Celebrity Ethics

dimpleart.com Art Caplan Terri Schaivo lies on life support in a Florida hospital and Art Caplan has work to do: an appearance on CNN's Wolfe Blitzer Reports and telephone interviews with reporters from Time magazine and US News and World Report. A driver awaits Caplan in an immaculate blue Cadillac parked in front of Montreal's Ritz Carlton Hotel. Caplan is attending the annual meeting of the American Society for Bioethics and Humanities (ASBH) in Montreal, and the cable news network has reserved time for the interview at a private Canadian broadcast studio. Once the driver dispatches Caplan to the studio and the ethicist settles onto a stool before a camera, Blitzer, broadcasting from Washington, DC, directs Caplan into a televised live discussion of living wills. These documents explain whether the patient wants to be sustained by life support. Caplan's delight--it's the topic he wanted to address--is palpable. Welcome to the bioethics business. Caplan is a prominent leader in a field that developed in the 1970s, as new technologies forced families like the Schaivos into debates over the clinical meaning of life. But as so often happens in academia, the discipline follows the funding, and with the rise of genetics and genomics, governments and the media increasingly rely on the Caplans of the world to help nations deliberate the social value of new scientific advances: stem cell technology, genetic testing, pharmacogenomics. No one disputes that nations need neutral experts to monitor the use of such cutting-edge technologies. But, the resultant media attention on the ethicists raises questions of priorities. "Doing bioethics is an exercise of power," says Margaret Somerville, a high-profile Canadian ethicist and professor at McGill University in Montreal. "Power should always be examined." VOICE OF SCIENCE Called on to make network pronouncements on such ethically tricky technology, the ethicists have become the public voices of science. "Scientists don't like to talk to the press, and they don't know how," says John Lantos, president of ASBH. "The people in bioethics know how to talk concisely about science." A search on Caplan's name on CNN.com brought up 15 articles since 2001, not including the latest Blitzer interview. Compare that to two hits for Elias Zerhouni, director of the National Institutes of Health, and one for Nobelist David Baltimore, president of the California Institute of Technology. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, drew a comparable number of hits (to Caplan) since 2001: 15 (and 54 since 1997). Other television Web sites show a similar, if less dramatic, disparity. Sometimes called the Caplan of Canada, Somerville polled 27 hits on Canadian Broadcasting's Web site since 1997, outscoring several science leaders. Somerville attributes her high visibility to the public's need to hear about science from people who don't have a financial interest in the research. "We are the mediators between the scientists and the public, sometimes between the scientists and the scientists," adds Somerville, who is also interviewed about social issues. Ethicists' stepping from the academic arena into the public eye, and the accompanying celebrity and funding that comes with it, sends tremors among these professional hand-wringers as they are called on to justify financing for new bioethics centers, departments, and research. These Socratic activists must both challenge their institutions' policies and meet their demands for independent funding. "Universities are interested in people who produce, have grants," says Hubert Doucet, director of the bioethics program at the University of Montreal, adding that bioethicists "are in conflict of interest most of the time. The whole idea of knowledge is at stake here." The need for trained ethicists who lack financial conflicts is more critical than ever as universities expand their ties to industries. The depth of those relationships was made clear in a survey conducted earlier this year by the Institute for Health Policy at Massachusetts General Hospital, Boston. The survey reveals that just less than half (47%) of roughly 330 Institute review board members, charged with monitoring the ethics of research, reported they had worked as industrial consultants. These industry relationships, the survey authors conclude, "raise ... potential conflicts of interest."1 Yet the professional ethicist community experienced a ripple itself last year when the Center for Science in the Public Interest (CSPI) proposed that academic ethicists disclose their funding sources.2 That the same pharmaceutical, chemical, and agricultural biotechnology corporations that sponsor life science researchers also finance these academic watchdogs has sparked questions about their value and objectivity. Somerville says she has no funding from any of these groups, and that's one reason why she's always on call by the media. A television station recently flew her to another Canadian city to discuss a report about a pharmaceutical company. She balked, citing the number of good ethicists at academic institutions closer to the station. "They were all receiving money from the company and felt like it was a conflict of interest," she relates, adding that the academics also feared their funding would be jeopardized. With the need for more funding from companies, ethicists can often come dangerously close to being the public voice of corporations, further blurring the boundary between watchdog and the people being watched. Pharmaceutical and biotechnology companies invite prominent academics to join their ethics committees, which can give corporations squeaky-clean images without the public ever knowing how effective the ethicists were in shaping corporate practices. "Having an ethicist on board can enhance a company's public image, deflect criticism, or lend credibility to its actions," independent ethicist Virginia Ashby Sharpe told members of the ASBH in 2002, when she was program director of the Integrity in Science project at the CSPI. "We're being naïve if we don't see that the perception of bioethicists as moral authorities can be exploited to burnish the public image of a company or its product." Caplan, whose center is now working with E.I. DuPont de Nemours and Co., the Wilmington, Del.-based chemical corporation, is the first to admit that gifts can alter research findings. With Pfizer financing, his center determined that even small gifts from companies influence physicians. Though the center's conclusion was not beneficial to its funders, it was published anyway.3 "The issue isn't corporate ties," Caplan says. "It's being able to walk away from corporate ties." SPOTLIGHT SCIENCE Media interest could pose an even greater threat to the validity of ethical analyses than that raised by corporate financial support, says R. Alta Charo, associate dean for research and faculty development at the University of Chicago. The problem with the media, she explains, is that reporters often want pronouncements. The role of the ethicist, however, should be to set out the framework for deliberating social values, not for telling the public what to think about certain technologies. "[Ethics is] about telling people how to think through for themselves what is right and wrong," she adds. "It's a different and far more modest approach." Somerville agrees: "It's not our job to make a choice." Tim Falconer, the author of a forthcoming book on ethicists, says that journalists should talk to the public and the scientists, not to ethicists. "This is too important to be left to the experts," says Falconer, who teaches journalism at Ryerson University in Toronto. dimpleart.com Margaret Somerville At the heart of the debate about media attention and financial conflicts of interest is a question about the role of ethicists. Should they be ivory-tower intellectuals or should they influence the way science is practiced? Once an ethicist decides to get involved, lines get blurred; compromises result. "Who are you doing bioethics for, the academics?" Caplan asks rhetorically. "Most of the new technologies are being developed by private companies, and if they want me to work with them, they have to pay me." Lantos echoes Caplan: "Nor do I think it's appropriate for me to donate my time." Nevertheless, Sharpe and others see problems with financial and other conflicts among ethicists, even when the conflicts are made public. "Disclosure isn't enough," she adds. With ethicists getting grants to examine the problems of stem cells, genomics, and genetic medicine, other issues such as access to healthcare dim in importance. "The fundamental questions are not getting asked," Sharpe says. "When you are harnessed to the market, you aren't asking fundamental questions about the market." Paula Park can be reached at ppark@the-scientist.com. References 1. E. Campbell et al., "Characteristics of medical school faculty members serving on institutional review boards: Results of a national survey," Acad Med, 78:831-6, August 2003. 2. H. Cohen, "Ethics on the corporate payroll," The Scientist, 16[15]:44, July 22, 2002. 3. D. Katz, J. Merz, A. Caplan, "All gifts large and small: Toward an understanding of the ethics of pharmaceutical industry gift giving," Am J Bioethics, 3:39-46, 2003. function sendData() { document.frm.pathName.value = location.pathname; result = false if (document.frm.score[0].checked) result = true; if (document.frm.score[1].checked) result = true; if (document.frm.score[2].checked) result = true; if (document.frm.score[3].checked) result = true; if (document.frm.score[4].checked) result = true; if (!result) alert("Please select") return result; } .myradio{background-color : #94bee5} Please indicate on a 1 - 5 scale how strongly you would recommend this article to your colleagues? 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Celebrity Ethics

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