There’s an interesting Op-Ed piece in today’s Boston Globe on conflicts of interest (Drugs and demagogues):
IN 427 BC, the Athenians recaptured the town of Mytilene from the Spartans. The historian Thucydides described the intense debate that followed over the fate of Mytilene’s citizens, who had collaborated with the enemy. Cleon, whom Thucydides characterized as a violent demagogue, argued for killing them all; Diodotus, who did business with the Mytilenians, recommended mercy.
In siding with Diodotus, Thucydides noted how some people invoke financial conflicts of interest to discredit worthy opponents: “If a man gives the best possible advice but under the slightest suspicion of being influenced by his own private profit, we are so embittered by the idea that we do not allow the state to receive the certain benefit of his good advice.” In this case, the state did not benefit, and Cleon prevailed.
Recently the Food and Drug Administration furthered this venerable tradition, when it proposed to keep anyone with a financial interest of $50,000 or greater in a field of medical technology from taking part in an FDA advisory panel in that same field…
Conflict-of-interest demagogues have been appealing to envy and impugning others’ motives for 2,500 years of recorded history. When Cleon tarred Diodotus as a liar for hire, 1,000 Mytilenians died. The proposed FDA regulations, if enacted, will be far more lethal.
The writer, Dr. Thomas Stossel from Harvard Medical School believes that the FDA is taking this stance for PR rather than real reasons. In Stossel’s view, financial relationships do not influence experts’ judgments. In addition, anyone who doesn’t have a conflict probably isn’t an expert.
I don’t really agree with the first point. He cites a JAMA study on a narrow issue to back up his claim, but there’s other evidence that experts are swayed by even small amounts of money, which is why pharma reps give out gifts even when they have only token value.
The second point is more of an issue: kind of like trying to seat a jury for a case that’s received tons of pre-trial publicity. The only jurors who haven’t heard of the case are probably ignorant or illiterate. In such cases the trial may be moved to a different jurisdiction, farther from the crime. That’s why in the past I’ve suggested outsourcing new drug evaluation to India. Maybe we could find a group of experts without conflicts. On the other hand, it may be too late.April 17, 2007