitment to the agency's commercialization mandate.  When the (Liberal) government created the CIHR to replace the Medical Research Council, it pointed to Canada's indifferent record of translating scientific knowledge and discovery into commercial products that would benefit the Canadian economy.  Hence the implicit quid pro quo:  government will give CIHR more money, but will also expect that the grant-generated science will translate into patents, products, and sales - the sooner the better.

Who better than a drug company executive to help shape CIHR commercialization policy? Pharma is the poster child of commercialized health. It is multi-national capitalism incarnate: mega-firms, blockbuster products, massive revenues, huge marketing campaigns (from 24% to 40% of revenues). With multi-billion R&D budgets, drug companies scour the basic science labs and journals in search of the next big thing. They partner with scientists and universities, buy up intellectual property, invest in clinical trials, go through years of testing and regulatory approval, and if it all works out, boom goes the GDP. If anyone can provide expert counsel on how to ensure that the D follows the R, it's a pharma exec.

The GC certainly thinks so - every one of them signed a letter to the House of Commons Standing Committee on Health supporting the appointment to their ranks. But is this marriage made in heaven?

The merit of the appointment rests on the answers to 4 questions:

  1. Is the commercialization mandate potentially in conflict with the CIHR's fundamental mandate to support excellence in all the health sciences (including health services research and population health) in service of the public interest?
  2. Are there other ways for CIHR to get commercialization advice and guidance than by appointing representatives of commercial corporations to the GC? 
  3. Is it appropriate and fair to appoint a representative of a particular commercial interest from a particular sector to the GC given the inevitable exclusion of competitors?
  4. Do we know anything about Pfizer that would make it an especially worthy or unworthy corporate presence at the CIHR governing table?

Many public policy and ethics questions are fraught with complexity and highly nuanced.  Fortunately for fans of short essays, these are not.  In sequence:

Of course the commercialization mandate on occasion conflicts with CIHR's fundamental mandate.  A great deal of health services and independent clinical research - much of which is supported by CIHR - reveals the unhappy truth that many commercial successes produce little or no health value.  Billions of dollars have been made hawking needlessly expensive me-too drugs, duping physicians into misprescribing, and convincing otherwise sane people to medicalize and medicate the normal vagaries of the human condition.  These commercial successes are public interest failures.  Furthermore, one of CIHR's core functions is to create and terminate institutes.  How does a Pfizer VP remain agnostic about whether the Institute for Health Services and Policy Research should be renewed if it supports research that shows a Pfizer drug is dangerous or identifies the massive public subsidies that flow to drug companies?

Is the GC table the only or best place to get commercialization advice?  There are innumerable alternatives, all of them cleaner and more transparent.  CIHR staff can talk to Dr. Prigent and his peers daily if they want.  CIHR can set up a commercialization committee to advocate for the cause within and outside the confines of CIHR.   All universities have technology transfer offices whose job is to promote the commercialization of research.  There are legions of former or retired executives who have commercialization expertise but no active loyalties to corporate entities. 

Dr. Prigent's fundamental allegiance is to Pfizer;  Pfizer competes with other drug companies; and pharma competes with other commercial sectors in health.  As a member of GC he will from time to time have access to information that his competitors do not, and he can exert a steering effect where they cannot.  Yes, there are ethical guidelines in place, and honourable people will absent themselves from decisions where conflict-of-interest is possible even where there is room for creative interpretation of the rules.  If Dr. Prigent's ethics are unimpeachable, he will recuse himself from both discussions and voting a great deal of the time.  That's of no benefit either to him or to GC.

Over the past decade or so the seemingly countless systematic transgressions of pharma against scientific integrity and honest marketing have been documented in grisly detail.  The industry's greatest innovations have occurred outside the lab:  expensive junkets for docs-for-hire to shill for their products to their peers; the purchase of previously distinguished academics to affix their names to ghostwritten papers; the suppression of unfriendly clinical trials and adverse effects data; the publication of the same data in different journals to bias systematic reviews and meta-analyses; etc. ad infinitum. 

It is hardly irrelevant that the company to which Dr. Prigent owes his livelihood and his allegiance has owned up to sleaze that stands out even among its shady peers.  Since 2004 it has paid $2.75 billion in criminal fines and penalties, most recently a whopping $2.3 billion for fraudulently marketing Bextra, a painkiller withdrawn from the market in 2005, and 3 other drugs.  Dr. Prigent's signature adorns the confessional letter that alerted Canadian practitioners to the company's malfeasance.  Given these facts, one is hard pressed to view the appointment as anything other than a deliberate provocation. 

There are excellent reasons to exclude people actively engaged in health care commerce from the GC table to save the institution, and themselves, from the appearance and reality of conflict-of-interest.  Canada would do well to take a lesson from the United States, which is moving in the opposite direction by removing registered lobbyists from advisory boards.  Some will counter that Dr. Prigent is but one of 17 GC members, so what's the harm and where's the risk?  A single person can exert influence in many ways, not just by voting.  Would you approve of a jury where "only one of 12" jurors has an obvious interest in one outcome over another? 

How this plays out is now in the political arena.  The House of Commons Standing Committee on Health held hearings to review the appointment on Nov. 30 and Dec. 7.  Over 3300 people have signed a petition protesting the appointment, many of them prominent researchers, ethicists, and public policy experts.  If you're concerned about commercial interests steering Canada's scientific agenda, sign the petition, write your MP, write an op-ed for your local newspaper.  The government and the CIHR want this to go away; their biggest allies are silence and resignation.

About the Author

Steven Lewis is a Saskatoon-based health policy consultant and part-time academic who thinks the healthcare system needs to get a lot better a lot faster.
Contact him at: Steven.Lewis@shaw.ca