Essays

Essays December 2009

Well I Declare:  The Emasculation of Conflict-of-Interest

Steven Lewis

Abstract

Science and public policy thrive when thoughtful people debate the issues. That Dr. Sharma has entered the debate about the Prigent appointment to the CIHR Governing Council is commendable.  He has marshalled a number of arguments in defence of the appointment.  I am certain that many scientists (but few ethicists) share his perspective.  Let me explain why I do not.

Dr. Sharma's case has 6 essential elements:

  1. Scientific inquiry is riddled with ethical transgressions (e.g., "climategate"), so why hold the CIHR GC to a higher standard?  Scoundrels abound,  so we might as well resign ourselves to this reality and invite them into the deliberative tent where we can look into their eyes.   This view is logically coherent - an endorsement of the race to the bottom in ethical conduct.  But the decline has consequences, not least of which is growing public scepticism of all science. 
  2. Dr. Sharma dismisses my reference of the "seemingly countless systematic transgressions of pharma against scientific integrity and honest marketing" as irrelevant to whether a pharma official ought to sit on the GC.  It is precisely the frequency and reach of pharma's malfeasance, some of which is criminal, that casts doubt on fitness to serve.  Disbarred lawyers or defrocked physicians don't get to make regulatory policy.  Members of Hell's Angels do not sit on parole boards even if they have not personally been convicted.
  3. Everyone has an angle on the GC; parochialism and special pleading are inevitable.  Dr. Sharma's proposed remedy is to balance out the interests in the hope that the collectivity will broker a reasonable approximation of the public interest.  But there is a profound difference between an academic with a particular disciplinary background whose career is devoted to discovery and free intellectual inquiry and a drug company executive accountable to shareholders.  The CIHR is mandated to support excellence in basic, clinical, health services, and population health research.  It is not mandated to serve pharmaceutical industry shareholders.  That some CIHR-supported science may one day serve those ends is an indirect consequence.  An interest in an expanded health services research agenda is quite different from a shareholder-driven interest in creating institutes committed to pharmaceutical research or terminating support for institutes that fund research that casts doubt on the value of certain drugs. 
  4. If we exclude pharma, we should have no commercial representatives on GC.   Here I agree with Dr. Sharma.  CIHR can get commercial advice from hundreds of sources.  Parliamentarians and public servants can and do talk to registered lobbyists pursuing their interests but it would be ethically indefensible to put active lobbyists in the Cabinet.  There should be no active commercial health sector officials on GC because their fiduciary obligation to private interests conflicts with the GC obligation to the public interest.     
  5. Pharma pays taxes, and taxes fund CIHR.  Dr. Sharma speculates that pharma deserves a privileged place at the GC table on the principle of "no taxation without representation".  Paying corporate taxes does not buy you a share in a national research granting agency any more than it entitles you to a percentage of seats in Parliament.  Pharma taxes are not earmarked for health research any more than yours or mine are.   Selling Indulgences went out of fashion with the Reformation.     
  6. The declaration of conflict of interest is sufficient to guarantee that it will not occur.  This is, I believe, the heart of the matter:  it is an all-too-commonly accepted norm in public life.  We no longer seek to avoidconflict of interest; we take the fox's word that he will become a vegetarian when given the keys to the henhouse.   No robust understanding of conflict-of-interest legitimizes this view. 

It must be said that Dr. Sharma takes his own theory seriously and walks his own talk.  He has received funding from 8 drug companies, including Dr. Prigent's employer Pfizer - a fact undisclosed in his essay.   Dr. Sharma may sincerely believe his long history of drug company funding for research, speaking, consulting, and travel has no influence on his opinion about the suitability of Dr. Prigent's appointment to the CIHR GC.  He may think reasonable people will agree that the Sharma-pharma connection does not put him in a conflict-of-interest position as an objective commentator on the suitability of the appointment.  Readers can decide for themselves whether this is a case of plausible deniability. 

I would simply pose three questions to Dr. Sharma.  First, would he have felt moved to write the article defending the appointment if he had never received drug company funding?  Second, does he think it's possible that pharma will be more inclined to support his work and fund his talks now that he has come out in favour of the GC appointment?  Third, if he felt the appointment violated conflict-of-interest principles, would he have published an essay opposing it? 

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

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