Friday, December 11, 2009

'Where there is smoke, there is Pfizer'

I took this header from the hugely recommended and informative site my colleagues at have put together. You might recall that it has been decided to appoint a Pfizer VP to the governing board of the Canadian Institutes of Health Research. The CIHR is a public agency funding biomedical research in the country. I have already pointed out elsewhere why such an appointment is untenable. It is untenable for one fundamental and one slightly more contingent reason. The fundamental reason is that the Pfizer VP has a fiduciary responsibility to the shareholders of his company to maximise profits. He is by necessity unable to prioritise the public interest over the profit interest over his employer, hence he has a continuing conflict of interest that makes him eminently unsuitable for accepting such a post. Just to be clear, maximising the profits of his publicly listed employer in its own right is not objectionable, what is objectionable is that someone representing such interests should serve on the board of a funding agency aimed at maximising the public good. The second reason is that Pfizer has a dismal record in terms of its business ethics. As noveltech documents on its site, the company has been paying out billions of dollars to extricate itself from ethics failings and violations of the law. Sweet irony that the CIHR's ethics chap should be supportive of the appointment...

The Canadian government is keen to have someone with a background in product development (commercialisation in the widest sense) on the CIHR governing council to ensure that more of the biomedical research undertaken in Canada, that is funded by taxpayers, is subsequently commercially exploited. In its own right this isn't a bad idea, even though the immediate worry would be that commercial organisations (Pfizer comes to mind) would try to exploit taxpayer funded research as a shortcut to product development, with a pittance flowing back to the publicly funded research and the public being bilked for what it's worth by Pfizer for a drug that we paid already for as taxpayers who fund the CIHR.

Francoise Baylis at Dalhousie University has written a letter to Harvey Chochinov, the ethics member of the CIHR governing council. Chochinov has made himself a name by way of writing about something he calls dignity enhancing end-of-life care. His trivial insight is essentially that we should meet dying patients' needs better and that that would reduce the number of such patients who ask for assisted dying. He is, of course, right on both counts. Google him for fun to see how often he has published that very same insight in an avalanche of similar papers.

Anyway, I digress, Baylis asked Chochinov why he has supported the Pfizer appointment. To the crucial conflict of interest charge Chochinov replies: 'GC members are not there to promote their own vested interests or those associated with their specific geographic, financial, disciplinary or pillar based affiliations. [...] Rather, GC members are expected to place those personal agendas aside, and promote the best interests of CIHR, the broad research community and health related concerns of Canadians.' The trouble is that the Pfizer employee could not act in this manner due to his contractual obligations to his employer. He could not put his employer's commercial agenda aside even if he wanted to. So, Chochinov fails fully to address the issue at hand. In his reply to Baylies he argues that 'Members of the ethics committee have taught over the years that it is possible for people to reach different conclusions, in spite of following ethically sound processes. I believe the process of ethical debate in this instance has been sound, in spite not reaching consensus.' This statement is sufficiently bizarre that I tried to find his CV online in order to ascertain whether the CIHR's Chair of the Standing Committee on Ethics has any qualifications in ethics at all or whether we have here another physician with an urge to go on about ethics who has no formal training in ethics. I have got to be honest, despite trying for some time to trace his academic CV, I was unable to find it. He may or may not have had ethics training, I do not know. I am doubtful at the very least. His statement to Baylis constitutes a petitio principii. He is well and truly begging the substantive question by saying that reasonable people can legitimately disagree in matter of ethics. That's true, but surely only after the issues at hand have been addressed. His explanation for why the Pfizer VP would not face conflicts of interest is plain wrong. So, if on that basis he supports the appointment, the fact that some process was followed does not make his stance any more right. Ethics is not that relative! It's not a matter of having a chat and then it's a free-for-all.

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