Sunday, September 1, 2013

Why There's No Such Thing as Conflict of Interest

A good deal of this blog is about conflicts of interest at the interface between medicine and the pharmaceutical industry, and we occasionally encounter those who deny that such conflicts of interest represent any serious problem, for instance:

I have also alluded to the ideology that I and some others have termed economism:
--about which, if anyone is interested in more discussion, they are welcome to peruse my other blog:

All that is a lead-in to a new book, Never Let a Serious Crisis Go to Waste, by a professor of economics at Notre Dame, Philip Mirowski (New York: Verso, 2013). Mirowski explains at a much deeper level why it is that critics of the position taken in this blog, and among the community of pharmascolds, insist that conflict of interest really doesn't exist.

First, on nomenclature--while I offer reasons to prefer the term 'economism' on my blog and in my own book, The Golden Calf, Mirowsky follows the practice of most of our colleagues in history and the social sciences in using the term 'neoliberalism.' So rather than get tangled in who calls it what, I will refer to this ideology henceforth as 'E/N'.

E/N starts off with the claim that the supposedly "free" market is the single most important institution in society, so much so that we ought to regard virtually all of human life as one big market and as following the rules of the marketplace. You might think this is just because a market is such a neat place to buy and sell stuff. But Mirowsky shrewdly notes that one of the great founders of E/N, the Austrian economist Friedrich Hayek, had another reason to glorify the market.

Hayek saw the market as the most perfect information processing system available to human society. If he were writing today, Hayek would probably use the metaphor of the computer. The market is a supercomputer that instantly receives input data from billions of sensors, which are the individual "rational agents" as orthodox neoclassical economics conceives of such a thing.

Now, since all of society ideally ought to be governed by the rules of the market, it follows that the only data worth knowing about anything is its current market price. The market price captures precisely the value of that commodity; the very idea that the market might overvalue or undervalue anything simply does not compute within E/N. The supercomputer of the market takes in all the data from all those who might like to sell a commodity--how much of it they have, and what price they are willing to accept for it. It takes in all the data from everyone who might buy that commodity--how badly they want it, what they might be willing to pay for it, what else they might be willing to forgo, or not, to get some of it. And the computer crunches all those numbers each millisecond to come up with the ever-changing fact, the true market value/price of that commodity.

This is E/N's picture of how society ought to run; and from that picture you can see that there are a number of flies in the ointment, called natural scientists. These folks persist in adhering to a hackneyed, obsolete idea-- that there is another source of valid facts that has nothing to do with how the market functions. These scientists actually think they can consult the body of evidence in their own field, and go into the labs and do experiments, and emerge with data that they view as reliable and true about how the world works.

If these scientists were ever to be taken seriously, all hell would break loose. For the proper role of government, according to E/N, is to stand out of the way and allow the unregulated "free" market to run itself. But so long as these scientists tell politicians that they know some facts--such as, that climate change is a real threat to the human future--then these politicians would be tempted to try to regulate the market to bring about the ends that they desire (like reducing carbon pollution). And that would simply never do. As Hayek famously explained, just let the government think it could regulate even one small thing, and we'd all instantly and permanently lose all of our freedoms.

(As a side issue, whether that was what Hayek really said is quite questionable, and on my other blog I go into some detail about why what today's E/N enthusiasts claim in Hayek's name may actually be a far cry from what Hayek actually wrote:
But for now we can ignore that fine point.)

Now, what in heck does all this have to do with conflict of interest? The point is that the entire ethical argument about conflict of interest assumes, well duh, a conflict of interests. Presumably a scientist has an interest (actually a moral duty) to discover and explain the truth according to the best scientific evidence and methods. If the scientist then proceeds to line his pockets with industry money, he acquires a second interest, in making those industry folks happy and telling them what they want to hear--such as their favorite new drug is extremely safe and effective.  The conflict between those two interests is what creates the ethical problem.

How does E/N see this situation? E/N cannot fathom the duality of interests. Since the market is the only reliable source of truth about value, then if the scientists accepts payment on the open market for his opinions, the market value of those opinions, not some silly body of scientific evidence, is what determines their truth. So the scientist creates no conflict of interest by becoming a corporate shill.

Mirowski looks at his fellow academics and notes spectrum of opinion on conflicts of interest. At one extreme end he places the biomedical folks. They have gotten their knickers more in a knot than anyone else over conflicts in their field, and have created this new cottage industry of COI guidelines and rules. Maybe that has something to do with the idea that some of them actually care about whether patients live or die after being given the newest drugs and devices.

At the far other end of the spectrum are the economists. As Mirowski characterizes the field of orthodox neoclassical economics (which has both taken over virtually all university departments of economics, and has also been fully captured by the E/N ideology, to hear his account of it), the typical econ professor takes a ton of money from various corporations, especially banks and financial firms, believes that nonetheless he's a completely neutral arbiter of fact, and discloses none of those financial involvements in his journal articles and other scholarly work. Plaintive calls among a few disgruntled folk after the start of the recent great recession, that the field of economics needed a code of ethics, were ignored.

When we understand what E/N teaches, we can see why the economists have figured out exactly what conflict of interest is all about, and why from their point of view the biomedical scientists are clueless. And that further explains why those within the biomedical community, who have been most sneering and dismissive of conflict of interest as an ethical concern, seem to be among those most committed to the E/N ideology.

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