An Intractable Conflict of Interest

(see previous entries)
If the Canadian Institutes of Health Research exists to promote the public interest, why has a VP at Pfizer been named to its governing body?

Francoise Baylis

Canadians are being invited to sign a petition against the appointment of Dr. Bernard Prigent, a senior executive of Pfizer, to the Governing Council of the Canadian Institutes of Health Research (CIHR) So far, over 3,000 Canadians have signed, including senior health researchers, clinicians, ethicists, health policy experts, as well as ordinary Canadians who understand that this appointment represents a significant threat to the integrity of CIHR by entrenching an intractable structural conflict of interest.

To quote from one of the signatories, “You don’t put the rooster in charge of the hen house.” The duty of pharmaceutical companies (e.g., Pfizer) is to make money for their shareholders. The duty of CIHR is to promote the public interest. The interests of shareholders and the interests of Canadians are not one and the same.

CIHR was created in 2000 as an arms-length federal agency responsible for funding health research in Canada. The 2009-2010 total budget for CIHR was just under a billion dollars. This is a lot of money and it is important that Canadians understand how their tax dollars are being spent.

The CIHR Governing Council sets the strategic direction for CIHR and determines where money should be invested. According to the CIHR Act, its members are “to contribute to the achievement of the objective of the CIHR in the overall interests of Canadians.” The prime directive of CIHR is to improve the health of Canadians by “accelerating the discovery of cures and treatments and improvements to health care, prevention and wellness strategies.”

Lately, this mission has been taking a back seat to a different objective: the commercialization of health research. On November 30, 2009, in describing the objective of CIHR to the Standing Committee on Health, the President of CIHR, Dr. Alain Beaudet, spoke about the agency as though its mandate was to stimulate the Canadian economy. There was nary a mention of promoting, assisting, and undertaking research to improve the health of Canadians. What was once supposed to be a means to that end has now become an end in itself.

This worrying trend is most evident in the recent appointment of Dr. Prigent, the Vice President and Medical Director of Pfizer Canada, to the Governing Council . Pfizer is the largest pharmaceutical company in the world with 2008 revenues of over $70 billion. It also has the dubious distinction of having the largest criminal fraud fine in the history of the U.S. Department of Justice (the full bill was $2.3 billion for the illegal marketing of certain pharmaceutical products). And now our federal government has honoured Pfizer with a seat at Governing Council where decisions are made about how to invest your health research dollars.
Sadly, not everyone objects to this appointment.

Some argue that Dr. Prigent was appointed as an individual, not as a representative of the company for which he has worked for the past 25 years. Dr. Prigent is not described as a leader in Pfizer, but as “a leader in the promotion of Research and Development within the Canadian Life Science Sector.” Supporters further note that Governing Council members are expected to place personal agendas aside, and promote the best interests of CIHR, the broad research community, and all Canadians. But if Dr. Prigent puts those interests above those of his company, how will he answer his shareholders? He has a legal obligation to serve the interests of the corporation.

Supporters of the Pfizer appointment further remind us that all members of the CIHR Governing Council must observe the Conflict of Interest Act, the Ethical Guidelines for Public Office Holders, and the Guidelines for the Political Activities of Public Office Holders as a condition of appointment. This is as it should be. But adherence to these guidelines does not address the structural conflict of interest. Dr. Prigent cannot serve two masters with potentially conflicting interests. Moreover, if Dr. Prigent sees and understands the deep-seated conflicts, he will need to recuse himself from the very discussions where advice from the business sector is needed.

Another reason given for supporting his appointment is that the CIHR Act mandates improving the health of Canadians by “encouraging innovation, facilitating the commercialization of health research in Canada, and promoting economic development through health research in Canada.” Conveniently, this forgets about the parts of the Act that refer to “promoting, assisting, and undertaking research that meets the highest international scientific standards of excellence and ethics and that pertains to all aspects of health” and “fostering the discussion of ethical issues and the application of ethical principles to health research.” Are these parts ignored because they set standards that Pfizer cannot meet? Pfizer’s well-documented history of transgressions against the integrity of science goes well beyond the most recent $2.3 billion settlement.

A third defence of the appointment is that the CIHR Governing Council has long recognized a gap in its membership relating to the commercialization of research. I disagree with this view insofar as there has always been a person with business expertise on the Council to advise on such matters. But, assuming there is a more specific gap requiring someone with international experience in pharmaceutical innovations, it could be filled by an individual without the intractable conflict of interest faced by Dr. Prigent (or any other active member of the pharmaceutical industry). Why not choose a retired member, or someone who has worked in the pharmaceutical industry but now works in another industry, in academia, or for a non-profit company instead?

Francoise Baylis is Canada Research Chair, bioethics and philosophy, Dalhousie University.