Is There Room for Real Engagement Between Bioethicsts and the Pharmaceutical Industry?

There is currently a lot of tension between bioethicists and the pharmaceutical industry.

On the one hand, bioethicists have had much to say about the ways in which the pharmaceutical industry distorts biomedical research, publication, policymaking, and clinical practice. Bioethicists are also often critical of doctors and policymakers who engage with industry, with many critics viewing such interactions the source of unconscionable conflicts of interest[1].

Supporters of the pharmaceutical industry counter that many critics of the pharmaceutical industry are engaged in a “witch hunt”, based on a naïve, if not paranoid, idea about the complexities of commercial world and the motives of those who engage with it or work within it. It is also argued that bioethicists offer little in the way of meaningful remedies for the problems it they supposedly expose.[2]

To some degree, tensions of this kind are inevitable and healthy, producing the kinds of checks and balances that ultimately benefit everyone concerned. We would not want a world without whistleblowers—people who are prepared to put their own professional, and even personal, wellbeing on the line in order to expose what they perceive to be individual or systemic wrongdoing.

But it could also be argued that no one really benefits from sustained mistrust, suspicion, and reluctance or inability to engage in shared moral deliberation, and that more needs to be done to encourage collaboration between ethicists and industry.

This raises the question: how can bioethicists and the pharmaceutical industry engage in more fruitful debate about morally-charged issues?

One approach that has been increasingly championed in the United States is for companies to employ or contract with bioethicists, who can advise on the management of ethical dilemmas as they arise in practice. While there are good arguments for such arrangements, questions are inevitably raised about, for example, the objectivity of such ethicists, and their capacity to expose wrongdoing in the companies with which they are engaged[3].

Whether or not these perceptions are accurate, they exist, and they underscore the need for there to (also) be bioethicists who sit outside industry, but who understand the nuances of industry, and are able engage meaningfully with those who work within, or with, pharmaceutical companies.

This is not an easy position for a bioethicist to inhabit, but is one that an organisation such as DIA can facilitate*. As a bioethicist who wishes to occupy this “middle ground,” I invite DIA members to offer their ideas as to how we, as DIA members, might move beyond the “hostile interdependence” that characterizes many of the interactions between biomedicine, bioethics and the pharmaceutical industry and engage with one another in shared moral deliberation.

Please respond to this Blog with your ideas—skeptics are most welcome, but constructive suggestions would be much appreciated.

*With this in mind, DIA has established a new Community: “Ethics and the Medicines Lifecycle”

[1]See for example: Elliott C. (2010) White coat, black hat: Adventures on the dark side of medicine. Beacon Press.

[2] See for example: http://www.medscape.com/viewarticle/822145; http://www.sciencebasedmedicine.org/irbs-conflicts-of-interest-and-witch-hunts/; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813836/; http://online.wsj.com/news/articles/SB10001424052970204468004577166840760748000

[3] See for example: http://virtualmentor.ama-assn.org/2006/02/msoc1-0602.html

Author Wendy Lipworth is Section Editor for Ethics and Policy for Therapeutic Innovation & Regulatory Science. Dr. Lipworth is a medically trained bioethicist and qualitative social researcher from Sydney, Australia. She is based at the University of New South Wales (Australian Institute of Health Innovation) and Sydney University (Centre for Values, Ethics and the Law in Medicine). Over the course of her Masters degree, PhD and National Health and Medical Research Council (NH&MRC) Postdoctoral Fellowship, she has developed a program of research focused on the ethics of biomedical innovation, with a particular focus on the ethics of drug development, regulation, funding and prescribing. Methodologically, her work is best described as empirical bioethics in which empirical research (e.g. stakeholder analysis) is used in conjunction with theoretical analysis to address real-world problems. 

 

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