Almost all ethics scandals and examples of outrageous unethical conduct are thoroughly predictable, whether they involve individual, organizations or institutions. The most obvious proof of this is in politics. Once we consider past patterns, current conditions, institutional habits and what we know about human nature, the question when a new political party takes over isn’t whether there will be instances of bribery, influence peddling, self-enrichment, and conflict of interest, but only which elected leaders will be caught at it. Sometimes even that part is easy: everyone should have been able to guess, long before they occurred, that Tom DeLay’s ethics-free philosophy of politics as warfare would lead him to commit serious misdeeds, just as the odds against former Florida Rep. Alan Grayson running a fair or civil campaign for re-election were prohibitively high. Similarly, sports scandals can usually be seen coming a long way off. Once New England Patriots coach Bill Belichik was caught making surreptitious videos of his team’s opponents’ practices, it was easy to guess that he wasn’t the only one, and that since both he and his team were so successful, it would be only a matter of time before a similar incident came to light. And it did, last week.
As I look through various Ethics Alarms posts, it is striking how many of them could have been written in advance, in fill-in-the-blank format. All you need to do is identify an industry with a history of ethics problems, a weak ethics culture, a trusting, under-informed audience, the potential for increased profit, power or influence, and a large population of corruptible, lazy, incompetent, venal, ambitious or cowardly allies. I’m sure a computer program could be developed, but for this holiday season, why not forecast next year’s ethics scandals as a party game? Challenge your guests: Which TV reality show will be shown to have completely manipulated “reality”? Which revered sports figure will be disgraced in a sex or drug scandal? Which Wall Street firm will be caught violating the “sacred principles” posted on its website? Which school will suspend or expel a student for violating the letter of an overly broad and horribly-written rule without actually doing anything wrong? Which universally accepted scientific research will turn out to be the result of manipulated data? Which embarrassments of the Obama Administration will only be reported by Fox News, and which outrages committed by Republicans will the same network ignore?
And, of course, where will TSA employees put their hands next?
This occurred to me as I read about the recent Big Pharma-manipulating-medical-practice scandal, involving drug giant GlaxonSmithKline, while slapping my forehead and shouting, “Of course! This was the logical next step!” For decades, drug companies have bought the loyalty of prominent doctors and researchers, paying their expenses to lavish medical conventions, sending them gifts and samples, and financing their research. Drug-makers have commissioned medical journal articles by prominent professors and supplied research assistance and regular input, oversight and review, with the resulting work never bearing any notice to readers that the endorsement of particular drug treatments may not be wholly based on the author’s independent judgement.
Now, the New York Times reports, documents obtained through discovery in a lawsuit reveal that two prominent doctors who were credited as authors of a 1999 book teaching family doctors how to treat psychiatric disorders actually were fronts for GlaxonSmithKline, which conceived the book, created its outline, reviewed it, drafted large segments of it, and funded it, all of which was only alluded to in the book’s preface as an “unrestricted educational grant.”
A drug company paying doctors to let it ghostwrite a book recommending the company’s products to other doctors! Why didn’t I see that as the next logical—and unethical— development?
The so-called grant, reports the New York Times, paid for a writing company to develop the book’s outline and text for the two named co-authors, Dr. Charles B. Nemeroff, chairman of psychiatry at the University of Miami medical school since 2009 and Emory University before that, and Dr. Alan F. Schatzberg, who was chairman of psychiatry at the Stanford University School of Medicine from 1991 until last year. The discovered documents show that the writing company contracted to show three drafts directly to the pharmaceutical company for comments, and page proofs for final approval.
“To ghostwrite an entire textbook is a new level of chutzpah,” said Dr. David A. Kessler, former commissioner of the Food and Drug Administration told the Times. “I’ve never heard of that before. It takes your breath away.”
A new level, but also a predictable level. The Times’s sources now say it is virtually certain that the 269-page Recognition and Treatment of Psychiatric Disorders: A Psychopharmacology Handbook for Primary Care was not the only medical reference created this way, based on sealed files at GlaxonSmithKline. If one drug giant was ghostwriting medical texts, how likely is it that at least some of rest them have been doing this as well?
Let’s guess which pharmaceutical companies have been paying doctors to lie to their colleagues, and trick them into prescribing drugs that may not really be the best way to treat us!
UPDATE: A helpful commenter (thank you, Beth Casteel!) on this article provided this jaw-dropping update from the Times:
“A headline on Nov. 30 with an article about SmithKline Beecham’s role in the publication of a book about treating psychiatric disorders overstated SmithKline’s actions. While documents show that SmithKline (now known as GlaxoSmithKline) hired a writing company for the book, they do not indicate that the company wrote the book for the authors, Dr. Charles B. Nemeroff and Dr. Alan F. Schatzberg. The article also described incorrectly, in some editions, events outlined in a letter from the writing company to Dr. Nemeroff. The correspondence proposed a timeline for the writing company to furnish the doctors and SmithKline with draft text and final page proofs for approval; the letter did not say that the company had already provided those materials for final approval. And the article misstated the context under which Dr. David A. Kessler, the former commissioner of the Food and Drug Administration, commented about the book’s production. The letter and other documents were described to him; he did not personally review the documents.”
These alter the details, but not the ultimate conclusion of the Ethics Alarms post. The involvement of the drug company went far, far beyond acceptable levels that could be legitimately called neutral. There was still a conflict of interest here, and it was not divulged by the authors. The book is still not trustworthy.
But we should also reflect on the Times’ sloppy handling of the story.