DANCING WITH THE PORCUPINES

DURING ONE OF THOSE LATE-NIGHT research sessions for GENERATION RX, I stumbled upon a wonderful commentary written by a group of academic researchers in Canada. It sucked me in immediately—and the work itself was full of insights into the way our friends up North view the issues surrounding ethics in medicine. For the most part, Canadians seem far more engaged in these ethical debates than do we Americans, and the commentary spoke of “tarnished institutional reputations, one-sided marriages” between business and universities, and “unsettling incidents” involving “intimidating tactics by industry that profoundly affect researchers' lives and careers.”

Many of you will recall my interview with Professor Sheldon Krimsky of Tufts University for GenRx that detailed how funding cuts in Academic research during the Reagan years helped propel a “blurring of the line” between academic/scientific research and commercial interests—and how this manifested recently as gross conflicts-of-interests worldwide. “What the Reagan administration thought they would do is to create a closer linkage between the corporate world and the academic world,” Krimsky told me. “So they created incentives for corporations to invest in universities. At the same time, they kept proclaiming that . . .the federal budget was going to be mean and lean, and that got university administrators became very concerned. How were they going to make up the financial downfall in the university budget?” The answer, Krimsky stated, was that universities often buckled under the immense pressure of drug and petrochemical companies. “You want the dollars,” they'd say, “then you'd better play ball.”

University presidents, Krimsky pointed out, were between a rock and an economic hard place in the Reagan/Bush years—and opted for survival by creating a new era of commercialized academia. It soon became acceptable for scientists to have a commercial affiliation while being paid as a basic researcher... but therein lies the problem. “The duty of universities is to seek truth,” wrote the Canadian researchers, and to ignore that premise could alter the ethos of science, perhaps forever.

In the old days — and by ‘old’ I mean the 1970s — academic and journalistic interests worked hand-in-hand to root out the best of scientific research. Integrity of the information was paramount — in fact, it was the stated goal. During that era, skepticism was a hallmark of the academic mission. It kept what some brilliant Canadian conflict-of-interest researchers called “the premature enthusiasms of industry,” in check.

As journalistic stalwarts like Robert Whitaker have discovered, those safeguards were abandoned years ago.He put forth many of the shocking details in GENERATION RX, but he and Sheldon Krimsky knew all of this would come to pass, sooner or later.

Krimsky tells viewers how there are two rules that operate within the federal advisory committees—the groups responsible for making recommendations on whether any given drug should be available to consumers. “Rule number one says that anyone who has a substantial conflict of interest cannot serve on a federal advisory committee,” Krimsky says with a knowing smirk. “Rule number two says that rule number one can be waived. And rule number one is waived; in some cases the evidence shows 50 percent of the time.”

So there you have it. The very rules written into law to protect the public from conflicts-of-interest actually make allowances for the rules to be broken — at least one-half the time. “One culture’s pursuit of the truth is supposed to be unencumbered by money,” Krmsky concludes, “and the other culture, for which money is the medium of exchange, is the bottom line.”

As the film points out, at least 56% of those serving on the Diagnostic and Statistical Manual for Mental Disorders (DSM) have conflicts of interest with the very drugs they are charged with approving. God knows how many of these DSM panel members began their questionable behavior during the Reagan years, but in 2010 it is a massive problem, and one which challenges the integrity of all of medicine.

The Canadian conflict-of-interest researchers recognized this ethical landmine as the most dangerous and daunting test for today’s academic research programs. They coined the perfect term to describe what it is like when academia, researchers, and the pharmaceutical companies are joined at the hip.

“Some bargains are Faustian, and some horses are Trojan,” the researchers wrote. “Dance carefully with the porcupine, and know in advance the price of intimacy.” It's the perfect description of the steep and painful price that we all pay when the cherished institutions we rely upon for truth — go awry.