Saturday, February 18, 2012

More on Bioethicists and COI

I've had considerable feedback both in the form of blog comments and off-line e-mail regarding the previous post on bioethicists and conflicts of interest. One e-mail raised a factual issue which I have tried to correct in an addendum to the original post.

However a couple of writers have raised a response which I need to identify and challenge. The claim is that Dr. Glenn McGee may have done something ethically questionable, if not actually shameful, by becoming an executive and spokesperson for a for-profit company that markets unapproved stem cell therapy. But this is of no interest to the field of bioethics. If there is shame, it falls solely on his own head.

Sorry, in my view, this won't wash. When I do our course on "professionalism" for our medical students, if one of them says, "Look, if I want to have sex with my patients, I will go ahead and do it; if somebody objects, the responsibility is solely my own and has nothing to do with the professional of medicine as a whole," then I would gently try to set him or her straight on what professionalism means. (OK, maybe not quite so gently.) The idea that becoming a part of a profession constitutes a sort of collective promise of ethical behavior to society at large is a concept that many of our students, imbued with good ol' American individualism, resist mightily. I would argue that nonetheless it is the only way to think coherently about the concept of professionalism as an ethical or normative (not as a sociological or descriptive) notion.

Now, just what bioethics is has been debated for decades, and many assert for good reasons that it is not a profession as such. (There is, for instance, no standard licensing exam.) That said, and not boring you with that debate, I would assert that bioethicists should regard themselves as professionals, and most are in fact professionals of one stripe or another--physicians, nurses, attorneys, university professors. So I think bioethics cannot evade the implication that bad behavior by one of us reflects badly on the entire "profession" or field or whatever; and without that assumption I would have had no grounds for calling attention to Dr. McGee's behavior or offering my opinion of it.

One writer suggested in an e-mail that Dr. McGee has now left the field of bioethics, so presumably if he wants to make a bundle of money doing something questionable (to put it as kindly as I can), so be it. If that were true, I wish he would have said so, instead of accepting a position that has "ethics" in its official title.

NOTE ADDED 2/29/12: Nature has chimed in with news coverage to confirm that Celltex is not only banking and growing stem cells, for a hefty price tag, but also is involved in injecting the cells into patients, which is not FDA approved and is considered unproven therapy:
The Nature coverage also quotes Dr. McGee as claiming that he's at work designing new, ethically sound rules for Celltex's research, which again does not suggest that he thinks he has "left the field" of bioethics. It may be worth noting that no one at Celltex, Dr. McGee included, was willing to answer Nature's questions on the record regarding what treatments thay are now offering to patients.


G. Owen Schaefer said...

I’ve been a bit surprised at the criticism leveled against Glenn McGee for his move to Celltex (COI issues with AJOB notwithstanding). Suppose we accept the premise that Celltex has indeed been involved in unethical behavior in its provision and marketing of unapproved stem cell therapies. I would think that we should welcome an effort by said company to provide more ethical oversight of their practices; indeed, in general, it is precisely those companies that have behaved unethically that are in need of ethical evaluation of their practices. The hope would be that a sufficiently empowered and conscientious ethicist could help the company reform its practices and behave in a more ethical manner. It is precisely that sort of private-sector reform that would speak well of the profession of bioethics.

I take it that you are skeptical of the prospect of such reform and take McGee’s position to be more of a cover than a sincere effort to reform practices, perhaps based on the track record of other companies that have hired ethicists. That’s fair enough, but I think we should suspend judgment on McGee until he has actually had the opportunity to influence the company’s behavior (perhaps a year down the line). At that point, it would certainly be appropriate to hold McGee accountable for ethical failings that continue to occur at Celltex; but conversely, if Celltex does indeed significantly reform its practices, he would rightly deserve praise and his move could be considered a justified and worthy effort.

Overall, I suppose I just think it somewhat unfair to hold McGee to account for the ethical failings of a company whose policies he has not yet been able to influence.

Howard Brody said...

Mr. Schaefer (thanks for writing in) has suggested that the relationship between Glenn McGee and Celltex might be on the up and up and good for bioethics and that the only way we'll know is to wait a year to see if Celltex policies change under Dr. McGee's influence. I have previously posted on this general issue and have offered praise for firms that realize ethical problems and take steps to assuage them-- see for example: If you look at previous cases where there appeared to have been a good-faith effort on the company's part to clean up its act, you'll see several elements that seem to be absent in the Celltex situation--for example, there was an open admission by Medtronic that they were seeking to improve their own behavior and needed outside guidance. I am aware of no such admission from Celltex but if anyone knows of one I will happily reprint it and set the record straight. Medtronic also realized that if they hired Dr. Krumholz of Yale and made him an exec of the company, it would look like they simply bought him off, so they wisely arranged a special arms-length relationship. Again, no parallel behavior at Celltex.