Watchdogs or Show Dogs?
It is no secret that many academic physicians work for the pharmaceutical industry as speakers and consultants. Less widely known is that the pharmaceutical industry also employs academic bioethicists.
Beginning in the 1990s, a number of pharmaceutical and biotechnology companies began to set up bioethics advisory boards, ostensibly to obtain guidance about controversial ethical issues. Over the years, the ties between industry and bioethics have gradually grown closer, with companies setting up endowed chairs and hiring bioethics consultants. Yet very little is known about how bioethics advisory boards work. What exactly is their purpose? Do they prevent ethical wrongdoing, or do they provide ethical cover? How many bioethicists are involved and who are they?
Not many people are better positioned to answer these questions than Jenny Dyck Brian, an Honors Faculty Fellow at Barrett, the Honors College at Arizona State University. For her doctoral dissertation, “Assessing Corporate Bioethics,” Brian interviewed industry executives, scientists and bioethics board members from three companies: Eli Lilly, Advanced Cell Technology, and SmithKline Beecham (which is now part of GlaxoSmithKline.) The result is a fascinating behind-the-scenes look at a very controversial relationship. Below is the first part of an extended interview that we conducted by email.
Q: A lot of people dismiss bioethics advisory boards as PR ploys, partly because they emerged during the same period as astroturf patient advocacy groups, pharma-funded educational events, and the use of video news releases and public-service announcements to market drugs. Why are bioethics advisory boards different?
A: They might not be different, but I wanted to take a closer look and see what exactly they were doing. The ones I studied had been working for about 10-15 years, with little outside awareness. Only Advanced Cell Technology advertises their bioethics committee on their Web site. Eli Lilly has a brief page on their bioethics activities and doesn’t name names, and GlaxoSmithKline (formerly SmithKline Beecham) has nothing. So at least in terms of public-relations ploys, in some ways they seemed rather ineffective.
Q: But even if the existence of a bioethics board is a secret, the members often have a public presence. Bioethicists publish articles, speak to the press, give lectures, serve on government bodies and so on. If a company can make friends with these bioethicists, wouldn’t that be likely to translate into good PR?
A: The activities of and rationales for each committee differed. One committee seemed to be mostly about gathering really smart, accomplished individuals together to have interesting conversations. Another committee is trying to set policies and offer something like the Stanford model of “benchside ethics consultations”, and the third one offers advice on all aspects from research ethics protocols to public relations. This is not all that different from presidential advisory committees, which can be set up to deflect attention from a controversy, to provide policy recommendations, to investigate an issue or controversy more closely, and so on.
Q: When I talked to medical “thought leaders” for White Coat, Black Hat, I found that companies did not simply hire academic physicians in order to influence them. They hired them as a source of information. They wanted to find out what was actually happening on the ground, in medical practice. Then they used that intelligence to decide how to market their drugs, and to develop new diagnostic categories such as “overactive bladder” or “erectile dysfunction” or “premenstrual dysphoric disorder.” This is classic PR, just as Edward Bernays envisioned it. Is it different for bioethics boards, or do companies also use them in order to gather intelligence?
A: I think that this was absolutely the case with Eli Lilly. They hired one of the architects of principlism (Tom Beauchamp) and a prominent clinical research ethicist (Robert Levine) to advise them on the ethics of their research activities. Lilly is not just seeking advice about the ethics, but advice about the kinds of values and principles to which they ought to pay attention.
And at the same time, the Lilly board is actually advising the company on research ethics. They are trying a few different things, but one thing they do is offer specific advice and guidance to research scientists about the ethics of their work. They take questions from anyone in Lilly Laboratories (the research division of the company). They have a 3-tiered consultation system and their in-house bioethicist determines which level the question needs to go to. If it’s Tier 1, she answers it or directs them to company policy, but Tier 3 goes to the full bioethics committee, including the external consultants. The Lilly Bioethics Committee meets about every 3-4 months.
I think SmithKline Beecham was unwilling to change much (or anything) within their research and development projects, so the primary benefit for them was sharing the industry perspective with prominent scholars (and to hear what those scholars thought about the same topics). I did not get the impression that the company was at all organized to use the opinions of the board members to then alter their marketing strategies.
The Ethics Advisory Board was able to have a significant influence at Advanced Cell Technology at the beginning of their tenure. However, they meet rarely now and only when the company decides there is an ethics dilemma they need help with. At both Advanced Cell Technology and SmithKline Beecham, one senior executive played a key role in deciding how and what influence the ethics board would have.
Q: I was a little surprised to see that the members of Advanced Cell Technology board were not paid. What about SmithKline Beecham (now GlaxoSmithKline) and Eli Lilly? Were the members of those boards paid, and if so, how much?
A: The members of the SmithKline Beecham Ethics and Public Policy board were paid, as are the external members of the Lilly Bioethics Board. No one from either SmithKline Beecham or Eli Lilly would tell me how much they got paid (though one member did say he regretted accepting payment). The Advanced Cell Technology Ethics Advisory Board members had decided to accept no more than the NIH per diem rate (about $250 per day), but most of them don’t even accept that.