Funding Agencies
THE big COI story in the Canadian academic community these days is the appointment to the Governing Council (GC) of the Canadian Institutes of Health Research (Canada’s main funder of health research), of Dr. Bernard Prigent, the Vice-President of Medical Affairs for Pfizer Canada.
It has resulted in a nationwide petition (to date, almost 4000 signatories – including me), organised by Bioethics Professor Francoise Baylis and colleagues at Dalhousie university, on the grounds that the appointment of Prigent “represents a significant threat to the integrity of CIHR by entrenching an intractable structural conflict of interest.” This has lead to a flurry of news stories, initially reported by the CBC in late November, then in the Canadian Medical Association Journal (here and here), in opinion piece by Professor Baylis, and most recently on CBC Radio’s The Current.
There is a very real concern — which I share — that the appointment of a Pfizer VP to the CIHR GC further entrenches a particular commercial perspective in the upper direction of CIHR; that is, that the role of this funding agency should be more about actively promoting knowledge transfer and commercialization than supporting academic training and research in the basic and applied health sciences. Yet the appointment of a member of industry is in one sense not surprising: governing boards of universities and other public institutions very often have members from outside the local (academic) community to help provide a broader range of expertise and perspectives, networking and fund raising, etc. At CIHR, 5 of the 17 members of the GC do not have current university appointments, so the “commercial perspective” might not seem that dominant. Moreover, given that the mandate of the GC includes “developing strategic directions, goals and policies” and “evaluating the agency’s overall performance”, not to mention supporting innovation and knowledge transfer, the appointment of someone from the health industry, such as Prignent, might seem completely reasonable.
But concerns about COI remain, even at this high level of governance. The interests of a pharma are pretty apparent, and may well diverge from the interests of Canadian researchers who benefit from CIHR funding, that the Canadian public that pays for it. And Pfizer does not have a very good reputation at this moment. Yet as Chris MacDonald clearly explains in his Research Ethics Blog entry on this subject,
“Divergence of interests’ between a company’s shareholders and the public isn’t sufficient reason to exclude executives from that company. Nobody’s interests are perfectly aligned with the public’s. What matters is whether the divergence is sufficient to render an individual’s advice suspect in a way that cannot be remedied through standard mechanisms used to mitigate the effects of conflict of interest (mechanisms such as disclosure and recusal). So simply working for industry doesn’t strike me as an insurmountable flaw, particularly if (if!) the governing council’s role makes an intimate understanding of the drug industry useful. But the main point remains: it’s very hard to support the inclusion of an executive from this pharmaceutical company on the governing council of Canada’s most important health-research-funding organization.”
And, as Steven Lewis notes,
“There are excellent reasons to exclude people actively engaged in health care commerce from the GC table to save the institution, and themselves, from the appearance and reality of conflict-of-interest. Canada would do well to take a lesson from the United States, which is moving in the opposite direction by removing registered lobbyists from advisory boards.”
P.S. (Feb 3, 2010): See this follow-on article by Steven Lewis in Open Medicine : Neoliberalism, conflict of interest, and the governance of health research in Canada