Conflicting with Reality

Former New England Journal of Medicine editor Jerome Kassirer, in an August 1 Washington Post op-ed, argues that conflicts of interest in medical science are so pervasive today that the new National Institutes of Health (NIH) cholesterol guidelines are somehow tainted—not because the guidelines are themselves wrong, but because of their authors. He seeks to use an ad hominem argument of the worst kind to dictate the future use of scientific research. <?xml:namespace prefix = o ns = “urn:schemas-microsoft-com:office:office” />


Some members of NIH's National Cholesterol Education Program (NCEP), which wrote the guidelines, have in the past received research grants, consulting fees, and speaking honoraria form drug manufacturers.  According to Dr. Kassirer, this alone should bring their advice into disrepute.


Kassirer's central point boils down to: You can't trust anyone who has ever been associated with profit-making venture; therefore, such tainted souls should be banned forever from public advisory roles.  Kassirer's vision of turning the virtues of capitalism into vices is a recipe for disaster, for public health and science.


To Kassirer, financial interests bias people in favor of those who fund them. Therefore, any advice that scientists who have ever accepted money from a business is necessarily tainted. Disclosure of interests, he argues, does not work, because it tells us nothing about whether the potential bias did taint the advice.  The only solution is to prohibit anyone with financial conflicts of interest from serving on public health advisory panels. Then those who wish to be respected as independent authorities will eschew such funding and all will be right with the world; their advice will be free from taint.


But would such advice really be untainted?  Kassirer's suggested approach ignores the basic human desire for self-advancement.  If someone has gone to the trouble to become an expert in a given field, then that person can reasonably expect to profit from that skill set.  By excluding those whose skills are most valuable, the public panels would exclude those most knowledgeable about the subject.


Such a ban would also reduce incentives to pursue scientific careers.  If achieving financial success in science would involve having one's integrity impugned, then the most intelligent among us might view science as an unattractive career.  The inability to profit sufficiently from scientific knowledge is the single biggest reason for the European brain drain to <?xml:namespace prefix = st1 ns = “urn:schemas-microsoft-com:office:smarttags” />America.


Moreover, Kassirer ignores the very real biases from other sources.  He appears never to have heard of the branch of economics known as public choice theory, whose principal thinker, James Buchanan, won a Nobel Prize in 1986.


Essentially, public choice points out that politicians, regulators, and official bodies are no less self-interested than private industry.  Those who receive their salaries ultimately from government are likely to argue in favor of more government.


For instance, Daniel Klein of Santa Clara University recently found that 75 percent of authors and all editors of The Journal of Development Economics have ties to international development institutions.  That this would color their view of international development should come as no surprise.  Thus, a panel of supposedly disinterested international development academics might argue for more government funding for the organizations they represent.


Contrary to Dr. Kassirer's apparent belief, there is no class of researchers immune to conflicts of interest.  Suffice it to consider Kassirer's own potential conflict of interest.  As his Post tagline says, he is the author of the forthcoming book, On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health.  Kassirer stands to benefit from people worrying about this, since it would boost sales of his book (and even if he gives the money away, his causes will benefit).  By his own logic, is his viewpoint not tainted by this fact?  He is asking us not to trust him.


But if we accept that everyone will act out of self-interest, then we can also accept, as did Adam Smith in 1776, that society benefits from people acting out of enlightened self-interest.  He said, “It is not from the benevolence of the butcher, the brewer, or the baker, that we expect our dinner, but from their regard to their own interest.”  Long before Adam Smith, the Roman statesman Cicero formulated the question “Cui bono” (who benefits?) to get to the root of who committed a crime.  If the answer is “the American people,” as has been so often the case when industry has helped advance scientific knowledge, then it should be clear no offense has been committed.  That is important to keep in mind before impugning scientists' integrity simply because of their choice of employer.