Shelley Tremain was having some trouble posting this to the
Fablist, and asked that I send it on.  It contains some very
interesting information about the dubiousness, in Carl
Elliot's opinion, of bioethicists accepting consulting fees
from research corporations and pharmaceuticals.

Best,
  Alison C. Reiheld
-------------------
http://slate.msn.com/id/2092442/

Not-So-Public Relations
How the drug industry is branding itself with bioethics.
By Carl Elliott
Posted Monday, Dec. 15, 2003, at 9:07 AM PT



The Wall Street Journal recently reported a story about
Xigris, Eli Lilly's new antisepsis drug. Sepsis, an
infection of the blood, is a life-threatening illness
sometimes contracted by hospital patients. Lilly had hoped
that Xigris would be its new blockbuster, but the drug
hasn't taken off. One reason for this is that Xigris may not
be any better than older treatments for sepsis, but the main
reason is that the drug is so expensive. Standard treatments
for sepsis (antibiotics, blood pressure drugs) usually cost
less than $50 per day, while Xigris costs $6,800 per
treatment. To promote the drug, Lilly has hired a public
relations agency; the PR campaign they've created is
called "The Ethics, the Urgency and the Potential," and its
premise is that it is "unethical not to use the drug." To
reinforce the point, Lilly has funded a $1.8 million project
called the "Values, Ethics & Rationing in Critical Care Task
Force," in which bioethicists and physicians from various
American medical schools will examine the ethics of
rationing certain drugs and services.

It is a brilliant strategy. There is no better way to enlist
bioethicists in the cause of consumer capitalism than to
convince them they are working for social justice. Many
bioethicists see it as part of their job description to
write and speak on behalf of those who are ill,
disadvantaged, or oppressed. In the words of one prominent
practitioner, bioethics is intimately concerned "with
liberty, with rights struggle, and with the drama of the one
against the powerful authorities." So when a drug company
gives money to bioethicists, it's a little like giving money
to the poor. This helps explain why bioethicists at the
University of Toronto take funding from GlaxoSmithKline,
Pfizer, and Merck to write editorials on bringing
biotechnology to the developing world. Or why the University
of Chicago's MacLean Center for Clinical Medical Ethics
cosponsored a recent conference with Pfizer, Merck, and
PhRMA, the pharmaceutical industry trade organization, on
inequities in American health care. Or why bioethicists at
the University of Pennsylvania take money from Pfizer to
write an article explaining why physicians should not accept
gifts from companies like Pfizer. We may take industry
money, bioethicists argue, but we're not industry stooges.
We're doing God's work.

Let's assume (rightly, I believe) that most corporate-funded
bioethicists are decent people of good conscience who
genuinely see nothing wrong with taking drug industry money,
as long as no strings appear to be attached. If the drug
company makes no effort to influence your work, is there
anything wrong with taking their money?

To answer that question, we need to ask another one: Why do
drug companies want to give money to bioethicists in the
first place? In the public relations business, this approach
is called "third-party strategy." Third-party strategy is
defined as the art of getting your message into the mouth of
an authoritative third party. Often, when a drug company is
launching a new drug, it recruits a third party known as a
Key Opinion Leader: an influential figure respected by his
or her peers and often eagerly sought out by the press. The
KOL could be a grand rounds speaker at a teaching hospital,
an author on the talk show circuit, or a freelance
journalist interested in covering a medical conference. It
could also be a socially conscious bioethicist.

While KOLs are frequently offered positions as consultants
or advisers, the drug companies do not expect them to push
their products directly. That would ruin the KOLs'
credibility. Instead, KOLs are expected to generate "buzz"-
by talking casually to colleagues, giving lectures at
meetings, speaking to the press, or doing virtually anything
else that will garner positive publicity for the
drug. "While the buzz must appear to be spontaneous,"
explains the PR agency Chandler and Chicco in
PharmaVoice, "it should, in fact, be scientifically crafted
and controlled as tightly as advertising in the New England
Journal of Medicine."

Of course, KOLs must be convinced of their own impartiality;
if they understood that they were being used as industry
mouthpieces, they would probably pull the plug on the whole
enterprise. Some public relations agencies advise drug
companies to encourage their KOLs to work for many different
companies in order to maintain a posture of objectivity. As
the PR firm Thunder Factory bluntly states, "KOLs must
maintain their credibility and integrity in order to have
maximum market impact."

But funding bioethics is less an act of corporate good will
than the latest move in a larger strategy: buying off the
entire apparatus of academic medicine. One way drug
companies can achieve "maximum market impact," for example,
is through funding medical education. Drug and device
manufacturers now supply over half of the $1.4 billion spent
on continuing medical education for physicians in the United
States. They have also begun funding patient support groups
and a handful of prominent bioethics centers, apparently
taking to heart Michael Corleone's advice, "Keep your
friends close, and your enemies closer."

The drug industry has even managed to turn peer-reviewed
scientific literature into a sophisticated marketing device.
It has long been known that corporate-funded research
studies are more likely than impartial studies to favor the
products of their corporate sponsor. But only recently has
evidence emerged to suggest how many "scientific" studies
have actually been ghostwritten by specialized PR firms-
"medical communications" agencies-that represent the drug
industry. These firms then pay well-known academic
researchers to sign on as authors. Often these academic
researchers are not even allowed to see the raw data upon
which the published studies are based. A recent article in
the British Journal of Psychiatry examined articles on
Pfizer's antidepressant Zoloft (sertraline) whose authorship
had been coordinated by the communications agency Current
Medical Directions. When checked against the raw data, which
had come to light in a lawsuit, it became clear that the
studies authored by Current Medical Directions omitted or
greatly minimized Zoloft's side effects, including the risk
of suicidal acts. Yet these studies
outnumbered "traditionally authored" articles, were
published in more prestigious journals, and were cited by
other researchers at a much higher rate.

It's no mystery, then, why pharmaceutical companies want to
brand themselves with bioethics. But do bioethicists really
want to brand themselves with Pharma? To take only one
example: The pharmaceutical sponsors of the University of
Pennsylvania Center for Bioethics and its faculty's projects
are now facing multimillion dollar fraud sanctions
(AstraZeneca), a Nigerian lawsuit for research abuse
(Pfizer), massive class-action payouts (Wyeth-Ayerst), a
criminal probe into obstruction of justice (Schering
Plough), an ongoing fraud lawsuit (Merck and Medco), and
allegations of suppressing research data on suicide in
children (GlaxoSmithKline).

Somehow corporate-funded bioethicists have not been touched
by the bad publicity. Many bioethicists continue to insist
that they are learning from their industry relationships and
shaping company policy for the better. A task force
commissioned by the two major American professional
bioethics bodies-the American Society for Bioethics and
Humanities and the American Society of Law, Medicine and
Ethics-concluded last year that private corporations should
be encouraged to seek out paid bioethics consultants,
because "bioethics will have an impact on that (corporate)
activity only if bioethicists can be part of the dialogue."
The task force went on to endorse the practice of
bioethicists advertising their own services as private
consultants.

So the next time you meet a bioethicist, pay close
attention; he may look like a bioethicist, but when you peel
back his mask, you just might see the adman smiling back.




Carl Elliott teaches at the Center for Bioethics at the
University of Minnesota and is currently visiting associate
professor in the School of Social Sciences at the Institute
for Advanced Study at Princeton. He is the author of Better
Than Well: American Medicine Meets the American Dream.




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