Academic freedom and academic-industry relationships in biotechnology

Commercial academic-industry relationships (AIRs) are widespread in biotechnology and have resulted in a wide array of restrictions on academic research. Objections to such restrictions have centered on the charge that they violate academic freedom. I argue that these objections are almost invariably unsuccessful. On a consequentialist understanding of the value of academic freedom, they rely on unfounded empirical claims about the overall effects that AIRs have on academic research. And on a rights-based understanding of the value of academic freedom, they rely on excessively lavish assumptions about the kinds of activities that academic freedom protects.

Improving access to medicines in poor countries: the role of universities

Universities Allied for Essential Medicines, a coalition of students and faculty across North America, focuses on how academic research institutions can help to improve access to essential medicines.

Lifting the veil of secrecy from industry funding of nonprofit health organizations

Those who provide information about scientific issues and science policy normally present themselves as being objective and "scientific." This article describes a range of health charities, professional associations, nonprofit advocacy organizations, and industry-created organizations that receive significant funding from industry. In some cases, industry appears either to influence an organization's positions or to limit an organization's freedom to speak out on matters of interest to the funders. Nonprofit organizations need to consider the potential influence on their independence if they accept funding from interested companies and trade associations.

Informing research participants of research results: analysis of Canadian university based research ethics board policies

BACKGROUND

Despite potential benefits of the return of research results to research participants, the TriCouncil Policy Statement (TCPS), which reflects Canadian regulatory ethical requirements, does not require this. The policies of Canadian research ethics boards (REBs) are unknown.

OBJECTIVES

To examine the policies of Canadian university based REBs regarding returning results to research participants, and to ascertain if the presence/absence of a policy may be influenced by REB member composition.

DESIGN

Email survey of the coordinators of Canadian university based REBs to determine the presence/absence of a policy on return of research results to research participants both during an ongoing study and at conclusion. REB coordinators were asked to return a copy of the policy or guidelines and to describe the member composition of their REB.

FINDINGS

Of 50 REBs that were contacted 34 (68%) responded and 22 (64.7%) met the inclusion criteria. Two (9.1%) had a policy that governed the return of research results while on a study, and seven (31.8%) following the completion of a study. Presence of an ethicist or a lawyer on the REB did not influence the presence/absence of such policies. No REBs had specific guidelines describing how participants should be informed of results.

CONCLUSIONS

Most REBs did not require researchers to disclose study results to research participants either during or following a study. Thus this study identifies an ethical shortcoming in the conduct of human research in Canada. It has also demonstrated that there are no clear recommendations by REBs to facilitate the return of results to participants following research projects.

Clinical bioethics integration, sustainability, and accountability: the Hub and Spokes Strategy

The "lone" clinical bioethicist working in a large, multisite hospital faces considerable challenges. While attempting to build ethics capacity and sustain a demanding range of responsibilities, he or she must also achieve an acceptable level of integration, sustainability, and accountability within a complex organisational structure. In an effort to address such inherent demands and to create a platform towards better evaluation and effectiveness, the Clinical Ethics Group at the Joint Centre for Bioethics at the University of Toronto is implementing the Hub and Spokes Strategy at seven hospitals. The goal of the Hub and Spokes Strategy is to foster an ethical climate and strengthen ethics capacity broadly throughout healthcare settings as well as create models in clinical bioethics that are excellent and effective.

Conflicting interests: the evolution of an issue

The systematic funding of University research has brought into relief a question of conflicting interests. The potential in funded research for conflict and the damaging effects that conflicting interests might have on civil society had been first noted by Eisenhower in the context of State-funded research. Since the 1980s, there has been greater concern with the corrosive effects of private or corporate funding on research. Initial efforts to manage the problems have focused on authorship declarations, but recent controversies with the SSRIs suggest the only way to manage the problem is by placing all clinical trial data in the public domain.

Feet in mouth disease

We can, and should, use the financial resources of our institutions to redress the serious inequities and problems that bright, ambitious women face in the scientific workplace.

The Olivieri case: lessons for Australasia

The case of Dr. Nancy Olivieri, the Hospital for Sick Children, the University of Toronto, and Apotex Inc. vividly illustrates many of the issues central to contemporary health research and the safety of research participants. First, it exemplifies the financial and health stakes in such research. Second, it shows deficits in the ways in which research is governed. Finally, it was and remains relevant not only in Toronto but in communities across Canada and well beyond its borders because, absent appropriate policies, what happened in Toronto could have happened (and could well still happen) elsewhere. In Part One of this paper, we review the facts of the Olivieri case relevant to the issues we wish to highlight: first, the right of participants in a clinical trial to be informed of a risk that an investigator had identified during the course of the trial and the obligation of the investigator to inform participants (both her own and those of other investigators); and second, the obligation of institutions to protect and promote the well-being of research participants as well as academic freedom and research integrity, the obligations of research sponsors to inform participants, research regulators, and others about unforeseen risks, and the obligations of research regulators to ensure that participants are informed of unforeseen risks and to otherwise protect and promote research integrity. In Part Two, we relate these facts and issues to New Zealand and Australia. We also make detailed recommendations for changes to the various instruments used for the governance of research involving humans in Australasia.

Confronting the conflict of interest crisis in medical research

In the last couple of years, serious controversies have raised doubts over the reliability of research supporting the efficacy and safety of Selective Serotonin Reuptake Inhibitors, popular drugs used for the treatment of depression and a variety of related conditions. These controversies have also evoked concerns over the promotional tactics used by industry to promote these drugs. In another article in this volume, David Healy argues that the tactics highlighted by these and some other recent controversies in psychiatry have brought medical research itself to the level of commercial publicity. In the following article, I provide some additional first-hand information about controversies in which David Healy was involved. I then situate these controversies within the context of the increasing commercialization of medical research. I discuss how the controversies highlight the failure of existing regulatory regimes in curbing inappropriate industry influence over research. I critically analyse some of the measures recently promoted by the medical research community, such as the introduction of a clinical trial registry, and I indicate why these measures are insufficient. In conclusion, I highlight how a more radical reform of the clinical trials scene is needed.

A Proposed Higher Education Institution-based Three Rs Advisory Service

The University of Oxford's Ethical Review Process (ERP) is promoting a pilot scheme for a collaborative UK higher education institution-based Three Rs advisory service. It is believed that there is scope for UK academia to make a significant contribution, through the spread of its science base and the availability of high-quality library and IT services. A collaborative approach based on the concept of the critically appraised topic is envisaged, to minimise duplication and to ensure that limited resources are used to good effect. The initial objective is to identify, research, and validate refinement and replacement alternatives, drawing on both the skills of the information professional and the analogy of evidence-based health care. The results would be disseminated among member institutions by way of web-based systems, which could also offer on-line training in search strategies. The service would provide assistance to university-based project licence applicants, and would contribute to achieving the aims of the ERP, as an initiative “leading to the widest possible application of the Three Rs”. It is hoped to develop the scheme in partnership with research council initiatives now under way, as the councils play a key role as funders, not only of research, but also of research student training. Universities are uniquely positioned, as centres of scientific education and, through continuing education, of continuing professional development, to provide a base for training in good practice. A successful pilot project could provide a foundation for a similar approach to reduction strategies and experimental design.

Biomedical conflicts of interest: a defence of the sequestration thesis-learning from the cases of Nancy Olivieri and David Healy

No discussion of academic freedom, research integrity, and patient safety could begin with a more disquieting pair of case studies than those of Nancy Olivieri and David Healy. The cumulative impact of the Olivieri and Healy affairs has caused serious self examination within the biomedical research community. The first part of the essay analyses these recent academic scandals. The two case studies are then placed in their historical context-that context being the transformation of the norms of science through increasingly close ties between research universities and the corporate world. After a literature survey of the ways in which corporate sponsorship has biased the results of clinical drug trials, two different strategies to mitigate this problem are identified and assessed: a regulatory approach, which focuses on managing risks associated with industry funding of university research, and a more radical approach, the sequestration thesis, which counsels the outright elimination of corporate sponsorship. The reformist approach is criticised and the radical approach defended.

The Cornell University experience

The authors provide an account of their 20-year-old history of collaborative research and publication at Cornell University on ethics in fetal diagnosis and therapy. This research first developed and applied a conceptual framework for ethics in maternal-fetal medicine based on the concept of the fetus as a patient. The basic elements of this framework are described, as well as their application to fetal diagnosis and fetal therapy. Related topics, including obstetrics and gynecology, clinical medicine, managed care, and the ethical dimensions of medical leadership, are also briefly described.

Ethics of research involving humans: uniform processes for disparate categories?

The Australian Health Ethics Committee's National Statement on Ethical Conduct in Research Involving Humans (1999) expanded the health and medical focus of preceding statements by including all disciplines of research. The Statement purports to promote a uniformly high ethical standard for this expanded range of research, and is endorsed by, inter alia, the Australian Academy of the Humanities, the Australian Academy of Science, and the Academy of Social Sciences in Australia. High ethical standards should apply to all research involving humans. However, uniformity in the review processes of disparate research endeavors is not a necessary condition for uniformly high ethical standards. Bringing the ethical review of all research under a model which has developed within the context of health and medical research ethics for over thirty years may be inappropriate and at times incoherent. The language, methods, nature and products of research in areas such as the Humanities are often very different from those of health, medical and other sciences. The Behavioral and Social Sciences Ethics Review Committee at The University of Queensland (UQ) had, since the mid-1980s, considered that the guidelines of the time did, in fact, cover all aspects of human experimentation. We describe the ways in which this position was implemented, how issues raised by the new wording in the National Statement have been recently managed by UQ's research ethics committees, and point to outstanding questions.

Developing a code of ethics for academics. Commentary on 'Ethics for all: differences across scientific society codes' (Bullock and Panicker)

This article discusses the possibilities and pitfalls of constructing a code of ethics for university professors. Professional, educational, legal, and policy questions regarding the goals, format, and content of an academic ethics code are raised and a series of aspirational principles and enforceable standards that might be included in such a document are presented for discussion and debate.

In the grip of the python: conflicts at the university-industry interface

When the University of Toronto withdrew a contract it held with me in December 2000, it initiated a sequence of events that led to a public letter to the University from senior figures in the world psychopharmacology community protesting against the infringement of academic freedom involved and a first ever legal action, undertake by this author, seeking redress for a violation of academic freedom. The issues of academic freedom surrounding this case have been intertwined with a debate about the possibility that the selective serotonin reuptake inhibitor (SSRI) group of antidepressants have the potential to trigger suicidality in a subgroup of patients. Whether the SSRIs do trigger suicidality or not, exploration of this issue has given rise to a number of worrying sets of observations. First, in my view, there is evidence that pharmaceutical companies have miscoded raw data on suicidal acts and suicidal ideation. Second, this author also maintains that there is a growing body of examples of ghostwriting of articles in the therapeutics domain. Many of the tensions evident in this case, therefore, can be linked to company abilities to keep clinical trial data out of the public domain--this is the point at which the pharmaceutical python gets a grip on academia.

G.A.T.S. and universities: implications for research

The likely impact of applying the General Agreement on Trade in Services (GATS) to higher education are examined. GATS aims to "open up" services to competition: no preference can be shown to national or government providers. The consequences for teaching are likely to be that private companies, with degree-awarding powers, would be eligible for the same subsidies as public providers. Appealing to the inadequate recently introduced "benchmark" statements as proof of quality, they would provide a "bare bones" service at lower cost. Public subsidies would go: education being reduced to that minimum which could be packaged in terms of verifiable "learning outcomes". The loss of "higher" aspirations, such education of critically-minded citizens of a democratic and civilized society would impoverish the university's research culture which demands honesty and openness to public scrutiny. Most university research is substantially supported by public subsidy. Under GATS discipline, commercial providers of research services could be entitled to similar public subsidies. Publicly funded fundamental research would fade, leaving university research totally dependent for funds upon the good will of industry and commerce. Present problems, such as the suppression of unwelcome results and the use of questionable results to manipulate public opinion, would considerably increase. The public would lose a prime source of trustworthy knowledge, needed in political discourse, legal disputation, consumer protection and in many other contexts.

Non-instrumental roles of science

Nowadays, science is treated an instrument of policy, serving the material interests of government and commerce. Traditionally, however, it also has important non-instrumental social functions, such as the creation of critical scenarios and world pictures, the stimulation of rational attitudes, and the production of enlightened practitioners and independent experts. The transition from academic to 'post-academic' science threatens the performance of these functions, which are inconsistent with strictly instrumental modes of knowledge production. In particular, expert objectivity is negated by entanglement with political and commercial interests. We cannot go back to the old academic model for science, but need to consider how to maintain its vital non-instrumental roles.