First Advice for Those Entering Retail Sales

If he were walking around the streets today, the richest man I ever knew might be mistakenly thought to be homeless. His clothes were well-worn, almost threadbare, the leather on his shoes was cracked, and he wore no jewellery. The man who accompanied him might be mistaken for a carer of some sort, except that this man was always wearing a tailored suit with fashionable leather shoes, carried a literal bag of money, and he was never without the aid of a reliable and recognisable timepiece. This sharp dressed man was, of course, was the personal assistant to Mr. Phipps, the bedraggled banker he served quietly and with great decorum. 

This PA (let’s call him Johnson, because I never had any idea what his name was) saw to the messy details of Mr. Phipp’s life such as paying for services, food, and the few material items Mr. Phipps might require. Mr. Johnson had an easy job, as Mr. Phipps was as gentle as he was austere. Mr. Phipps also knew that money was about the filthiest thing you could touch, so he never touched it unless it was fresh from the mint. Any previously used money was handled strictly by Mr. Johnson, who took his chances with the germ-ridden currency, but still saw to wash his hands frequently. 

I had a fairly intimate relationship with Mr. Phipps myself. At least I guess it was more intimate that what most of the local 12-year-old boys had with him—I shined his shoes. The leather was old and cracked, as I said, but I did my best to restore it and bring the shine back. He always seemed grateful for my efforts, and he’d have Mr. Johnson reward my labor handsomely by the standards of a 12-year-old shine boy. 

I think of him every time I hear a salesperson brag about the ability to size up potential customers as soon as they walk through the door. “I can tell right off,” they’ll say, “whether someone is ready to spend money. Or even has any money to spend.” The snap judgement and dismissive following behaviour serve only to fulfil the bigoted prophesy. But I suppose our days are filled with nothing but minor miscalculations. We trip over our own feet constantly but usually carry on to walk again. 

All Research Is Biased – Might As Well Get Paid For It

Capitalist Epistemology: Is Money Truth?

On November 28, 2014, the BMJ (formerly the British Medical Journal) posted an announcement that it would no longer publish papers from authors with financial ties to industry with the aim of eliminating harmful bias from published articles. I’ve since talked to some researchers who quickly pointed out that everyone has biases, so eliminating financial conflicts of interest will not result in objective research free from fraud or manipulation, and I agree with them on that point. [Note, a response from Fiona Godlee clarifies this policy: “The policy applies only to editorials and clinical education articles designed to guide patient care and does not extend to other types of article published in The BMJ.” updated 1/14/15.]

As far as I know, Gregor Mendel had no financial conflicts of interest, but his data proved Pharmaceutical-cartonhis theory of genetics perfectly—too perfectly, almost everyone agrees, to be true (see a brief discussion here). Paradoxically, Mendel seems to have cleaned up his data in order to help promote his theory, which happened to be true, so he used untruth to promulgate truth. Other researchers have let their biases affect them more nefariously, letting sexism and racism cloud their ability to form accurate or even coherent theories of health, intelligence, or moral agency.

But the goal of science has always been for an objective pursuit of truth free from emotional bias. Philosopher Alison M. Jaggar made a compelling argument that no scientific inquiry is value free or separate from emotion. She argues, on the contrary, that emotion is a necessary part of any pursuit of knowledge. “Disinterested inquiry,” she says, “Is an impossible dream.” (See “Love and Knowledge: Emotion in Feminist Epistemology.”) A scientific researcher with no bias and no values is both impossible and undesirable, I agree, but it is one thing to have a socially constructed bias and another to have a financially constructed bias. Being paid to have a bias raises a whole new set of problems.

I don’t mean to suggest that pharmaceutical or biotechnology companies should be prohibited from hiring scientific researchers or even that those researchers should be prohibited from publishing in scientific journals. They should, of course, have adequate oversight to detect and prevent fraud, but I’m sure many great products in medicine and elsewhere have resulted from an unbridled pursuit of profit.

The problem is that we don’t have enough independent researchers to ensure a robust search for solutions to human problems that may not lead to profit. Further, we don’t have enough independent researchers to prevent harm from flawed conclusions that may, in fact, generate a profit in spite of their flaws at great risk to public health.

We need publicly funded research centers or anonymously funded research centers where researchers can pursue knowledge that may or may not be convenient for corporations. These researchers would be freer to publish negative results of “promising” treatments. They would be freer to pursue treatments that may be effective but less profitable. As anyone familiar with this problem is aware, it is far more profitable to market maintenance treatments than treatments that will actually cure any given medical condition. Imagine if public funding were also used to manufacture inexpensive and effective cures rather than expensive and less effective treatments.

Of course, this is not the direction the United States (or the world, really) is heading. Rather, we have now entered the age of “venture philanthropy.” (Read Llewellyn Hinkes-Jones’ piece in the New York Times. ) Venture philanthropy enables foundations to use tax-exempt donations to invest in for-profit companies. Rather than using public funds to ensure research free from financial conflicts, venture philanthropy uses public funds to develop and market new products. As Hinkes-Jones puts it, “If the intent is to cure rare diseases, then we should be increasing the budget for the National Institutes of Health and other research initiatives. Instead of gala balls and donor drives, higher taxes on the same rich benefactors could be used to fund the research that isn’t already being supported.”

When the BMJ announced it would no longer publish pieces by authors with industry ties, one chilling line from the article leapt out at me: “In some fields—for example, obesity medicine, genetics, and rheumatology—we may find it difficult to recruit authors free of relevant financial links with industry. It might even prove impossible.” Somehow, we must find the will to make it possible for researchers to make a living and publish their findings without joining the payroll of for-profit corporations. I do not believe all researchers are motivated only by the opportunity to accumulate wealth. Jonas Salk passed the opportunity to amass great wealth with the polio vaccine. Others deserve the chance to do the same.

Will industry-funded research kill you?

Last week, I wrote a blog about the effects of financial conflicts of interest (FCOI) on treatment decisions of doctors and whether disclosure alone will have any effect on eliminating bias and corruption. As a result, I received some comments and information on FCOI in published research.

Before I say more, I would like to clarify that someone who is conducting research funded by industry is not technically, in my studied opinion, involved in a FCOI, because such a person has the single interest of generating products that will result in profit for industry. It is possible that research undertaken with the aim of commercial success will benefit humanity, but if profit is not possible, humanity be damned. (I am making an assumption, which may be naive, that most of us think medical research should be aimed at making life better for humanity.)

To help combat the problem of bias in research, John Henry Noble suggests prison time for those found guilty of scientific fraud. In my opinion, he makes two strong claims: 1. “The false claims of the perpetrators rise to the status of crime against society, insofar as they endanger public health by sullying and misdirecting the physician’s ‘standard of care.’” 2. “The due process of law is likely to uncover and judge the evidence of guilt or innocence more reliably and fairly than will the institutions of science and the professions that historically have resisted taking decisive action against the perpetrators.”

I agree that jail time is appropriate for egregious cases of scientific fraud, but I’m not sure it eliminates the problem of industry-driven research. Another person told me industry-funded research should be published for two reasons: 1. Some people are biased without the benefit of industry funding. 2. Some industry-funded research proves to be quite beneficial. Perhaps surprisingly, I agree with both of these statements as well–as far as they go. Certainly, many people carry any number of biases that do not result from corporate funding, and the history of scientific fraud is littered with examples. Further, corporate labs frequently create products I enjoy immensely.

Oddly enough, the person defending industry-funded research sent me a link to a paper to support the contention that FCOIs are not a strong predictor of bias. I say it is odd because the paper didn’t seem to support that position. The paper analyzed the associate between industry funding and the likelihood that the researchers would find an association between sweetened beverages and obesity. The authors of the paper found that “Those reviews with conflicts of interest were five times more likely to present a conclusion of no positive association than those without them.” It is perhaps the conclusion of the paper that gives hope to those advocating for industry funding:

They [results of the study] do not imply that industry sponsorship of nutrition research should be avoided entirely. Rather, as in other research areas, clear guidelines and principles (for example, sponsors should sign contracts that state that they will not be involved in the interpretation of results) need to be established to avoid dangerous conflicts of interest.

In other words, it would reduce bias if sponsored researchers were limited to collecting data without analyzing it. This is hardly a ringing endorsement of industry-funded research, but so be it.

So, I do not think all industry-funded research should be banned. Rather, I think we (as a society) need to ensure that we have ample researchers who are free of FCOIs. In other words, we need substantial funding for independent research centers where researchers can work for the advancement of knowledge without a constant concern for the production of profit. Forcing our public universities and research labs to turn to corporations for funding corrupts our pursuit of knowledge and the advancement of society. We must restore public funding to education and research.

For more on the possible risks of funded research, read about Dan Markingson here. Or read about Jesse Gelsinger here.