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_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$675000 gift from the pharmaceutical industry.10,11 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.
Many North American bioethicists have been reluctant to admit that industry funding is an ethical problem. 3 years ago, a task force on bioethics consultation for industry commissioned by the two major US bioethics associations published its recommendations in The Hastings Center Report.13 The task force found no ethical barrier to industry-funded bioethics consultation, and went on to endorse bioethics advertising (eight of its ten members had done industry-funded work themselves). Similarly, the editors of Theoretical Medicine and Bioethics have argued that financial disclosure in bioethics is positively harmful, because it encourages readers to judge an article by its funding rather than by its merits.14
Yet industry funding will surely lead readers to question the impartiality of bioethics as a discipline. And so it should. The pharmaceutical and biotechnology industry has a clear interest in the work that bioethicists do. Bioethicists write scholarly articles about the actions and policies of industry. They lecture on issues of concern to industry at conferences and in university classrooms. They serve on regulatory committees, governmental task forces, and professional bodies. Many offer comments on ethical controversies in the popular press. Bioethicists help write the policies that govern the ethics of medical research, and they sit on the institutional review boards and research ethics committees that decide which research protocols can go forward. It should be no surprise that the pharmaceutical industry is eager to influence them.
Public relations experts clearly understand the advantages of using academic experts to advance a cause. Some companies pay academics to promote their points of view on television, in newspapers and magazines, in academic journals, and in letters to editors.15 In one case, a Washington speaker's bureau and a public relations firm were found to be recruiting academic experts to attack Eliot Spitzer, the crusading attorney-general for New York who has launched high-profile investigations of the pharmaceutical and insurance industries.16 In the early 1990s, a tobacco company paid a statistician $10000 to write one letter to the Journal of the American Medical Association.17
Some critics of industry-funded bioethics have argued that the remedy is full disclosure. But disclosure is unlikely to solve the problem. In science, in which far more attention has been paid to issues of conflict of interest, a study18 found that only 0ú5% of over 60000 published articles included any disclosure of competing financial interests. At the time, it was estimated that about a quarter of researchers actually had industry funding. Those articles were published in science and medical journals with clear guidelines on conflict of interest. Most bioethics journals do not even ask authors to disclose their funding sources. A survey by the Center for Science in the Public Interest in 2002 found that only two of 53 bioethics journals had published guidelines requiring authors to disclose potential conflicts of interest.19 Even that small number represents an improvement over academic book publishers, who typically have no conflict-of-interest guidelines whatsoever.
Nor have disclosure policies eliminated the problem of bias. In medicine, industry-funded research produces findings that are more favourable to industry than research funded by other sources.20 Clinicians who accept gifts and honoraria from industry are more likely to prescribe drugs from that particular industry and more likely to request that those drugs be added to their hospital's formulary, even when they do not themselves believe they have been influenced.21 It would be very surprising if industry funding, even if disclosed, did not also influence what bioethicists publish.
Disclosure policies raise a red flag and should be retained, but they do nothing to eliminate the real problem of industry funding, which is not secrecy but influence-peddling. The pharmaceutical industry is arguably the most profitable and politically influential industry in the USA.22 It now funds about 60% of all Americans continuing medical education.23,24 A large health-care public-relations industry, funded largely by pharmaceutical companies, routinely commissions journalists to cover conferences in which their products are being discussed, distributes copies of favourable journal articles to practitioners and to the press, sponsors disease-awareness campaigns, funds disease-advocacy groups, and commissions key-opinion leaders to present papers at conferences and lectures.25_27 If bioethics scholarship is to retain any measure of independence and credibility, it will need to take much stronger measures.
Newspapers have understood this for years. Financial columnists are not allowed to accept money from the companies they write about, and film critics are not allowed to accept money from the studios producing the films they review. This standard may well be honoured less in the observation than in the breach, but in principle, it is a standard worth emulating. The Washington Post, for example, states in its ethics code: _We pay our own way. We accept no gifts from news sources. We accept no free trips. We neither seek nor accept preferential treatment that might be rendered because of the positions we hold._28
The editors of medical and bioethics journals should adopt a similar policy. If an editorialist writing on ethics or health policy has a financial interest in the topic on which he or she is writing, the journal should not publish the article. Such a policy would prohibit articles on the ethics of antidepressant use funded by antidepressant manufacturers, articles on the ethics of stem-cell research funded by biotechnology companies working on stem cells, and articles on the ethics of genetically modified crops funded by agribusiness. Such a policy would be similar to the one adopted for several years by The New England Journal of Medicine, which stipulated that authors of editorials and review articles (as opposed to scientific reports) _will not have any financial interest in a company (or its competitor) that makes a product discussed in the editorial._29,30
The details of such a policy would also need to be worked out carefully. For example, editors would need to decide just how close a tie to industry should be sufficient to trigger the policy. Almost all universities have some ties to industry, but in most cases those ties have little to do with the funding of a bioethics centre or department. These arrangements are clearly not as worrisome as, for example, a bioethics centre directly funded by industry, or one whose faculty members generate their own salaries with grants from industry. Editors would also need to decide what kinds of articles should be prohibited and what kind should merely require disclosure of a financial interest. Journals that are reluctant to prohibit such articles entirely might decide to reserve a special, visibly marked place in the journal for industry viewpoints.
Of course, such a policy would not solve all the problems of industry funding. Bioethicists would still be free to publish their opinions in books, the popular press, and non-peer-reviewed intellectual magazines. But the symbolic effect of such a policy would be very powerful indeed. Bioethicists would be faced with a choice: either forego industry funding, or forego writing scholarly articles about the practices of their funders.
Conflict of interest statement
I declare that I have no conflict of interest.
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