Attack of the PharmascoldsCan bad companies fund good research? That's the question raised by recent reports of a promising new test for lung cancer, which turns out to have been developed with funding from a leading tobacco company.
David A. Shaywitz, Thomas P. Stossel, M.D.
The Weekly Standard
May 11, 2008
The research in question was conducted by an investigator at Cornell Medical College who proposed that an imaging technique called spiral CT (computed tomography) can detect lung cancers early enough for surgeons to remove them, thereby preventing the tumor spread that kills affected patients.
Prior to the publication of this research in the New England Journal of Medicine, conventional wisdom held that preventing lung cancer deaths by early detection was impossible, a conclusion informed by a succession of failed attempts using older screening methods. Fueling this pessimism is the fact that, since smoking is the major cause of lung cancer, anti–tobacco activists worry, probably incorrectly, that any advance in lung cancer management might be misinterpreted to encourage smoking.
These forces of diagnostic nihilism got a boost from the New York Times, which splashed on its March 26 front page the news that the spiral CT researchers are "tainted" by conflicts of interest. The investigators received financing from a charitable foundation supported by the Liggett Group, a cigarette maker, and they allegedly failed to disclose patent applications concerning the spiral CT technology.
The attempt to discredit the CT researchers taps into reflexive beliefs that money and the profit motive determine the outcome of research. And, since tobacco companies are presumably evil incarnate, nothing they support can possibly be worthwhile.
This premise—that research supported by industry is inevitably corrupt, while academic research funded by the government is intrinsically pure—has been repeated so often by an impassioned cadre of medical journal editors and self–righteous academics (let's call them the pharmascolds) that it has assumed the patina of fact.
Reporters have learned that they can generate a buzz by identifying corporate sponsorship of academic research and eliciting outraged soundbites from the pharmascolds, who are always ready to castigate the sinner in their midst while extolling their own implied virtue.
If reporters took the care to evaluate the evidence, they might be surprised to learn that scientists—even academic researchers not receiving industry funding—have feet of clay. They can be as ambitious as CEOs and as covetous as hedge fund managers (if not more so). Careful reporters might also discover that corporate sponsorship of research has proved highly beneficial for medical innovation. Industry–sponsored research enabled the introduction of cholesterol–lowering statin drugs, for example, contributing to spectacular declines in deaths due to heart attacks and strokes.
Instead of accusing researchers of taking "blood money" from corporations, we should be asking whether the Cornell findings hold up: Is the study methodologically sound? Has it been subjected to a peer review process? Have other researchers duplicated their results? These are the questions serious scientists ask when they review any research, regardless of who paid for it.
Perhaps not surprisingly, journalists seem more interested in advancing a facile "saints vs. sinners" story line than in challenging it, and their exposés tend to conform to a highly stylized, moralistic plot. Critics of the sponsored research (the pharmascolds) are described glowingly, while investigators with industry funding are routinely maligned.
The reporter covering the spiral CT story, for example, described the critics of the project's funding as "prominent cancer researchers and journal editors." But the Cornell scientists promoting it are also trained professionals who have (conflict of interest disclosure infractions aside) successfully run the gauntlet of peer review. The top Cornell administrator who approved the tobacco payments is also a distinguished physician–scientist.
In an astonishing example of anti-industry bias, the Times cited a medical journal editor declaring that she "would never publish a paper dealing with lung cancer from a person who had taken money from a tobacco company." Regardless of the merits of the technology or study design? Not even a cure for cancer? This is a sad commentary on what passes for "objectivity" among many of medicine's self-appointed moral guardians.
We neither smoke nor encourage others to do so. We don't forgive the tobacco industry's historical resistance to acknowledging smoking's health risks. We have no qualifications to judge whether spiral CT is a good medical value—and we have no financial interests in spiral CT.
But we do know this: If ongoing research shows that spiral CT prevents death from lung cancer, the finding will deserve celebration. Journalists should keep their eye on the ball and focus on the quality of the science rather than the character of its sponsors—and demand that pharmascolds do the same.
David A. Shaywitz, an endocrinologist, is a management consultant in New Jersey. Thomas P. Stossel is American Cancer Society professor of medicine at Harvard and senior fellow at the Manhattan Institute.