Monday, May 22, 2006

Health Affairs Interview Lets Dr David Baltimore Sing the Praises of Biotechnology

Health Affairs recently interviewed Dr David Baltimore, the current President of the California Institute of Technology, and winner of a Nobel Prize. Its abstract stated, "as a man with equal interests in science and science policy, David Baltimore has been at the forefront of many of the important debates that have shaped science since the 1970s." [Culliton BJ. Science for life: a conversation with Nobel Laureate David Baltimore. Health Aff 2006; 25: w235-240.]

The interviewer pretty much let Dr Baltimore sing the praises of biotechnology. The article included his justification for the extremely high prices of biotechnology drugs. He acknowledged prices were high, but felt the prices were justified by the benefits, and to some extent the small size of the market for the drugs.
Well, the people who do benefit, benefit enormously. I would only support a system that enabled those people to get them. Now, the cost of their getting it could be very high. But we’re willing to pay enormous sums of money for people to get drugs that are worthwhile.... But they’ve been able to charge hundreds of thousands of dollars per patient per year for the drug because people believe that it’s important for it to be available. And it’s not because the drug is so expensive to make. It’s because there are so few patients who need it that to have a supply of it and therefore to make it valuable to the company to produce it, they’ve got to charge a lot for it.
Furthermore, Dr Baltimore argued that the US is rich enough to afford high-priced biotechnology drugs.
We’re in a highly developed country where it’s a matter of, Do you spend the money to keep a few people alive, or do you spend the money on something crazy like the war in Iraq? In my opinion, it is much more important to keep those few people alive.
That industry has provided expensive treatments for life-threatening diseases. It’s clearly met previously unmet medical needs. And the overall financial burden on the health care system, as I understand it, is not enormous because drugs are still 10–15 percent of medical costs. So for all the development of biotechnology, it has not overwhelmed the health care industry.
Finally, he argued for the economic benefits of the biotechnology industry.
And the amount of revenue that comes to the state of California is clearly in the billions of dollars. You know, a company like Amgen—one of the early biotech companies—probably employs 15,000 researchers and other workers. So, sure, these are big companies. Amgen is the cornerstone of the wealth of Thousand Oaks.
The interview did include a brief aside about conflict of interest, an issue that Dr Baltimore did not find very problematic.
This can be a sticky issue, but I think most universities have handled it well. The major conflicts relate not to basic research but to clinical research.
We have not instituted new policies at Caltech, but we do monitor the situation closely.
All in all, it amounted almost to a hymn of praise for biotechnology, unmarred by any doubts about its usefulness or value to society, or any doubts that society should pay every dollar charged by biotechnology companies. It was quite a striking testimonial, coming as it did from a Nobel Laureate.

What the article left out was that it was also coming from someone with very strong financial ties to the biotechnology industry. In fact, Dr Baltimore sits on the board of directors of three biotechnology companies: Amgen, MedImmune, and Cellerant Therapeutics. Note that Dr Baltimore above praised the economic contribution of Amgen to California without acknowledging his legal responsibility to maximize the profits of that self-same corporation.

Perhaps the interviewer could be excused for not discovering these apparent conflicts of interest. Caltech's main presidential biographical page on Dr Baltimore fails to list his board memberships, as does his page in the Biology Division, as does the press release announcing his appointment as president.

If Health Affairs wants to let a member of the board of directors of Amgen sing the praises of biotechnology, that is fine, but the journal should thus identify that person. Readers ought to know about strong financial interests, and in this case, fiduciary interests, that may have bearing on the content of what they publish.


Anonymous said...

I have long worried about David Baltimore.

He has had a profound effect on the way in which
research misconduct is viewed, and on the
willingness of individuals to discuss concerns
about science. He contributed to the impression
that there exists a subset of individuals within
the higher echelons of science who are immune to
almost all criticism.

Having studied the elements of the so called
"Baltimore affair" in some detail, it seems
obvious to me that he participated in a grave
injustice, and operated in a manner completely
inconsistent with a man in his position. It
also seems obvious that the
power of his position led to the ultimate
whitewash and so called "vindication".
The most worrying elements of this
affair have never been properly explained, and Dr
Baltimore has always seemed to think that he is
beyond having to explain.

To hear Dr Baltimore discuss science is one thing.
To hear him babble about ethics and procedure I
find nauseating.

Anonymous said...

Congressional discussion in the wake of the Baltimore affair. Remains as true today as then.

"If a young scientist believes that he or she has witnessed a case of fraud. and comes to ask me about reporting it to the authorities, I would have to warn him or her emphatically about the dangers of doing so. If the potential whistlebiower decided nevertheless to proceed, I would admire and greatly respect the person and the decision, but I would have serious anxiety about the future of that individual. as the system operates today."