Side effects of capitalism

In recent years, Duke Medicine has toed the line on an ethical issue that has come into the spotlight this week.

Dr. Victor Tapson – a researcher and faculty member here at Duke – has been unfavorably singled out in a report produced by the Senate Finance Committee because of his financial ties to pharmaceutical company Sanofi.

It’s definitely not out of the ordinary for a medical researcher to act as a sort of pharmaceutical sponsor – giving presentations on behalf of certain drugs in return for large sums of money. In fact, as the Duke Chronicle reported last December, the University is proud of its policies regarding such relationships. However, in a presentation to the Federal Drug Administration, Tapson allegedly did just what these policies try to prevent – he showed undue bias in favor of a Sanofi product while conveniently failing to mention his $260,604 tie to the company.

In theory, these relationships between medical companies and researchers should act benignly, especially because people’s health and medical safety are on the line. It would have to act, though, in such a way that, in every instance, the doctors would simply present the facts of the products when asked by an outside party – unlike when a company like Gatorade gives an athlete millions of dollars to drink, breathe and sweat the sports beverage, though its health benefits are actually limited.

However, can a doctor suppress the fact that a company is giving him $200,000 and present 100-percent unbiased facts when he is speaking on behalf of that company? Look at it from the other side, too – would a company continuously fork out hundreds of thousands of dollars to have their drug promoted as having something like “dangerous side effects” or as being “not much better than the competing brand?”

At first glance, this idea of pharmaceutical sponsorship seems to be negative on all accounts. In truth, however, the line separating right and wrong on this issue is hazy. Although Tapson’s case is a clear, irresponsible and surface-level display of conflict of interest, the problem has deep and tangled roots.

Assume there is a doctor who, despite the large check he may receive, promotes a drug to the best of his ability with honesty and integrity – his audience members are still not aware of the bias that the pharmaceutical company is slyly feeding them. As a 2010 New Yorker article discussed, an epidemic of selective scientific reporting is surfacing – when a researcher reports the best or the most groundbreaking results of an experiment, even though those outcomes might not statistically be the norm. Many researchers even skip repeat trials for fear of disappointment. The article lists several popular medicines, like Zyrtec, that have had this kind of invalid promotion – and all of this happens before the information even reaches the sponsor doctor.

Pharmaceutical companies and researchers are not immune to the effects of capitalism – they fight for limited government regulation; they make choices that will increase profits; they have a drive to develop the first and the best and the cheapest products, and they craftily advertise so they are seen in a better light than competing companies. If we were to question the morality of this seemingly skewed version of the scientific method, a concept always held to high standards of integrity, we would also have to question the foundations of capitalism. But we must also look at the benefits of developing medicines in an entrepreneurial manner – new medicines are constantly being imagined, researched and developed, a process that would be slowed significantly if it was over-regulated by the Food and Drug Administration.

Cases like Tapson’s happen because of personal greed, encouraged in a free market society – and this greed drives our economy and encourages innovation, and too much government regulation might prevent growth and stifle incentive. However, companies – particularly those who claim to protect our health – should have internal regulations that preserve its integrity from the moment someone has an idea to the day the idea reaches the hands of the consumer, all while maintaining the company’s market competitiveness.