… medical school professors conspiring to place fake articles praising their products in respectable journals, the reporter stumbles on one John Buse. Buse, a professor at the University of North Carolina, is remarkably candid about things.
Buse said in a Nov. 28, 2006, deposition that working with drugmakers over a long period of time can change the way doctors think about clinical problems.
“It’s sort of like Stockholm Syndrome,” Buse said in the deposition, referring to a psychological phenomenon in which kidnap victims begin to sympathize with their captors.
“I’m not saying that the pharmaceutical industry captures me,” Buse said. “But to the extent that the relationship has something above and beyond medicine, science, you know, it could cloud one’s judgment.”
Buse added that many researchers develop emotional attachments to drugs they’ve discovered or studied extensively.
“There’s this natural tendency for people to fall in love with your drug: it’s like your child,” Buse said. “So you have a hard time accepting criticism.”
So there are at least two motives behind the outrageous conflict of interest scandal in America’s medical schools:
1.) A passionate affair with your drug which makes you desperate to protect it and show it in its best light — a desire its manufacturer abets.
2.) Raw greed.
June 12th, 2009 at 1:42AM
Psychologically speaking, the compromise of academic physicians by Pharma is not hard to understand. It’s like any other form of seduction — you have to want it to happen. If you need a rationalization, what better than "A passionate affair with your drug which makes you desperate to protect it and show it in its best light — a desire its manufacturer abets."
June 12th, 2009 at 7:31AM
Hmm…
It should be understood that the actual discoverer or creator of a drug is most often not a physician. The personal understanding of the drug discovery process by physicians is usually laughable. More typically, some chemist in industry or a university is responsible.
Now I know two examples – academics – of people who have discovered so called blockbuster drugs. Both of these guys have become enormously wealthy and made huge financial contributions to their institutions. But they are remarkably unaffected by all this and continue working away doing research and teaching – because they actually enjoy it.
June 12th, 2009 at 9:10AM
I think the "supremely weird shit" part is unfair. Reason #1 is just an awkward expression of a problem most academics face — having their objectivity compromised by their engagement with the subject of their research. (I can only imagine the metaphors used by those publishing long-gestating biographies.) Reason #2 (greed) is somewhat more distinctive and likely more powerful in this context. But those who depend on grants are hardly immune, I would guess.
June 12th, 2009 at 9:38AM
I think it’s fair. One is welcome to have a complex relationship with the subject of one’s research; one is welcome to be engaged in it in all sorts of weirdly intense ways. The reason COI is such a problem is that there’s a clear difference between complex research relationships and mercenary, mendacious research relationships. Buse’s thing is weird shit because he’s offering as a kind of defense of corrupt and destructive behavior his (admirable) intensity about his work. That’s not only weird. It’s totally unpersuasive.
In fact there’s nothing complex or even interestingly psychological about trading your name or institutional affiliation or reputation for money (Reason #2), and neither is there much of interest on that level about lobbying in underhanded ways — colluding in ghostwriting, for instance — for your drug or your medical device (#1). You believe in it, you want it to get attention and to do well, so when people come along offering to help you along those lines, you say yes, even though their motives may be unscrupulous and may draw you into unethical behaviors.
Both Reason #1 and Reason #2 are crucially about compromising the integrity of your research in various ways. Until biography-gestators begin lying about their subjects for money, or putting their name on a biography they haven’t written, they don’t belong in this discussion.
June 12th, 2009 at 11:03AM
Thanks for the reply. I think you are using #2 to drive all your concerns about #1. You suggest that Buse is being extremely weird and unpersuasive with regard to #1, but that seems to punish him for being candid, transparent, and in my view reasonably accurate — about an attachment problem that colors all kind of work not driven to such a degree by greed (#2). As to whether he is defending his behavior by alluding to his mothering instincts, I again don’t think that’s fair: I haven’t seen his deposition, but the link you provide suggests he said "I’m not saying that the pharmaceutical industry captures me * * * But to the extent that the relationship has something above and beyond medicine, science, you know, it could cloud one’s judgment." That sounds more explanatory than justificatory to me.
If we focus, as I think is appropriate, on greed as the distinguishing feature of this conduct — which I think is consistent with the vast majority of your criticisms on this topic — I do think it is appropriate to acknowledge that there are a variety of ways in which findings are encouraged by financial incentives that are less overt than the drug company examples. I agree that most misconduct that results from these incentives is less obvious than what we are seeing here. But I’d wager we can call to mind examples in which it’s quite obvious that promotion, leadership within learned societies, and grants establish very strong incentives for skewing scholarship. . . . even if it’s sometimes harder to evaluate any resulting falsity, or associate it with real-world consequences for consumers.
June 12th, 2009 at 11:46AM
Ani: I think I take your point, and it’s an important one. There’s a continuum here, and at all levels and types of scholarship we can see plenty of examples of people responding to incentives — financial, reputational, whatever — by skewing their research in various ways.
I mean, we could move from the crudest and most obvious forms of compromising your work — Doris Kearns Goodwin and Charles Ogletree plagiarize in order to get lots of books out quickly and keep their names in the public eye — that’s the incentive of ambition and all its attendant goodies — or the presidents of Jacksonville State and Southern Illinois Carbondale plagiarize their dissertations because they have to have a PhD. to get a certain job — we could move from that to, as you suggest, much more complex forms of self-compromise… The sort of forms you see Buse impressively trying to get at.
These more complex forms seem to have to do with, as you say, attachment problems – the ways in which we become caught up in our own sense of what’s true and important, and then become over-eager to have the world accept as true and important what we think true and important. To have the world pay attention…
I guess the only point to make, in this particular regard, is the obvious one — There are indeed real-world consequences for vulnerable populations when people like Buse – for reasons that might even be admirable – allow themselves to be co-opted by commercial interests.
June 12th, 2009 at 12:07PM
Thanks for the gracious reply. As I hope is clear, I don’t mean to excuse the behavior you criticize. I just sometimes worry that the features distinguishing medical school academics from everyone else are (1) tangible, discrete, and traceable financial gain, and (2) real-world consequences for error. Macroeconomists probably bear a close resemblance.