Okay, I will admit this--I have officially become paranoid. Where others see only individual actions, I now see an orchestrated conspiracy. In a way my paranoia is self-congratulatory. Because those of us who are advocating serious reforms in the medicine-Pharma relationship are finally starting to be heard, we now threaten the industry sufficiently to make us worth powder and shot for a counter-attack.
The first form of counter-attack I became aware of is efforts by industry apologists, like law professor Richard Epstein at Chicago, to re-define "conflict of interest" so that it no longer worries us as an ethical issue. (I'll address that in another venue.)
The second form of counter-attack, I will suggest, shows up in this month's issue of Critical Care Medicine, in the form of a charge of "intellectual bias."
In an exchange of letters to the editor, three NIH scientists, Peter Eichacker, Charles Natanson, and Robert Danner, attack critical care guidelines promulgated by the Surviving Sepsis Campaign. They detail their disagreements with the position those guidelines took in recommending the very expensive drug, Xigris (recombinant human activated protein C) sold by Eli Lilly. (HOOKED details the earlier chapters in the Xigris saga, when Lilly recruited some of my own colleagues in bioethics to inveigh against "unethical rationing" of care in ICU's when many intensivists read the literature and decided that Xigris was simply not worth its high costs.) They point out the many avenues of commercial influence on the SSC, and how other medical groups in Europe and elsewhere are calling for new studies or otherwise rejecting the SSC's advice.
Two members of SSC, Phillip Dellinger and Charles Durbin, then proceed to reply, mainly in the form of accusing the NIH scientists of having no real evidence to back up their claims and yet repeating their attacks on Xigris incessantly despite having no evidence. Here is the key paragraph:
Drs. Eichacker, Natanson, and Danner accuse the SSC of being biased toward industry, yet fail to acknowledge their own intellectual (academic) bias. This form of bias can be defined as presenting personal, entrenched beliefs as scientific truth in an area where no clear-cut consensus exists. We believe this intellectual bias can be more insidious and damaging than the potential bias arising from affiliations with industry.
Now, this is quite a piece of work. The NIH scientists believe that the preponderance of the scientific evidence supports their point of view. The SSC guys believe the same for their own point of view. That makes the NIH people guilty of "intellectual bias" while the SSC remains innocent of that sin.
What is even more breathtaking is that intellectual bias (whatever that turns out to be) is actually much worse than commercial bias. As I have reviewed in HOOKED and on this blog, and as numerous meta-analyses and systematic reviews have shown, commercially sponsored studies are roughly 4 times more likely than neutral studies to favor the company's drug. So commercial bias has been shown to be real and substantial. Against that empirical proof, we are being invited to dismiss commercial bias as no big deal, but to quake in our boots at the possibility of "intellectual bias."
The implicit subtext, as best as I can read it, is that people ("academic intellectuals") who work at NIH, or at universities that believe in avoiding conflicts of interest with industry, are some sort of ivory-tower, goody-two-shoes weirdos. They think they are intellectually superior to the rest of us mere mortals, and the best thing to do with these insufferable twits is to ignore them. By contrast, scientists who jump into bed with industry at the first opportunity are regular people just like us, and are hard-headed, pragmatic realists. Their take on the world is much more reliable.
Stay tuned. I expect to see charges of "intellectual bias" repeated regularly whenever Pharma feels that it is being placed on the defensive by demands for reform.
Eichacker PQ, Natanson C, Danner RL. Separating practice guidelines from phramaceutical marketing [special letter to the editor, with reply]. Crit Care Med 35:2877-80, 2007.