Wadmann, S. (2014). Physician–industry collaboration: Conflicts of interest and the imputation of motive. Social Studies of Science, 0306312714525678.
Outline of the research
Government intervention with research can generate a contradictory set
of circumstances. The study focuses on the case of industry involvement
with clinical research in Denmark. Where on one side governmental policies welcome interaction between the
industry and research as they potentially “economic interests will motivate researchers to develop
knowhow and products that can strengthen Denmark’s competitive position in what
is depicted as a global ‘knowledge economy’ (Aagaard and Mejlgaard, 2012[1]:
11).” (p. 532). But on the other hand this relationship is perceived as problematic because it
casts doubt “whether economic interests influence professional recommendations”
(p. 532). In both cases policies are designed to address the issue. However,
they are seen as distinctive issues, because the first is perceived as
generating economic gain for Denmark as whole, while the latter cast the
financial gain of the individual scientists into question. Her argument is that
“‘corporate’
and ‘academic’ research is entangled as physicians engage in industry
trials to pursue their own research.“ (p. 533). The debate often focuses on
the motivation of the physicians, which turns the public debate into “blame game” (p. 533), which is non
informative if the process, is seen as a system.
Academics position
Analyses from academia pretty much fall along this good/bad divide.
Where on one side the (good) aspects
of “advancing
medical innovation and technological dissemination” (p. 533) while on the other (bad)
side the “risks of ‘biased’
knowledge production […,] unwanted commercialization of science […,] unwarranted alterations of
prescription patterns […] and ‘disease mongering’” (p. 355) are
emphasized. This perfectly mirrors the
public debate about the industry clinical binary.
The rhetoric used in the
proposals and applications of academics for grants is very much influenced by
the rhetoric of policy than their actual day to day practice. This means that “research
collaborations cannot be understood separately from the political landscape in which they operate” (p. 354),
because “physicians’ ideas of legitimate
exchange are shaped by politico-economic conditions of possibility” (p.
534). However, when drawing physicians to accountability, the motivation is always simplified to a one
dimensional pecuniary motivation (or sometimes desire for prestige). That
this simple motivational spectrum cannot account for possible other forms of
motivations is of little concern. [this is very much a neoliberal assumption]. Furthermore, “a phenomenon is not explained by explicating a given constellation of
anticipated interests” (p. 534)
Public-private links with clinical research
Researchers emphasize the independence they get from conducting private
research. As they can ‘nest’ their own research within these larger
projects, but more common can allocate the funds to their ‘own’ research.
However, this influx depends on the
availability “of human and material
resources at the public hospitals“
(p. 535). For example a hospital might create facilities to better accommodate
for private research trials (building facilities, allocating staff or working
systems), which in term makes them more attractive to consecutive private
research trials. “Thus, ‘public’ and ‘private’ research resources do not flow in distinct
streams; they are premised on each other.” (p. 536).
On the other hand, the criticism depicts only “economic interests as a driver of
physician–industry collaboration, and political intervention is motivated by
concern that industry payments may bias physicians’ judgment at the expense of patients’ or ‘public’
interests.” (p. 538). This puts the blame
on the practitioners and industry interaction and NOT on the system which made this collaboration necessary (or
rallied for its implementation). Because, “the organization of research funding systems
and institutional pressures towards high research productivity.” (p. 538) put pressure on already
tight resources. As such, practitioners
feel that they gain autonomy from this pressure (even if they have to bow
to a different master now).
Industry dependency and academic freedom
Physicians acknowledge that they
are dependent on the industry,
because “‘medical science cannot exist without external [private/industry] partners – at least not at its current” (p. 539). This is due
to the fact that the academic environment
has changed for research. It several changes have occurred in the funding
of public research; ”First, it has shifted from budgetary funding
of research institutions towards greater
competition for external project funding. Second, there has been a move from ‘free’ towards more ‘strategic’
research, in that more funds have been earmarked for research into
politically defined problems and the promotion of industrial aims. Third, funds have been reallocated from multiple,
smaller research grants towards fewer and larger grants” (p. 538). This
has consequences for the research
environment in that “These reforms
are coupled with institutional pressures
towards high research productivity. Measures such as the number of peer-reviewed publications, doctoral degrees,
and patent applications have become benchmarks that guide Danish
national research regulation, and these measures of research ‘productivity’ are
translated into regulatory instruments
such as university ‘development contracts’ and hospital audit systems”
(p. 538), also in “highly competitive
medical fields […] institutional
pressures towards high research productivity are further fuelled by job competition.” (p. 539). Therefore, when
academic speak of ‘academic’ freedom
what they refer to is ‘the allocation of funds
that are generated from privately funded projects to their own research’ and that they are less vulnerable to changes in the public funding environment. As such, the apparent
oxymoron of dependency/freedom makes sense, BUT ONLY when considering the
system in which (medical) academics operate.
Funding / research cycle
How similar is this to this quote (p. 540)
to the ‘shit academics say comic’?
“You earn your salary in the first couple of months [of your doctoral
research] by working with industry-sponsored trials. At the same time, you
apply for grants. When they come – if they come – many continue to do the
trials, partly as a way of ‘paying back’ and partly as a way to create a
foundation for the next generation. (Interview with resident, 2011)”
Figure 3
Grant cycle[2]
Contract research becomes something that researchers “ought to do” (p. 540) as it fulfils the generational contract to
past and future researchers. However, this turns
industry sponsoring into a “moral
obligation” (p. 540) for medical academics. External investigators and industry executives put forth three potential problems, in their view, with
this collaboration. These were: “(1) when
dependency on collaboration leads physicians to expend resources on industry studies they considered a ‘waste of time’;
(2) when industry executives worried that poor
research quality may result from what they considered a downgrading of
industry trials by health professionals; and (3) when economic self-interest was depicted in public debate as the main driver
– and the main danger – of physician–industry collaborations.” (p. 540)
It is a waste of time, because the studies carried out does no add anything new to the scientific
expertise, they primarily function as a way for pharmatheutical companies
to obtain patens, or even in cases (phase IV studies) also serve as a marketing
campaign. As such, when physicians imply that contract research isn’t ‘real’
research this is what they mean. Resources
could be spend more productively on other projects. However, they do spent
the majority of their time (75 – 80%) on these research trials because as one
respondent put it: “we have to compromise a bit; when it’s not
really interesting from my point of view. But that’s the way it is. When the funds start to dwindle” (p.
542).
Industry officials express concern regarding the scientific quality
and are drawing into question the commitment of the scientists to their study
because clinical researchers “might also run five other trials, and to make them
then prioritize [one particular study] is a true challenge’” (p. 543).
This also adds cost and draws the data
quality into question, which usually adds to the cost of the trials.
However, the industry doesn’t want to be too harsh in their critique ‘practical
challenges’ of these aspects or when physicians are “not turn[ing] up for training
sessions and meetings or fail[ing] to
recruit patients in due time” (p. 543), because future collaboration might
be put into jeopardy.
The conflict of interest debate
Politian’s urge for more transparency, to circumvent that physicians
use fund for their own personal gain, calls their hippocratic oath into question. As such, turning the argument into a question of the morality of the
practitioners, however they reply by questioning the morality of the Politicians.
Because, “Politicians urge […] very
loudly to collaborate with private companies but when it comes to payment, the
arguments turn circular” (p.
544-545). The pharmatheutical industry
often opts to remain quite, as they are put by default into the ‘bad guys’ position, and no matter what
they do (publicly speak out or stay quite) all actions on their part are
negatively interpreted. As such, the “public
debates are easily led into moralistic
‘blame games’ (Hood, 2002) that focus public debates on morality while leaving unaddressed the political
priorities and the research infrastructures that contribute to creating the feared COI [conflict of interest]”. (p. 545). The current trend for more transparency “Ironically, […] may serve to silence voices and generate new ‘unknowns’ that leave the
public even more ignorant about some aspects of physician–industry
collaboration” (p. 546), as it easier to stay mute than taking up the
fight.
Things to take away for my research
- Explaining an ‘interest’ behind an action does not necessarily describe the outcome of an action. The framework has to be taken into account as well.
- The rhetoric of political system for more “industry collaboration which can generate profit” is misguided in medical practice, as it ignores the existing correlation of industry and academic collaboration, which is quite different in practice.
- The morality of a situation depends on what connections you make. The medical professionals justify their position as morally right, given the framework they have to operate in. Similarly do the Politicians, when only taking into account their preconceptions of how the relationship between research and industry ‘ought’ to work. As such, morality becomes relative to the particular circumstances.
[1]
Aagaard K and Mejlgaard N (2012) På vej mod en ny forskningspolitik [Towards a
new research
politics]. In: Aagaard K and Mejlgaard N (eds) Dansk
forskningspolitik efter årtusindskiftet
[Danish Research Politics after the Turn of the
Century]. Aarhus: Aarhus University Press,
pp. 11–35.
[2] http://www.phdcomics.com/comics/archive.php?comicid=1431,
accessed 2014-11-25
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