The Ethics of Catherine DeAngelis

12.3.06

The editor of the Journal of the American Medical Association (JAMA), Catherine DeAngelis, was on NPR recently (the Living on Earth program for December 1, 2006), complaining about how corrupt medicine is because medical research is funded by industry.

The segment involved an awful lot of moral posturing, yet not one concrete example of proven bias or falsehood. I include the link here because it is worth listening to for the sheer tone of it, from the sanctimonious reporter, to his self satisfied interview subjects.

http://www.loe.org/shows/segments.htm?programID=06-P13-00048&segmentID=1

The segment begins with a German doctor who did a study showing that much industry funding of research is not disclosed. I wholeheartedly agree that research should fully disclose all funding sources, both profit and nonprofit. But it is simply wrong to say, as the segment did, that a grant from industry implies that the research is biased. Any research study can have bias or lack quality, from any number of causes. Industry-funded studies can be nonpareil in objectivity, quality and rigor. Not-for-profit organizations with partisan agendas, for their part, are just as if not more likely to pressure researchers to tilt their studies to yield particular results. The quality or slant of an article can only be judged by reading it. Yet, to this crowd, all "non profit" or government funded studies are necessarily pure as the driven snow, and all corporate grantees tainted.

Professor Richard Clapp, an epidemiologist at Boston University, admits that no company who funded him ever tried to influence his research. But he does say that certain unnamed persons have objected to some of his research and, he claims, tried to prevent him from publishing it. It would be interesting to hear the exact details, but he doesn't give any. Instead he says everybody else out there suffers immense conflicts of interest. Precisely what, he does not say.

Then there is JAMA editor DeAngelis. The reporter points out that JAMA is 2/3rds drug company ads. DeAngelis responds by deploring ads as a necessary evil, since magazines are so expensive to publish—but, defensively, excuses herself from their taint, on the grounds that her publisher sells all the ads, not she. She touts JAMA's strict rules of ethics, such as their rule that no ad may run with related research articles. Then she tells a little story. Once, her ad department asked her for permission to let a 4 page ad run with a related research article. To their surprise, DeAngelis agrees. Then DeAngelis says, triumphantly, as if it were a clever and praiseworthy move on her part, she doublecrossed the evil drug company by moving the article to a different issue.

DeAngelis is the unethical one here. She tricks her own ad department into misleading a company who is being promised a specific ad placement. If the drug company were dealt with honestly, it might have chosen to send its ad dollars elsewhere. (Ads in JAMA cost plenty.) JAMA thus pockets its cash based on DeAngelis's deception. Humble ad personnel can lose jobs over this kind of thing.

JAMA's so called ethical rule is ridiculous. There is absolutely nothing "unethical" about running an ad in the same issue as related content. What ethical purpose does separating these two things serve? Ads simply tell doctors what manufacturer sells the drug reviewed in the magazine. What is unethical about being convenienced in serving patients, rather than inconvenienced by having ad information shuffled off to some other location?

This program was a remarkable display of faulty logic, blithe equations of appearance with substance and correlation with cause, obliviousness to their own ethical shortcomings, and a truly frightening eagerness to smear the motives of others with a broad brush.

Highminded ethical poses are often used to distract attention from other, hidden unethical behavior. For instance, journalists make a fetish out of source secrecy. Journalists have an ethical duty to fulfill a promise to a source, surely. But that secrecy claimed as a privilege, and a moral pose, can have other motives as well—like falsifying information, as with Jayson Blair and Phillip Glass, or keeping data away from your competition so as to monopolize it for yourself. Bibliographies and full footnotes and ample citation to sources—transparency—is the ethical way, which is why academic ethics requires this. Journalists sometimes follow a different and cagier path, not always for the right reasons. So I would think about the agenda behind all this muggery, too.