March 8, 2004

Money and medicine don't go

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“Who, McWilliams, was the greatest Irish man ever?” bellowed Sandy, my first physics teacher.

“Forget de Valera,” he said, “forget Parnell, Pearse, Joyce and all those second raters; the greatest Irish man was a Protestant.Who was he?”

My reply was always the same. (Sandy asked the rhetorical question practically every week.) “Robert Boyle, of course.”

“And why was he more clever than Newton?”

“Because he experimented, sir.” “And why is this so important, McWilliams?”

“Because, Sir, anyone can invent a theory – only the experimenter tells the truth.” (Weird, the stuff you remember from school, isn’t it?)

Boyle, who was born in Lismore, Co Waterford in 1627, is widely regarded as the father of modern scientific inquiry. He made his name, not from great Newtonian theories, but by simple testing and experimentation culminating in Boyle’s Law on the nature of gasses. Two days after his funeral on January 7, 1692, Samuel Pepys invited his fellow diarist, John Evelyn, to his house for a social gathering, the purpose of which was to anoint the new leader of science.

The person chosen was Isaac Newton. The episode shows how late-17th century savants were unanimous in their choice of Boyle and Newton as the two great icons of early-modern science.

Science was not Boyle’s first passion. During the 1640s, he believed he had a calling as a moralist and a literary writer, but gradually became drawn to the sciences. However, his moral concerns and religious convictions dominated his discourse on science and its relationship with both society and commerce.

Probably because he was the son of the greatest robber baron of the day – Richard Boyle, the first Earl of Cork and an Elizabethan land thief of gargantuan proportions – he was very wary of the motives of commerce and was insistent that business and science should not mingle.

He went as far as to say that he had “found by long and unwelcome experience that very few tradesmen will give a man a clear and full account of their practices; partly as a result of envy”.

Boyle was warning that business by its competitive nature would always lead to half-truths, obfuscation, at best white lies and at worst outright lies. He warned that science should have nothing to do with commerce and that scientific inquiry should never be driven and determined by economic prerogatives.

Whether one agrees with his stance or not, the concerns of the 17th century father of science are shared by the modern-day father of the Catholic Church, Pope John Paul II.

Many would agree with the Pope that the “ownership of scientific knowledge” will be one of the crucial political and ethical questions in the near future. In the 25 years since the Pope’s visit to Ireland, the scientific world has experienced huge changes, leading to the dawning of a new age – the age of “McScience”,whereby inquiry is driven almost exclusively by commercial demands.

Increasingly, over the last two decades, large biotech and pharmaceutical companies have become financiers of scientific research in many of the world’s universities. The major question is whether the lure of profit is corrupting biomedical research. (This is the subtitle of an excellent new book “Science in the Private Interest” by Sheldon Krimsky.) The Pope certainly thinks so and believes that it is crucial to save the world from McScience.

Before we talk about the Pope, let us examine McScience in a bit more detail. Like all former and current areas of the public realm, financing is a problem. Universities all over the West have seen their budgets cut and their research budgets particularly so. Therefore, they have turned to large companies for financing.

The companies have taken up the challenge with gusto, sponsoring projects, entire research departments, building wings of universities and offering bursaries and grants. Of course, the USA is a decade or so further down this road than Europe, but the pattern here is the same.

As a result, many argue that our “independent” scientific institutes have become little more than research departments of the large pharmaceutical companies.The conflict of interest is clear.

Critics believe that universities will not bite the hand that feeds them, and therefore could become little more than rubber-stamping, clearing houses for the highly profitable drugs industry. These fears have been substantiated by highprofile cases where sceptical scientists and professors were sacked from their positions for being critical of one drug or another.

As the industry moves more comprehensively into the area of lifestyle drugs such as Viagra, diet suppressants and other drugs that are based on medicalising “normal” conditions such as looks, weight or sex drive, modern ailments become a matter of opinion, not science.

The scientific journals are supposed to be policed by the much vaunted peer-review system whereby eminent experts rank and judge new procedures, drugs, breakthroughs and innovation. But there is a problem here too. Because the drug companies finance the journals via significant advertising and conference promotions, some say that the journals are bought off as well.

The implications for science are truly shocking. If there are no independent arbiters to gauge the effects of drugs,what is the point of it all? We will be faced with the prospect that research is only being carried out to make money. Should a drug have harmful side-effects, they might not come to light if independent research is suppressed. The implications in the area of genetic engineering are self-evident.

The Pope has written extensively on the subject and has condemned the “overriding financial interests” that operate in biomedical and pharmaceutical research. In a letter to the papal nuncio in Poland last year, the Pope wrote: “The pre-eminence of the profit motive in conducting scientific research ultimately means that science is deprived of its epistemological character according to which its primary goal is the discovery of the truth.

The risk is that, when research takes a utilitarian turn, its speculative dimension, which is the inner dynamic of man’s intellectual journey, will be diminished or stifled.”

Because the Catholic Church spent the 500 years since Galileo trying to snuff out such earthly curiosity, many readers might understandably scoff at it jumping to the defence of scientific enquiry and the search for rational truth. However, the Church is now one of the few powerful institutions beginning to question what has been described as the “privatisation of knowledge”.

The privatisation of knowledge goes to the heart of the great political battle taking place in every aspect of our society. Its lines are drawn between evangelical economists,with their “divine right of the markets”doctrine, and the sceptics drawn ironically from the Church, the scattered left, community groups and disparate political movements lumped together under the anti-globalisation umbrella.

These folks, among whom are many economists, either reject markets or believe that they can fail and fail badly.

Of the many casualties when markets fail, probably the biggest one is trust – trust in the system, trust in the institutions, trust in the knowledge. So far, we have been amazingly lucky in the scientists we have been blessed with.

On a variety of potentially dangerous innovations, from nuclear power, to biological weapons to genetic research, thus far, scientists have been moral, just and rarely driven by personal gain alone. It is non-scientists, such as politicians, corporate bosses and others, who have undermined our trust in science.

Trust is the most ephemeral of assets. It is extraordinarily difficult to build, and comparatively easy to lose. Every time we take a pill for a headache, we place our trust in science. Every time we go to the chemist, we are entirely at the mercy of the integrity of the product. Every time a doctor recommends a treatment and course of drugs, or even an antibiotic, we base our judgment on the integrity of the doctor,the remedy and the science behind it.

If that integrity is compromised,trust is lost.Yet trust is all we have.Without trust, the gelling agent of all contracts disappears. In the area of medicine, this would leave us prey to quacks, alchemy, prejudice, opinion and the dangers of personalised, single-issue campaigners.


  1. ron

    the inevitable conflict between scientific enquiry and
    corporate profits means a concerted effort is needed to
    preserve the integrity of the scientific community . a
    gloabl scientific body free from corporate influence that
    protects dissenting voices in the scientific community may
    help.
    of greater concern is the market failure for the delivery
    of medical services and technology etc which leads to such
    suffering around the world.

  2. Ronan L

    An interesting article, which raises many issues (see
    http://www.nofreelunch.org, for example).

    Is this critique of the ownership of ideas restricted to
    pharmaceuticals and drugs? If so, why? If not, where does
    it stop? The incentive of reward for the development of
    ideas and the expansion of the technological frontier has
    been at the core of economic growth (and indeed recent
    economic growth theory) in the last centuries. Put another
    way, the lack of protection of incentives for research and
    invention has been the bane of economic growth. Given the
    Baconian and Newtonian flavour to the original piece, it
    is worth remembering that the father of modern economics,
    Sir William Petty, himself foiled in the patenting of
    various inventions, viewed such patent laws as vital to
    the development of inventions beneficial to society
    generally.

    The key point, and one that many people miss or
    consciously ignore, is that private reward and profit are
    not incompatible with massive public benefits. Perhaps the
    prime example is computers. Although the development of
    the industry was not optimal (from a competition policy
    perspective), to say that the protection from reverse
    engineering and plagiarism of certain applications of
    knowledge regarding microprocessors has not served a huge
    benefit to the general public is a gross misrepresentation
    of reality. We all benefit enormously from the ability of
    billions of zeros and ones to change and change back (for
    want of a better explanation!), as seen in this very
    exchange of ideas.

    The positive externalities of ideas – Newton’s ‘standing
    on the shoulders of giants’ effect – mean that we must
    preserve incentives to further our technological frontier,
    something that has enabled many of us to prosper and
    should allow many more to do the same.

    That, of course, is not to say that pharmaceutical
    companies should be allowed to make R&D grants conditional
    on finding “favourable” results regarding their
    forthcoming drugs. Leaving aside the fact that they should
    recognise that it is not in their own long-run interests
    to do so, there is certainly a role for moral norms, which
    are entirely compatible with economics. One suggestion
    would be for pharmaceutical companies and universities to
    sign the above clause into their contract. If companies
    refused to do this, universities could sign an agreement
    between them, pledging not to undermine their principles
    by allowing misrepresentation or non-dissemination of
    their studies and research. Pharmaceutical companies would
    soon see that they could not survive without the
    generation of new ideas and the refinement of existing
    ones for very long.

    Ronan.

  3. David Mc Williams

    Dear Ronan,

    You make v fair points and as I said in the piece you do
    not have to agree with Boyle’s logic. There is a clear link
    between the direct protection of innovation and economic
    growth, beginning at the Renaissance. However, you can
    only protect innovation by being sure that you know why the
    product is innovative and this is, it appears to me, to be
    what is a stake when we lose “independent” research.

    Thanks for the email and the ideas,

    Regards, David

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