Wednesday, April 11, 2012

Sismondo on How Pharma Disguises Interest as Science

I've reviewed the work of philosopher Sergio Sismondo of Queen's University, Kingston, Ontario previously, for example:

Thanks to my esteemed colleague Daniel Goldberg, I learned of a recent paper by Dr. Sismondo (subscription required), which offers a number of observations about drug industry activities and also a bit of philosophical analysis. While many of the factual observations have previously been discussed here and other places, I thought a few tidbits were worth mentioning before I get to the philosophical part:

  • Dr. Sismondo extends the concept of "ghostwriting" medical journal articles into the more general practice of "ghost managing" entire publicity campaigns, and medical communications companies market their wares to big drug companies based on their success in doing this. While major medical journals commonly reject 90% or more of all submitted manuscripts, several top communications companies claim that they have a nearly 80% success rate with manuscripts they produce. This is not surprising, he notes, when a firm such as Complete Healthcare Communications can draw on the talent of more than 50 medical writers and editors and more than 30 publication planners, plus numerous other staff. No academic author doing legitimate research publishing without industry support can draw upon anything like that battalion of resources.

  • Dr. Sismondo takes us behind the scenes at a 2-day conference sponsored by ExL Pharma, a "KOL Relationship Summit" to discuss how to best utilize physician-scientist "key opinion leaders." One KOL, Dr. Michael Thase, noted how difficult it had been for him when he served as an expert witness in a court case and the attorney for the opposing side hit him with documents describing the drug company's "individual management plan" for him. Thus, he said, it's problematic when companies talk about "managing" KOLs. This led to a long discussion of semantics in which phrases such as "opinion leader engagement" were tossed about. Dr. Sismondo noted that there was a lot of debate on what to call the behavior but no one suggested changing the behavior itself.
Now for the more general philosophical point, which I shall modify somewhat from Dr. Sismondo's rendition. Many pharmapologists accuse pharmascolds like me of creating a straw man argument when we talk about "conflict of interest." They claim that after all, we are here dealing with scientists doing science. All human beings have various biases and prejudices that influence how they think and act. But the norms and methods of science are designed to transcend those personal quirks and assure that the outcome is valid and "objective." To claim that a scientist produced bogus data because he had a conflict of interest is a sort of ad hominem argument--we cannot dispute the science and so we resort to name-calling to discredit the author.

The point I take away from Dr. Sismondo's discussion is that whatever the rest of us may think about interests and science, when one reads the internal documents of the drug industry and attends conferences such as the ExL Pharma KOL management conference, it's quite clear that "interest" describes exactly the way the industry thinks and behaves. They believe that they've bought and paid for the science and the scientists and therefore they can expect the scientists to dance to their tune and the science to translate directly into sales and profits. And if it doesn't work out that way they figure they've been had.

A point Dr. Sismondo does make is that the industry shows how much it believes in the idea of "interest" by realizing that if it wants to sell drugs using science, it has the go to great lengths to disguise the "interest." So the industry values KOLs, ghostwritten articles, and the entire "ghost management" process precisely because docs can easily be made to believe that what they get from these sources is disinterested science, and not industry interest.

Sismondo S. "Corporate Disguises in Medical Science: Dodging the Interest Repertoire." Bulletin of Science, Technology & Society 31:482-492, 2011.

No comments: