HIV/AIDS Skepticism

Pointing to evidence that HIV is not the necessary and sufficient cause of AIDS

CONFLICTS OF INTEREST

Posted by Henry Bauer on 2007/12/15

Healthy people are told to take drugs known to cause severe “side” effects that some find literally intolerable (see WHAT HIV DRUGS DO, 15 December; OFFICIAL GUIDELINES FOR HIV TREATMENT, 14 December; ANTIRETROVIRAL DRUGS: HISTORY AND RHETORIC, 12 December; BEST TREATMENT FOR HIV: THIS YEAR’S ADVICE, LAST YEAR’S, OR NEXT YEAR’S? , 10 December 2007).

These debilitating drugs are recommended by people who have vested financial and career interests in them through connections with drug companies–a clear case of conflicts of interest. This in itself should discredit, thoroughly and completely, everything in the Treatment Guidelines featured in those recent posts.

The Panel responsible for the December 2007 Guidelines had two co-chairs, both with financial connections to drug companies. Only 3 of the 24 Panel members disclaimed such a conflict of interest. More details about the connections of some HIV experts to drug companies can be found at http://www.shillfactor.net/.

Recall that the most important criterion for each recommendation is “expert opinion” (BEST TREATMENT…, 10 December). Perhaps the most basic fact about conflicts of interest is that they influence opinions.

The significance of conflicts of interest is widely ignored in contemporary affairs in the United States, and not only in science and medicine. Circumstances have become accepted as normal which, if occurring in other countries, would be easily recognized as utterly corrupt. Here’s a synopsis of Conflicts of Interest 101.

If I teach a class that has my daughter in it, no conscious effort on my part can ensure that she will be treated in exactly the same manner as the other students. Subconscious and unconscious emotions can influence my thoughts and actions in ways that I am unaware of and therefore cannot do anything about. No matter how consciously honorable and upright I may be, no matter how unfailingly rule-abiding and law-abiding and ethical in all my other interactions, there can be no guarantee that my daughter will not receive some degree of special treatment.

THE ONLY SAFEGUARD AGAINST THE POSSIBLE INFLUENCE
OF CONFLICTS OF INTEREST IS TO HAVE NO CONFLICTS OF INTEREST.
PERIOD.

Once upon a time, this was widely understood. That time was not even so long ago. When President Eisenhower nominated Charlie Wilson, the CEO of General Motors, as Secretary of Defense, Wilson was asked about a possible conflict of interest. His response was,

“What’s good for General Motors is good for the country,
and what’s good for the country is good for General Motors”.

The naive absurdity of that response was so widely appreciated at the time that it was featured in cartoons and comic strips and late-night comedy shows. Collections of quotations and infamous sayings still feature it. Check it out: just Google “What’s good for General Motors”.

Nowadays, the experts who draw up Treatment Guidelines, and the people who choose those experts to make up the Panel, are telling us implicitly that what’s good for the drug companies and for those who consult for them and get grants and presents from them is also good for the rest of us, for the people who will be using the drugs and for those who will be paying for the drugs.

At a conscious level, no doubt these are all ethical, well-intentioned, upright people who would never allow possible financial gain to sway their expert scientific judgment. But they are no more able to control their subconscious drives than I could control mine about my daughter in class.

In fact, to venture some amateur psychological speculation, the most consciously upright and ethical people are also those most likely to succumb to subconscious corruption, because they are least on guard against the possibility. Furthermore, human beings are protected against acknowledging to themselves their own misdeeds, through the phenomenon of compartmentalization: we can and do hold incompatible views simultaneously, and we manage to do things while imagining not only that we are not doing them but even that we never would do them:
Think Jimmy Swaggart and other sinners who preach against sin.
Think ex-Senator-to-be Larry Craig.
Recall the sublimely naïve response of David Baltimore when asked about a potential conflict of interest: “I think people are entitled to ask that of me. But I do think the statements and decisions I make come from the highest sense of integrity” (Chemical & Engineering News, 15 March 1982, 12).

Of course he thinks that. They all do. WE all do.
That’s why we have to be protected against ourselves, against doing for unconscious reasons what we would not wish to do. That’s why the only protection against undue influence is to have no conflicts of interest at all.

THE ONLY SAFEGUARD AGAINST THE POSSIBLE INFLUENCE
OF CONFLICTS OF INTEREST IS TO HAVE NO CONFLICTS OF INTEREST.
PERIOD.

 

Andrew Stark, in the book “Conflict of Interest in Public Life”, makes it very clear. There are three aspects of a conflict of interest:
1. The connections
2. The associated state of mind
3. Actions that may stem therefrom

For example:
1. My daughter is a student in the class I teach
2. My feelings about her and my attitudes toward grading
3. I assign a grade

Or:
1. X consults for a drug company
2. X’s judgments about the drug company’s products
3. X recommends wider use of the company’s product

Stark points out that there is no way of knowing or finding out, what my state of mind was when I awarded the grade, whether my love for my daughter influenced it one way or the other, favoring her or overcompensating against favoring her; and there is no way of knowing whether X’s attitude toward the drug company influenced the decision to recommend its product.

However, any number of studies have amply confirmed that on average, statistically, such situations do influence the resulting actions: those experts with conflicts of interest are more likely than others to judge favorably toward approval of a drug. For instance, when the question was, should Vioxx and the other drugs in this class, Bextra and Celebrex, be allowed to remain on the market, this is how the experts voted:

Vioxx: Full panel: 17 yes, 15 no. Panel without those with conflicts of interest: 8 yes, 14 no.
Bextra: Full panel: 17 yes, 13 no. Panel without those with conflicts of interest: 8 yes, 12 no.
Celebrex: Full panel: 31 yes, 1 no. Panel without those with conflicts of interest: 21 yes, 1 no.
(Goozner, AARP Bulletin, May 2006, p. 10, citing New York Times, 25 February 2005).

Industry sponsorship made studies 4 to 8 times more likely to be favorable to beverage companies (Chronicle of Higher Education, 19 January 2007, A27-8). “Psychiatric drugs fare favorably when companies pay for studies” (Elias, USA Today, 25 May 2006, 1A). Those are just a few of the innumerable such social-science studies all confirming what plain common sense already knows. Doctors with financial stakes in analytical labs prescribe more lab tests than those without such interests. And so on and on.

THE ONLY SAFEGUARD AGAINST THE POSSIBLE INFLUENCE
OF CONFLICTS OF INTEREST IS TO HAVE NO CONFLICTS OF INTEREST.
PERIOD.

 

Many individuals, institutions, and organizations simply don’t understand that when they blather about “apparent” or “negligible” or “potential” conflicts of interest. There are no such things. A conflict of interest is Stark’s aspect 1: the connections.
Either there is a connection or there isn’t.
PERIOD.
“Apparent”, “negligible”, “potential” are intended to address stage 3, to express doubt as to whether the connections will actually exert an influence. As Stark points out, that cannot be known. What is known, beyond any doubt, is that conflicts of interest exert a statistical influence. No matter how hard human beings may try, they cannot know or control or counteract their subconscious or unconscious motives.

To recuse people who have conflicts of interest, to exclude them from particular activities, is not to accuse them of being consciously swayed by those conflicts of interest, still less is it to accuse them of being consciously self-serving evil-doers. Recusing people with conflicts of interest is to their own benefit, to protect them from doing what they would not consciously wish to do. Recusing people with conflicts of interest is simply an acknowledgment of the fact that paths to Hell are paved with good intentions.

* * * * * *

Some of the above I’ve taken from my seminar “Ethics in science” posted at http://www.chem.vt.edu/chem-ed/ethics/hbauer/hbauer-ref.html and being reprinted in “Against the Tide: A Critical Review by Scientists of how Physics and Astronomy get done”, M. López-Corredoira & C. Castro (Eds.), 2007 (in press).

While the titles of some of the following books may suggest sensationalist muckraking, that is far from the case. All the authors are respectable mainstream figures: senior tenured faculty, a couple of former editors of top medical journals, a former university president, and several respected journalists. All the books are written in matter-of-fact prose with proper citation of sources.

For corruption at the National Institutes of Health through conflicts of interest, see the series of articles by David Willman in the Los Angeles Times, 7 December 2003, pp. A1, A32-35, and 22 December 2004.

For further reading on the corruption of science and medicine in general, start with Daniel Greenberg (2001) “Science, Money and Politics: Political Triumph and Ethical Erosion” and Sheldon Krimsky (2003) “Science in the Private Interest”.

For the corrupting influence of Big Pharma, see John Abramson (2004) “Overdosed America: The Broken Promise of American Medicine”; Marcia Angell (2004) “The Truth about the Drug Companies: How They Deceive Us and What To Do about It”; Jerry Avorn (2004) “Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs”; Merrill Goozner (2004) “The $800 Million Pill: The Truth behind the Cost of New Drugs”; Jerome Kassirer (2004) “On The Take: How Medicine’s Complicity with Big Business Can Endanger Your Health”.

For the commercial corruption of contemporary academe, see for example Derek Bok (2003) “Universities in the Marketplace: The Commercialization of Higher Education” and Jennifer Washburn (2005) “University, Inc.: The Corporate Corruption of American Higher Education”.

2 Responses to “CONFLICTS OF INTEREST”

  1. mountainmere said

    On February 5, 2007, over at “You Bet Your Life“, there was an interesting discussion of the
    shillfactor site and possible conflicts of interest, or the lack thereof. The post attracted a long comment from Mike Barr, the proprietor of shillfactor.

  2. hhbauer said

    Thanks, that’s interesting and important material at “You Bet Your Life“. Certain activist groups and individuals, not only researchers, get financial support from drug companies. A few examples are given in Steven Epstein’s book and Robin Scovill’s film, cited in “Strange bedfellows”, pp. 214-5 of my book,
    The Origins, Persistence and Failings of HIV/AIDS Theory

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