Skip to main content
Erschienen in: Journal of Bioethical Inquiry 2/2020

13.07.2020 | Symposium: Conflicts of Interest

Lessons from Corporate Influence in the Opioid Epidemic: Toward a Norm of Separation

verfasst von: Jonathan H. Marks

Erschienen in: Journal of Bioethical Inquiry | Ausgabe 2/2020

Einloggen, um Zugang zu erhalten

Abstract

There is overwhelming evidence that the opioid crisis—which has cost hundreds of thousands of lives and trillions of dollars (and counting)—has been created or exacerbated by webs of influence woven by several pharmaceutical companies. These webs involve health professionals, patient advocacy groups, medical professional societies, research universities, teaching hospitals, public health agencies, policymakers, and legislators. Opioid companies built these webs as part of corporate strategies of influence that were designed to expand the opioid market from cancer patients to larger groups of patients with acute or chronic pain, to increase dosage as well as opioid use, to downplay the risks of addiction and abuse, and to characterize physicians’ concerns about the addiction and abuse risks as “opiophobia.” In the face of these pervasive strategies, conflict of interest policies have proven insufficient for addressing corporate influence in medical practice, medical research, and public health policy. Governments, the academy, and civil society need to develop counterstrategies to insulate themselves from corporate influence and to preserve their integrity and public trust. These strategies require a paradigm shift—from partnerships with the private sector, which are ordinarily vehicles for corporate influence, to a norm of separation.
Fußnoten
1
The Sackler family’s arts philanthropy has attracted much attention. I focus my analysis here on relationships with entities in health and policy spheres because they appear to have most directly contributed to the opioid crisis. But I recognize that arts philanthropy also merits ethical scrutiny that I cannot provide in the space permitted.
 
2
Although university gifts made by Purdue Pharma and the Sackler family have attracted the most public scrutiny, the conviction of the former CEO of Insys, John Kapoor, drew attention to his gifts to the University of Buffalo’s School of Pharmacy and ultimately led to the removal of his name from the school’s building (McNeil 2019).
 
3
For a thoughtful critique of this definition, see Rodwin 2018. Rodwin argues that the Institute of Medicine’s 2009 definition of conflicts of interest “neglects the actor’s compromised loyalty to the party or mission she is supposed to serve” (70) and that, by referring to conflicts between primary and secondary interests rather than conflicts between obligations and interests, this definition “diminishes the conflict’s significance” (70). Rodwin also expresses concern that “[e]fforts to include so-called intellectual or nonfinancial conflicts as conflicts of interest blur the concept” (75).
 
4
Physicians are not dependent on drug companies for pens and mugs—they can afford to buy their own! But these small gifts influence them nonetheless. See, e.g., Sah and Fugh-Berman 2013; Lo and Grady 2017.
 
5
Although widely publicized investigations revealing opioid company payments to PAOs and health professional associations led to withdrawals of funding and, in a few cases, to the recipient organizations ceasing to operate, industry funding of patient advocacy groups remains pervasive. One recent study found that 83 per cent of the 104 largest groups received funding from drug, device, or biotechnology companies (McCoy et al. 2017). We should not expect disclosure alone to lead to the widespread elimination of these relationships, especially if the pervasiveness of these relationships reinforces the (problematic) view that they are acceptable or unavoidable.
 
Literatur
Zurück zum Zitat Aaron, D., and M. Siegel. 2017. Sponsorship of national health organizations by two major soda companies. American Journal of Preventive Medicine 52(1): 20–30.CrossRef Aaron, D., and M. Siegel. 2017. Sponsorship of national health organizations by two major soda companies. American Journal of Preventive Medicine 52(1): 20–30.CrossRef
Zurück zum Zitat Applbaum, K. 2009. Getting to yes: Corporate power and the creation of a psychopharmaceutical blockbuster. Culture, Medicine, and Psychiatry 33(2): 185–215.CrossRef Applbaum, K. 2009. Getting to yes: Corporate power and the creation of a psychopharmaceutical blockbuster. Culture, Medicine, and Psychiatry 33(2): 185–215.CrossRef
Zurück zum Zitat Bachynski, K.E. and D.S. Goldberg. 2018. Time out: NFL conflicts of interest with public health efforts to prevent TBI. Injury Prevention 24(3): 180–184. Bachynski, K.E. and D.S. Goldberg. 2018. Time out: NFL conflicts of interest with public health efforts to prevent TBI. Injury Prevention 24(3): 180–184.
Zurück zum Zitat Bekelman, J.E., Y. Li, and C.P. Gross. 2003. Scope and impact of financial conflicts of interest in biomedical research: A systematic review. JAMA 289(4): 454–465.CrossRef Bekelman, J.E., Y. Li, and C.P. Gross. 2003. Scope and impact of financial conflicts of interest in biomedical research: A systematic review. JAMA 289(4): 454–465.CrossRef
Zurück zum Zitat Bertrand, M., M. Bombardini, R. Fisman, B. Hackinen, and F. Trebbi. 2018. Hall of mirrors: Corporate philanthropy and strategic advocacy. NBER Working paper 25329 (December 2018). http://www.nber.org/papers/w25329. Accessed December 1, 2019. Bertrand, M., M. Bombardini, R. Fisman, B. Hackinen, and F. Trebbi. 2018. Hall of mirrors: Corporate philanthropy and strategic advocacy. NBER Working paper 25329 (December 2018). http://​www.​nber.​org/​papers/​w25329. Accessed December 1, 2019.
Zurück zum Zitat Cain, D., G. Loewenstein, and D. Moore. 2005. The dirt on coming clean: Perverse effects of disclosing conflicts of interest. Journal of Legal Studies 34(1): 1–25.CrossRef Cain, D., G. Loewenstein, and D. Moore. 2005. The dirt on coming clean: Perverse effects of disclosing conflicts of interest. Journal of Legal Studies 34(1): 1–25.CrossRef
Zurück zum Zitat Chambers, T. 2017. The illusion of transparency. American Journal of Bioethics 17(6): 32–33.CrossRef Chambers, T. 2017. The illusion of transparency. American Journal of Bioethics 17(6): 32–33.CrossRef
Zurück zum Zitat Freudenberg, N. 2014. Lethal but legal: Corporations, consumption, and protecting public health. New York: Oxford University Press. Freudenberg, N. 2014. Lethal but legal: Corporations, consumption, and protecting public health. New York: Oxford University Press.
Zurück zum Zitat Gluck, A.R., A. Hall, and G. Curfman. 2018. Civil litigation and the opioid crisis: The role of courts in a national health crisis. Journal of Law, Medicine, and Ethics 46(2): 351–366.CrossRef Gluck, A.R., A. Hall, and G. Curfman. 2018. Civil litigation and the opioid crisis: The role of courts in a national health crisis. Journal of Law, Medicine, and Ethics 46(2): 351–366.CrossRef
Zurück zum Zitat Goldberg, D.S. 2019. The Shadows of sunlight: Why disclosure should not be a priority in addressing conflicts of interest. Public Health Ethics 12(2): 202–212. Goldberg, D.S. 2019. The Shadows of sunlight: Why disclosure should not be a priority in addressing conflicts of interest. Public Health Ethics 12(2): 202–212.
Zurück zum Zitat Greene, J.A., and S.H. Podolsky. 2009. Keeping modern in medicine: Pharmaceutical promotion and physician education in postwar America. Bulletin of the History of Medicine 83(2): 331–377.CrossRef Greene, J.A., and S.H. Podolsky. 2009. Keeping modern in medicine: Pharmaceutical promotion and physician education in postwar America. Bulletin of the History of Medicine 83(2): 331–377.CrossRef
Zurück zum Zitat Hadland, S.E., M.S. Krieger, and B.D.L. Marshall. 2017. Industry payments to physicians for opioid products, 2013–2015. American Journal of Public Health 107(9): 1493–1495.CrossRef Hadland, S.E., M.S. Krieger, and B.D.L. Marshall. 2017. Industry payments to physicians for opioid products, 2013–2015. American Journal of Public Health 107(9): 1493–1495.CrossRef
Zurück zum Zitat Hadland, S.E., M. Cerdá, Y. Li, M.S. Krieger, and B.D.L. Marshall. 2018. Association of pharmaceutical industry marketing of opioid products to physicians with subsequent opioid prescribing. JAMA Internal Medicine 178(6): 861–863.CrossRef Hadland, S.E., M. Cerdá, Y. Li, M.S. Krieger, and B.D.L. Marshall. 2018. Association of pharmaceutical industry marketing of opioid products to physicians with subsequent opioid prescribing. JAMA Internal Medicine 178(6): 861–863.CrossRef
Zurück zum Zitat Hadland, S.E., A. Rivera-Aguirre, and B.D.L. Marshall. 2019. Association of Pharmaceutical Industry marketing of opioid products with mortality from opioid-related overdoses. JAMA Open 2019(1): e186007.CrossRef Hadland, S.E., A. Rivera-Aguirre, and B.D.L. Marshall. 2019. Association of Pharmaceutical Industry marketing of opioid products with mortality from opioid-related overdoses. JAMA Open 2019(1): e186007.CrossRef
Zurück zum Zitat Homeland Security and Government Affairs Committee (HSGAC). 2018a. Fueling an epidemic—Report Two: Exposing financial ties between opioid manufacturers and third party advocacy groups. Washington, D.C.: U.S. Senate. https://www.hsdl.org/?view&did=808171. Accessed December 1, 2019. Homeland Security and Government Affairs Committee (HSGAC). 2018a. Fueling an epidemic—Report Two: Exposing financial ties between opioid manufacturers and third party advocacy groups. Washington, D.C.: U.S. Senate. https://​www.​hsdl.​org/​?​view&​did=​808171. Accessed December 1, 2019.
Zurück zum Zitat Kanter, G.P. 2018. Extending the Sunshine Act from physicians to patient advocacy organizations. AJPH 108(8): 978–979.CrossRef Kanter, G.P. 2018. Extending the Sunshine Act from physicians to patient advocacy organizations. AJPH 108(8): 978–979.CrossRef
Zurück zum Zitat Kanter, G.P., and G. Loewenstein. 2019. Evaluating open payments. JAMA 322(5): 401–402.CrossRef Kanter, G.P., and G. Loewenstein. 2019. Evaluating open payments. JAMA 322(5): 401–402.CrossRef
Zurück zum Zitat Kanter, G.P., D. Carpenter, L. Lehmann, and M. Mello. 2019. Effect of the public disclosure of industry payments information on patients: Results from a population-based natural experiment. BMJ Open, no. 024020. Kanter, G.P., D. Carpenter, L. Lehmann, and M. Mello. 2019. Effect of the public disclosure of industry payments information on patients: Results from a population-based natural experiment. BMJ Open, no. 024020.
Zurück zum Zitat Keefe, P.R. 2017. The family that built an empire of pain. New Yorker, October 30. 34–49. Keefe, P.R. 2017. The family that built an empire of pain. New Yorker, October 30. 34–49.
Zurück zum Zitat Lessig, L. 2015. Republic, lost: The corruption of equality and the steps to end it. New York: Twelve. Lessig, L. 2015. Republic, lost: The corruption of equality and the steps to end it. New York: Twelve.
Zurück zum Zitat Lin, D.H., E. Lucas, I.B. Murimi, et al. 2017. Financial conflicts of interest and the Centers for Disease Control and Prevention’s 2016 guideline for prescribing opioids for chronic pain. JAMA Internal Medicine 177(3): 427–428. Lin, D.H., E. Lucas, I.B. Murimi, et al. 2017. Financial conflicts of interest and the Centers for Disease Control and Prevention’s 2016 guideline for prescribing opioids for chronic pain. JAMA Internal Medicine 177(3): 427–428.
Zurück zum Zitat Lo, B., and M. Field. 2009. Conflict of interest in medical research, education, and practice. Washington, D.C.: National Academies Press. Lo, B., and M. Field. 2009. Conflict of interest in medical research, education, and practice. Washington, D.C.: National Academies Press.
Zurück zum Zitat Lo, B., and D. Grady. 2017. Payments to physicians: Does the amount of money make a difference? JAMA 317(17): 1719–1720.CrossRef Lo, B., and D. Grady. 2017. Payments to physicians: Does the amount of money make a difference? JAMA 317(17): 1719–1720.CrossRef
Zurück zum Zitat Loewenstein, G., D.M. Cain, and S. Sah. 2011. The limits of transparency: Pitfalls and potential of disclosing conflicts of interest. American Economic Review 101(3): 423–428.CrossRef Loewenstein, G., D.M. Cain, and S. Sah. 2011. The limits of transparency: Pitfalls and potential of disclosing conflicts of interest. American Economic Review 101(3): 423–428.CrossRef
Zurück zum Zitat Loewenstein, G., S. Sah, and D. Cain. 2012. The unintended consequences of conflict of interest disclosure. JAMA 307(7): 669–670.CrossRef Loewenstein, G., S. Sah, and D. Cain. 2012. The unintended consequences of conflict of interest disclosure. JAMA 307(7): 669–670.CrossRef
Zurück zum Zitat Lundh A., J. Lexchin, B. Mintzes, J. Schroll, and L. Bero. 2017. Industry sponsorship and research outcome. Cochrane Database of Systematic Reviews. Issue 2. Art. No.: MR000033. Lundh A., J. Lexchin, B. Mintzes, J. Schroll, and L. Bero. 2017. Industry sponsorship and research outcome. Cochrane Database of Systematic Reviews. Issue 2. Art. No.: MR000033.
Zurück zum Zitat Macy, B. 2018. Dopesick: dealers, doctors, and the drug company that addicted America. New York: Little, Brown & Co. Macy, B. 2018. Dopesick: dealers, doctors, and the drug company that addicted America. New York: Little, Brown & Co.
Zurück zum Zitat Marks, J.H. 2017. Caveat partner: Sharing responsibility for health with the food industry. American Journal of Public Health 107(3): 360–361.CrossRef Marks, J.H. 2017. Caveat partner: Sharing responsibility for health with the food industry. American Journal of Public Health 107(3): 360–361.CrossRef
Zurück zum Zitat ———. 2019a. The Perils of partnership: Industry influence, institutional integrity, and public health. New York: Oxford University Press. ———. 2019a. The Perils of partnership: Industry influence, institutional integrity, and public health. New York: Oxford University Press.
Zurück zum Zitat ———. 2019c. Are corporations nudging the nudgers? American Journal of Bioethics 19(5): 70–72. ———. 2019c. Are corporations nudging the nudgers? American Journal of Bioethics 19(5): 70–72.
Zurück zum Zitat McCoy, M.S., M. Carniol, K. Chockley, J.W. Urwin, E.J. Emanuel, and H. Schmidt. 2017. Conflict of interest for patient advocacy organizations. New England Journal of Medicine 376: 880–885.CrossRef McCoy, M.S., M. Carniol, K. Chockley, J.W. Urwin, E.J. Emanuel, and H. Schmidt. 2017. Conflict of interest for patient advocacy organizations. New England Journal of Medicine 376: 880–885.CrossRef
Zurück zum Zitat McCoy, M.S. 2018. Industry support of patient advocacy organizations: The case for an extension of the Sunshine Act provisions of the Affordable Care Act. American Journal of Public Health 108(8): 1026–1030.CrossRef McCoy, M.S. 2018. Industry support of patient advocacy organizations: The case for an extension of the Sunshine Act provisions of the Affordable Care Act. American Journal of Public Health 108(8): 1026–1030.CrossRef
Zurück zum Zitat McCoy, M.S., and G.P. Kanter. 2018. Campaign contributions from political action committees to members of congressional committees responding to the opioid crisis. JAMA 320(14): 1489–1491.CrossRef McCoy, M.S., and G.P. Kanter. 2018. Campaign contributions from political action committees to members of congressional committees responding to the opioid crisis. JAMA 320(14): 1489–1491.CrossRef
Zurück zum Zitat McGreal, C. 2018. American overdose: The opioid tragedy in three acts. New York: Hachette. McGreal, C. 2018. American overdose: The opioid tragedy in three acts. New York: Hachette.
Zurück zum Zitat ———. 2018. Pain killer: An empire of deceit and the origin of America’s opioid epidemic. New York: Random House. ———. 2018. Pain killer: An empire of deceit and the origin of America’s opioid epidemic. New York: Random House.
Zurück zum Zitat Michaels, D. 2008. Doubt is our product: How industry’s assault on science threatens your health. New York: Oxford University Press. Michaels, D. 2008. Doubt is our product: How industry’s assault on science threatens your health. New York: Oxford University Press.
Zurück zum Zitat ———. 2020. The triumph of doubt: Dark money and the science of deception. New York: Oxford University Press. ———. 2020. The triumph of doubt: Dark money and the science of deception. New York: Oxford University Press.
Zurück zum Zitat Podolsky, S.H. 2015. The antibiotic era: Reform, resistance, and the pursuit of a rational therapeutics. Baltimore: Johns Hopkins University Press. Podolsky, S.H. 2015. The antibiotic era: Reform, resistance, and the pursuit of a rational therapeutics. Baltimore: Johns Hopkins University Press.
Zurück zum Zitat Podolsky, S.H, D. Hertzberg, and J.A. Greene. 2019. Preying on prescribers (and their patients)—Pharmaceutical marketing, iatrogenic epidemics, and the Sackler legacy. New England Journal of Medicine 380(19): 1785–1787.CrossRef Podolsky, S.H, D. Hertzberg, and J.A. Greene. 2019. Preying on prescribers (and their patients)—Pharmaceutical marketing, iatrogenic epidemics, and the Sackler legacy. New England Journal of Medicine 380(19): 1785–1787.CrossRef
Zurück zum Zitat Purdue Pharma. 2018. We manufacture prescription opioids. How could we not help fight the prescription and illicit opioid abuse crisis? New York Times, January 2. http://bit.ly/PurduePartnerAd. Accessed January 31, 2018. Purdue Pharma. 2018. We manufacture prescription opioids. How could we not help fight the prescription and illicit opioid abuse crisis? New York Times, January 2. http://​bit.​ly/​PurduePartnerAd. Accessed January 31, 2018.
Zurück zum Zitat Quinones, S. 2006. Dreamland: The true tale of America’s opiate epidemic. New York: Bloomsbury. Quinones, S. 2006. Dreamland: The true tale of America’s opiate epidemic. New York: Bloomsbury.
Zurück zum Zitat Relman, A.S. 1980. The new medical-industrial complex. New England Journal of Medicine 303(17): 963–970.CrossRef Relman, A.S. 1980. The new medical-industrial complex. New England Journal of Medicine 303(17): 963–970.CrossRef
Zurück zum Zitat ———. 1984. Dealing with conflicts of interest. New England Journal of Medicine 310(18): 1182–1183. ———. 1984. Dealing with conflicts of interest. New England Journal of Medicine 310(18): 1182–1183.
Zurück zum Zitat Rodwin, M. 2018. Attempts to redefine conflicts of interest. Accountability in Research 25(2): 67–78.CrossRef Rodwin, M. 2018. Attempts to redefine conflicts of interest. Accountability in Research 25(2): 67–78.CrossRef
Zurück zum Zitat Rose, S.L. 2013. Patient advocacy organizations: Institutional conflicts of interest, trust, and trustworthiness. Journal of Law, Medicine, and Ethics 41(3): 680–687.CrossRef Rose, S.L. 2013. Patient advocacy organizations: Institutional conflicts of interest, trust, and trustworthiness. Journal of Law, Medicine, and Ethics 41(3): 680–687.CrossRef
Zurück zum Zitat Rose, S.L., J. Highland, M.T. Karafa, and S. Joffe. 2017. Patient advocacy organizations, industry funding, and conflicts of interest. JAMA Internal Medicine 177(3): 344–350.CrossRef Rose, S.L., J. Highland, M.T. Karafa, and S. Joffe. 2017. Patient advocacy organizations, industry funding, and conflicts of interest. JAMA Internal Medicine 177(3): 344–350.CrossRef
Zurück zum Zitat Ross, J., K. Hill, D. Egilman, and H. Krumholz. 2008. Guest authorship and ghostwriting in publications related to Rofecoxib: A case study of industry documents from Rofecoxib litigation. JAMA 299(15): 1800–1812.CrossRef Ross, J., K. Hill, D. Egilman, and H. Krumholz. 2008. Guest authorship and ghostwriting in publications related to Rofecoxib: A case study of industry documents from Rofecoxib litigation. JAMA 299(15): 1800–1812.CrossRef
Zurück zum Zitat ———. 2019. Conflict of interest disclosure as a reminder of professional norms: Clients first! Organizational Behavior and Human Decision Processes 154: 62–79. ———. 2019. Conflict of interest disclosure as a reminder of professional norms: Clients first! Organizational Behavior and Human Decision Processes 154: 62–79.
Zurück zum Zitat Sah, S., and A. Fugh-Berman. 2013. Physicians under the influence: Social psychology and industry marketing strategies. Journal of Law, Medicine, and Ethics 41(3): 665–672.CrossRef Sah, S., and A. Fugh-Berman. 2013. Physicians under the influence: Social psychology and industry marketing strategies. Journal of Law, Medicine, and Ethics 41(3): 665–672.CrossRef
Zurück zum Zitat Sah, S., G. Loewenstein, and D. Cain. 2019. Insinuation anxiety: Concern that advice rejection will signal distrust after conflict of interest disclosure. Personal and Social Psychology Bulletin 45(7): 1099–1112. Sah, S., G. Loewenstein, and D. Cain. 2019. Insinuation anxiety: Concern that advice rejection will signal distrust after conflict of interest disclosure. Personal and Social Psychology Bulletin 45(7): 1099–1112.
Zurück zum Zitat Schwab, T. 2019. US opioid prescribing: The federal government advisers with recent ties to big pharma. BMJ 366: I5167.CrossRef Schwab, T. 2019. US opioid prescribing: The federal government advisers with recent ties to big pharma. BMJ 366: I5167.CrossRef
Zurück zum Zitat Sismondo, S. 2018. Ghost-managed medicine: Big pharma's invisible hands. Manchester, U.K.: Mattering Press. Sismondo, S. 2018. Ghost-managed medicine: Big pharma's invisible hands. Manchester, U.K.: Mattering Press.
Zurück zum Zitat Steinman, M., L. Bero, M. Chren, and C. Landefeld. 2006. Narrative review: The promotion of gabapentin: An analysis of internal industry documents. Annals of Internal Medicine 145(4): 284–293.CrossRef Steinman, M., L. Bero, M. Chren, and C. Landefeld. 2006. Narrative review: The promotion of gabapentin: An analysis of internal industry documents. Annals of Internal Medicine 145(4): 284–293.CrossRef
Zurück zum Zitat Volkow, N., and F.S. Collins. 2017. The role of science in addressing the opioid crisis. New England Journal of Medicine 377(4): 391–394.CrossRef Volkow, N., and F.S. Collins. 2017. The role of science in addressing the opioid crisis. New England Journal of Medicine 377(4): 391–394.CrossRef
Zurück zum Zitat Young, I.M. 2011. Responsibility for justice. New York: Oxford University Press.CrossRef Young, I.M. 2011. Responsibility for justice. New York: Oxford University Press.CrossRef
Metadaten
Titel
Lessons from Corporate Influence in the Opioid Epidemic: Toward a Norm of Separation
verfasst von
Jonathan H. Marks
Publikationsdatum
13.07.2020
Verlag
Springer Singapore
Erschienen in
Journal of Bioethical Inquiry / Ausgabe 2/2020
Print ISSN: 1176-7529
Elektronische ISSN: 1872-4353
DOI
https://doi.org/10.1007/s11673-020-09982-x

Weitere Artikel der Ausgabe 2/2020

Journal of Bioethical Inquiry 2/2020 Zur Ausgabe

Editorial

Life Goes On