Magazine article Dissent

When Ethicists Have Conflicts of Interest

Magazine article Dissent

When Ethicists Have Conflicts of Interest

Article excerpt

IN FEBRUARY, the online magazine Slate published an article with the title, "Go Away, Ethics Police; Leave the NIH Alone." The author of the piece was Richard Epstein, a law professor at the University of Chicago and a senior fellow at the Maclean Center for Clinical Medical Ethics. The "ethics police" to whom Epstein objected were the critics who had pushed the National Institutes of Health (NIH) into adopting a strict new set of conflict-of-interest regulations. Last year, a muckraking series of reports in the Los Angeles Times revealed that some NIH scientists had parlayed their elite scientific positions into lucrative consulting contracts with the pharmaceutical industry. Several NIH scientists had received more than $2.2 million in company fees and stock options. The director of one NIH institute received more than $600,000 from Schering AG and other companies at the same time that his institute conducted studies for Schering and pledged it $ 1.7 million in grants. Another scientist wrote national cholesterol guidelines while accepting $114,000 from the makers of cholesterol-lowering drugs.

When Congress decided to investigate, the NIH began to clean up its house. In early February, the NIH director, Elias Zerhouni, announced that the NIH would impose strict limits (which were later loosened) on the relationships that its staff could maintain with industry. It was this strict policy to which Epstein objected. "In my experience as a member of a conflict-of-interest committee at the University of Chicago," wrote Epstein, "it is par for the course for the leaders in cutting-edge technologies to take consulting jobs or stocks in outside ventures that harness the results of their academic research."

What Epstein did not say (and what Slate did not reveal until later) is that Epstein has one of the same kinds of financial relationship to the pharmaceutical industry that he wants the NIH to preserve. Not only is Epstein a paid consultant to Pfizer, the world's largest pharmaceutical company, he also consults for PhRMA, the pharmaceutical trade organization. Along with Merck, those two organizations have underwritten an annual medical ethics and health policy conference at the University of Chicago that Epstein helps to organize and whose 2003 proceedings he recently published in the bioethics and medical humanities journal Perspectives in Biology and Medicine. The 2004 proceedings were published (without disclosure) in the Yale Journal of Health Policy, Ethics and Law. Ironically for the sponsors of a bioethics conference, Merck and Pfizer were both among the nine companies included in the Dow Jones Industrial Index that were convicted of corporate crimes last year.

Epstein's ties to the pharmaceutical industry are no secret. Epstein himself wrote about them in a recent article in Legal Affairs that was advertised on the cover with the slogan "I Heart Big Pharma." But Epstein's article in Slate (perhaps inadvertently) raises a far more important ethical question: what is a person with such obvious conflicts of interest doing on a University of Chicago conflict-of-interest committee?

In the world of bioethics and health policy, such questions are no longer academic. The pharmaceutical and biotechnology industries have begun adding academic bioethicists and health policy analysts to their corporate payrolls. Some companies employ bioethicists as consultants or advisers; others contribute funds to academic bioethics and health law centers; many sponsor bioethics projects, task forces, and conferences. For example, the program of the 2005 spring meeting of the American Society for Bioethics and Humanities included full-time bioethicists from Glaxo SmithKline and Millennium Pharmaceuticals; a bioethics consultant to Eli Lilly; and a presentation by Glenn McGee, editor of the American Journal of Bioethics, who spoke about a funding grant he and his bioethics colleagues had received from deCODE Genetics. Bioethicists are no longer disinterested commentators on the question of whether pharmaceutical industry money constitutes a conflict of interest for academic researchers. …

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