Institutionalizing conflicts of interest

A fellow scientist of my generation likes to describe us as “dinosaurs”, and periodically accuses me of naivety if I slip into suggesting that facts win out in the end or that scientific ideals and traditional ethics have not been completely abandoned.

I guess it’s true that I’ve written and continue to write as though there are people out there who share my disbelief at, for example, the brushing aside of conflicts of interest as only “apparent” (see “Consequences of misconduct in science”).  And there ARE people who share my attitude, call them naïve and unrealistic if you wish: there’s Sheldon Krimsky, Science in the Private Interest: Has the Lure of Profits Corrupted Biomedical Research? (Rowman & Littlefield, 2003); there’s Andrew Stark, Conflict of Interest in American Public Life (Harvard, 2000); there are Centers for Ethics, and periodicals devoted to ethics in research. Plenty of academics are aware of the sad fact that science and medicine, both research and patient care, have been pervasively infiltrated in a way that might even be called corrupting.

Researchers and administrators of research, however, seem oblivious. Well into the 1970s and even the 1980s, universities were at least trying to apply some brakes. We had to make formal application if we consulted more than half a day per week, and if our remuneration exceeded some modest amount. We were not permitted to run a business that was in any way connected with our academic responsibilities. We took for granted the burden of offering our professional advice as to the publishability of manuscripts or the qualifications of candidates for jobs or promotions. When we traveled to present invited seminars or to advise academic institutions, we didn’t expect honoraria in addition to having our expenses covered — and we felt unusually appreciated when we received honoraria equivalent to a few hours of our annual salary. We regarded it as exceptional perks — comparing ourselves to so many other people- — that our university salaries were paid on a 9-month or 10-month basis, permitting us to teach r do research for an extra 20% or so of annual remuneration. I recall being shocked, in the early 1980s, when professors of English were asking remuneration for reading book manuscripts of candidates for tenure.

What a different world it is, just a couple of decades later. A misguided Director of the National Institutes of Health dropped certain restrictions on outside income, with predictably disgusting consequences (David Willman, Los Angeles Times, 7 December 2003: “Stealth merger: Drug companies and government medical research”, p. A1; “Richard C. Eastman: A federal researcher who defended a client’s lethal drug”, p. A32; “John I. Gallin: A clinic chief’s desire to ‘learn about industry’”, p. A33; “Ronald N. Germain: A federal lab leader who made $1.4 million on the side”, p. A34; “Jeffrey M. Trent: A government accolade from a paid consultant”, p. A35; “Jeffrey Schlom: A cancer expert who aided studies using a drug wanted by a client”, p. A35.)

Just as with political lobbying, we Americans seem able to euphemize, ignore, and even defend practices that in other lands we would be quick to recognize as plain corruption. What set off this tirade was a news item in the Chronicle of Higher Education, 20 June 2008, p. 13: “To lure top scientists, NIH raises pay for some peer reviewers”, by Jeffrey Brainard. Here are a few extracts:

“The National Institutes of Health plans a major increase in the money to provides to long-serving peer reviewers . . . . Some will receive $250,000 for six years . . . . Under the current terms of $200 per day, such scientists would net only about $6000 after six years”.
[Peanuts! Coffee money! But, after all, this is in addition to their salaries wherever they happen to be working, their pay isn’t cut just because they’re away from the office or the lab. And that $200 per day is in addition to expenses, of course, for travel, food, and accommodation; expenses that can be and are often padded a little.]

“But the largesse . . . . would benefit only a few hundred of the several thousand scientists who help evaluate grants of the institutes. . . . Traditionally, many scientists have willingly reviewed applications, though the fees they have been paid fell well short of the value of the time commitment required: at the NIH, 40 to 80 hours of preparation for each day-and-a-half meeting” — Right. I’ve known quite a few people who have served in this way. (Serving as  an academic dean teaches quite a lot about human nature.) Those who spent anything like that amount of preparatory time did it because of their sense of responsibility and don’t need extra money, while those who expect the money and will not otherwise serve will also not spend that amount of time on it.

“’In the end, peer review is only as good as the quality of the people doing it,’ said Elias A. Zerhouni, the NIH’s director”.
Yes, indeed. We need honest, conscientious people who do these things because their profession is a vocation, a calling, not just a way to earn a living, and certainly not a way to acquire wealth.
[Zerhouni continued,] “I think you get what you pay for”.
And there you have it.
— Want medical care? The more you pay, the better care you’ll get. But didn’t we used to think that was a dreadful situation, when behind the Iron Curtain one had to give bribes and tips to get proper care?
— Want education for yourself or your children? The more you can pay, the better education they will get. But isn’t there some sort of consensus still that every American child should get every educational opportunity they can benefit from?
— Want honest evaluation of research? You’d better pay for it, especially to people who don’t need the money because they earn so much already.
It reminds me of the philosopher, I don’t recall whether it was Mort Sahl or Bob Newhart or Tom Lehrer, certainly one of their ilk, about responding to question from students: “And, of course, if you raise my pay, I’ll even give them correct answers”.

But it’s not all gravy, we’re told. “The $250,000 compensation [lovely choice of word] will be awarded as an ‘administrative supplement’ to existing research grants”, so the recipients can use it at will: “They will keep only some of the money, as salary — the underlying grants also typically finance research equipment and laboratory assistants”.

And of course this administrative supplement is in addition to the $200 daily honoraria.

“NIH leaders rejected, though, a controversial proposal by a peer-review task force that would have capped at five the number of research grants that any one scientist could hold, in order to spread dollars among more grant applicants, including younger ones”.
[An earlier piece in the Chronicle had mentioned that scientists are on average 42 years of age before they get their first NIH grant. Got to keep those young Turks in their place, kowtowing as “postdoctoral fellows” to us experienced gurus; otherwise, who could we get to actually do the work in our labs?]

Robert Merton, founding sociologist of science, long ago identified the “Matthew Effect”:

For unto every one that hath shall be given, and he shall have abundance: but from him that hath not shall be taken away even that which he hath.
—Matthew 25:29, King James Version.

It’s not new, in science, it’s just become as egregious as Credit Default Swaps and other scams. I usually resist the notion that there exists a self-interested, self-serving Establishment, be it in government or in education or in research. But facts are stubborn things, as they say, and sometimes my naivety bows to them. Dr. Zerhouni and the other “NIH leaders” have certainly provided us with some very stubborn, unpalatable facts.