Conflict of Interest-
A Crucial Issue for Academic Medicine

By Howard Brody

In 1994, Gordon Rausser, an economist, became Dean of the College of Natural Resources at University of California-Berkeley (UCB). Frustrated by the erosion of state funding–his college received only 34 percent of its budget from the state–he decided aggressively to pursue corporate money. The end result was a 5 year, $25 million deal between the giant pharmaceutical company Novartis (through an agricultural products subsidiary) and UCB’s Department of Plant and Microbial Biology. In exchange for this support, Novartis received first rights to negotiate for any license from patented discoveries resulting from faculty research.

In May, 2000, the California Senate held hearings on the Novartis deal. “Dean Rausser was asked the following: Suppose a professor who has signed a confidentiality agreement comes across data that represents a serious danger to the public and wishes to speak out as a matter of conscience. Will UCB come to the scientist’s aid? The answer was unambiguous. The university had no obligation to defend scientists who break the contract, even if there is a public interest in revealing information.” (Sheldon Krimsky, Science in the Private Interest: Has the Lure of Profits Corrupted Biomedical Research? New York: Rowman and Littlefield, 2003, p. 37).

Rewind the tape now to 1982. Donald Kennedy, president of Stanford University, convened an invitation-only conference at Pajaro Dunes (on the Monterey Peninsula in California), bringing together top administrators and scientists from the most prestigious American research universities with executives from 11 major corporations. The goal was to develop guidelines to manage the relationship between the corporate world and the academic scientists.

“‘It is important that universities and industries maintain basic academic values in their research agreements,’ their draft statement declared. ‘Agreements should be constructed, for example, in ways that do not promote a secrecy that will harm the progress of science, impair the education of students, interfere with the choice of faculty members of the scientific questions or lines of inquiry they pursue, or divert the energies of faculty members from their primary obligations to teaching and research.’... Within a few years, every one of these supposedly sacrosanct tenets of ‘basic academic values’ had been violated. They were trampled in the stampede to stake a claim in what science reporter Nicholas Wade called ‘the genetic El Dorado.’” (Linda Marsa. Prescription for Profits: How the Pharmaceutical Industry Bankrolled the Unholy Marriage Between Science and Business. New York: Scribner, 1997, p. 133.)

The conflicts of interest created by the increasing reliance of academic science–particularly biomedical science–on the largesse of industry have created a real danger of the erosion of the core public service mission of the university, and of the public trust that academic scientists now enjoy. The university has tended to respond to this threat with both eyes firmly fixed on the mirage of the city of gold in the distance. Don’t worry about conflicts of interest. They can be managed. Arthur Schafer, writing about the ethics of this relationship, compares the university dean or president deciding whether to sell off an academic department to Novartis, with the practicing physician deciding whether or not to accept gifts from the pharmaceutical company sales representative:

“Doctors seldom admit that their clinical judgment has been influenced by the acceptance of lavish dinners, free laptop computers, or skiing holidays to Vail, Colorado. Top university and hospital officials strenuously deny any suggestion that the receipt of donations or research funds from drug companies has skewed in any way their performance of their duties. Nor do they believe that a university’s ownership of patents in new drugs being tested at the university could potentially undermine the rigour with which the university polices the integrity of the research carried out under its aegis.

 

“‘I can’t be bought for ... (fill in the blank: research funding, major donations, ... laptop computer, fancy dinner...)’. Employing these or similar words, [all] confidently affirm that there is no harm done–certainly not to their own integrity–by the acceptance of drug company beneficences.” Arthur Schafer, “Biomedical conflicts of interest: a defence of the sequestration thesis--learning from the cases of Nancy Olivieri and David Healy.” Journal of Medical Ethics, 2004: 30(1): 20.

Schafer forces us to confront the possibility that the same thing that is true of practitioners may be true of academic administrators. As is increasingly shown by empirical research, medical practitioners tend to be readily influenced by drug company gifts and other contacts, and remain largely clueless that they are subject to influence. University administrators may be similarly in denial about the threat to academic values posed by feeding at the corporate trough. One form this denial frequently takes is the promulgation of conflict of interest policies within universities to govern conflicts that occur among individual faculty members who own stock in, or have lucrative consulting or speaker fees from industry. Universities have been much slower to develop conflict of interest policies that govern the entire university and its top administrators, though the UCB-Novartis example makes clear that there is potentially far greater danger at that level.

I take very seriously the signs that greet me when I drive onto this campus to go to work every day, proclaiming that this is the “pioneer land grant university.” I take this to mean among other things that MSU cannot exist in a state of pristine academic purity, and that we must strive to address the real problems that affect the people of Michigan. This inevitably means that we must seek collaborative relationships with industry. Schafer, in his thoughtful analysis, points out that collaborating effectively with industry to be sure that academic discoveries actually go out to benefit the general public need not necessarily imply that academics take their funding directly from industry. Indeed, he calls for the creation of additional forms of what are commonly called “firewalls” in industry funding of academic research. I suggest that anyone arguing for the maintenance of the status quo read Schafer’s article carefully and be required to indicate exactly where his analysis goes off track.

Two sets of folks must accept responsibility for the present state of affairs. One is we, the academic community. We have allowed our greed (sorry, I can’t think of a kinder word) to blind us to the real dangers of the relationship that has slowly developed over time, to the point where we cannot rely on scientists at a state university to warn us of clear and present dangers posed by agricultural chemicals because their department has been “sold” to the company that makes the chemicals. The other group who must accept blame is we, the American taxpayers. We have allowed our greed (sorry, I can’t think of a kinder word) to persuade us that we can have all the benefits of living in a modern, technologically advanced society while paying far less in taxes, proportionately, than is paid by the citizens of virtually every other highly developed nation. In the process, along with allowing our public health infrastructure to fall apart and denying more than 40 million fellow citizens access to medical care, we have been willing to auction off our universities to the highest bidder. Sadly, neither group today seems willing to admit that we are part of the problem.

Howard Brody , MD, PhD
Professor, the Center for Ethics and Humanities in
the Life Sciences, and Department of Philosophy