[Ip-health] How the drug industry is branding itself with bioethics

[Robert Weissman]

http://slate.msn.com/id/2092442/
Slate
December 15, 2003

Not-So-Public Relations
How the drug industry is branding itself with bioethics.
By Carl Elliott

The Wall Street Journal recently reported a story about Xigris, Eli
Lilly's new antisepsis drug. Sepsis, an infection of the blood, is a
life-threatening illness sometimes contracted by hospital patients.
Lilly had hoped that Xigris would be its new blockbuster, but the drug
hasn't taken off. One reason for this is that Xigris may not be any
better than older treatments for sepsis, but the main reason is that the
drug is so expensive. Standard treatments for sepsis (antibiotics, blood
pressure drugs) usually cost less than $50 per day, while Xigris costs
$6,800 per treatment. To promote the drug, Lilly has hired a public
relations agency; the PR campaign they've created is called "The Ethics,
the Urgency and the Potential," and its premise is that it is "unethical
not to use the drug." To reinforce the point, Lilly has funded a $1.8
million project called the "Values, Ethics & Rationing in Critical Care
Task Force," in which bioethicists and physicians from various American
medical schools will examine the ethics of rationing certain drugs and
services.

It is a brilliant strategy. There is no better way to enlist
bioethicists in the cause of consumer capitalism than to convince them
they are working for social justice. Many bioethicists see it as part of
their job description to write and speak on behalf of those who are ill,
disadvantaged, or oppressed. In the words of one prominent practitioner,
bioethics is intimately concerned "with liberty, with rights struggle,
and with the drama of the one against the powerful authorities." So when
a drug company gives money to bioethicists, it's a little like giving
money to the poor. This helps explain why bioethicists at the University
of Toronto take funding from GlaxoSmithKline, Pfizer, and Merck to write
editorials on bringing biotechnology to the developing world. Or why the
University of Chicago's MacLean Center for Clinical Medical Ethics
cosponsored a recent conference with Pfizer, Merck, and PhRMA, the
pharmaceutical industry trade organization, on inequities in American
health care. Or why bioethicists at the University of Pennsylvania take
money from Pfizer to write an article explaining why physicians should
not accept gifts from companies like Pfizer. We may take industry money,
bioethicists argue, but we're not industry stooges. We're doing God's
work.

Let's assume (rightly, I believe) that most corporate-funded
bioethicists are decent people of good conscience who genuinely see
nothing wrong with taking drug industry money, as long as no strings
appear to be attached. If the drug company makes no effort to influence
your work, is there anything wrong with taking their money?

To answer that question, we need to ask another one: Why do drug
companies want to give money to bioethicists in the first place? In the
public relations business, this approach is called "third-party
strategy." Third-party strategy is defined as the art of getting your
message into the mouth of an authoritative third party. Often, when a
drug company is launching a new drug, it recruits a third party known as
a Key Opinion Leader: an influential figure respected by his or her
peers and often eagerly sought out by the press. The KOL could be a
grand rounds speaker at a teaching hospital, an author on the talk show
circuit, or a freelance journalist interested in covering a medical
conference. It could also be a socially conscious bioethicist.

While KOLs are frequently offered positions as consultants or advisers,
the drug companies do not expect them to push their products directly.
That would ruin the KOLs' credibility. Instead, KOLs are expected to
generate "buzz"=97by talking casually to colleagues, giving lectures at
meetings, speaking to the press, or doing virtually anything else that
will garner positive publicity for the drug. "While the buzz must appear
to be spontaneous," explains the PR agency Chandler and Chicco in
PharmaVoice, "it should, in fact, be scientifically crafted and
controlled as tightly as advertising in the New England Journal of
Medicine."

Of course, KOLs must be convinced of their own impartiality; if they
understood that they were being used as industry mouthpieces, they would
probably pull the plug on the whole enterprise. Some public relations
agencies advise drug companies to encourage their KOLs to work for many
different companies in order to maintain a posture of objectivity. As
the PR firm Thunder Factory bluntly states, "KOLs must maintain their
credibility and integrity in order to have maximum market impact."

But funding bioethics is less an act of corporate good will than the
latest move in a larger strategy: buying off the entire apparatus of
academic medicine. One way drug companies can achieve "maximum market
impact," for example, is through funding medical education. Drug and
device manufacturers now supply over half of the $1.4 billion spent on
continuing medical education for physicians in the United States. They
have also begun funding patient support groups and a handful of
prominent bioethics centers, apparently taking to heart Michael
Corleone's advice, "Keep your friends close, and your enemies closer."

The drug industry has even managed to turn peer-reviewed scientific
literature into a sophisticated marketing device. It has long been known
that corporate-funded research studies are more likely than impartial
studies to favor the products of their corporate sponsor. But only
recently has evidence emerged to suggest how many "scientific" studies
have actually been ghostwritten by specialized PR firms=97"medical
communications" agencies=97that represent the drug industry. These firms
then pay well-known academic researchers to sign on as authors. Often
these academic researchers are not even allowed to see the raw data upon
which the published studies are based. A recent article in the British
Journal of Psychiatry examined articles on Pfizer's antidepressant
Zoloft (sertraline) whose authorship had been coordinated by the
communications agency Current Medical Directions. When checked against
the raw data, which had come to light in a lawsuit, it became clear that
the studies authored by Current Medical Directions omitted or greatly
minimized Zoloft's side effects, including the risk of suicidal acts.
Yet these studies outnumbered "traditionally authored" articles, were
published in more prestigious journals, and were cited by other
researchers at a much higher rate.

It's no mystery, then, why pharmaceutical companies want to brand
themselves with bioethics. But do bioethicists really want to brand
themselves with Pharma? To take only one example: The pharmaceutical
sponsors of the University of Pennsylvania Center for Bioethics and its
faculty's projects are now facing multimillion dollar fraud sanctions
(AstraZeneca), a Nigerian lawsuit for research abuse (Pfizer), massive
class-action payouts (Wyeth-Ayerst), a criminal probe into obstruction
of justice (Schering Plough), an ongoing fraud lawsuit (Merck and
Medco), and allegations of suppressing research data on suicide in
children (GlaxoSmithKline).

Somehow corporate-funded bioethicists have not been touched by the bad
publicity. Many bioethicists continue to insist that they are learning
from their industry relationships and shaping company policy for the
better. A task force commissioned by the two major American professional
bioethics bodies=97the American Society for Bioethics and Humanities and
the American Society of Law, Medicine and Ethics=97concluded last year
that private corporations should be encouraged to seek out paid
bioethics consultants, because "bioethics will have an impact on that
(corporate) activity only if bioethicists can be part of the dialogue."
The task force went on to endorse the practice of bioethicists
advertising their own services as private consultants.

So the next time you meet a bioethicist, pay close attention; he may
look like a bioethicist, but when you peel back his mask, you just might
see the adman smiling back.

Carl Elliott teaches at the Center for Bioethics at the University of
Minnesota and is currently visiting associate professor in the School of
Social Sciences at the Institute for Advanced Study at Princeton. He is
the author of Better Than Well: American Medicine Meets the American
Dream.