Sunday, December 09, 2007

"Intellectual Bias," the New Bogey-Man

On the Hooked: Ethics, Medicine and Pharma blog, Dr Howard Brody discussed a new accusation leveled against those who may criticize relationships among academics and researchers and pharmaceutical, biotechnology and device companies. Dr Brody started by noting

Because those of us who are advocating serious reforms in the medicine-Pharma relationship are finally starting to be heard, we now threaten the industry sufficiently to make us worth powder and shot for a counter-attack.

The latest counter-attack seems to be to accuse those advocating reform of the dread "intellectual bias." This charge surfaced in a response to a letter to the editor in Critical Care Medicine.(1) The letter disagreed with recommendations in guidelines written by the Surviving Sepsis Campaign, and discussed commercial ties of the SSC to the pharmaceutical industry. Note that the authors of the letter, Eichacker, Natanson, and Danner, had previously criticized the SSC guidelines in the New England Journal of Medicine,(2), as discussed in this post.

Two members of SSC, Phillip Dellinger and Charles Durbin, then proceed to reply, mainly in the form of accusing the NIH scientists of having no real evidence to back up their claims and yet repeating their attacks on Xigris incessantly despite having no evidence. Here is the key paragraph:

'Drs. Eichacker, Natanson, and Danner accuse the SSC of being biased toward industry, yet fail to acknowledge their own intellectual (academic) bias. This form of bias can be defined as presenting personal, entrenched beliefs as scientific truth in an area where no clear-cut consensus exists. We believe this intellectual bias can be more insidious and damaging than the potential bias arising from affiliations with industry.'

Now, this is quite a piece of work. The NIH scientists believe that the preponderance of the scientific evidence supports their point of view. The SSC guys believe the same for their own point of view. That makes the NIH people guilty of 'intellectual bias' while the SSC remains innocent of that sin.

What is even more breathtaking is that intellectual bias (whatever that turns out to be) is actually much worse than commercial bias. As I have reviewed in HOOKED and on this blog, and as numerous meta-analyses and systematic reviews have shown, commercially sponsored studies are roughly 4 times more likely than neutral studies to favor the company's drug. So commercial bias has been shown to be real and substantial. Against that empirical proof, we are being invited to dismiss commercial bias as no big deal, but to quake in our boots at the possibility of 'intellectual bias.'

The implicit subtext, as best as I can read it, is that people ('academic intellectuals') who work at NIH, or at universities that believe in avoiding conflicts of interest with industry, are some sort of ivory-tower, goody-two-shoes weirdos. They think they are intellectually superior to the rest of us mere mortals, and the best thing to do with these insufferable twits is to ignore them. By contrast, scientists who jump into bed with industry at the first opportunity are regular people just like us, and are hard-headed, pragmatic realists. Their take on the world is much more reliable.

Dr Brody then warns,

I expect to see charges of 'intellectual bias' repeated regularly whenever Pharma feels that it is being placed on the defensive by demands for reform.

The good news here is that those within the cozy academic-medical-industrial complex, and particularly the academic leaders who work part time for health care corporations, and often seem to be promoting their products and services in the guise of disinterested academics, are no longer so comfortable in these roles. Rather than merely ignoring the few people who think that such conflicts of interest may be bad for academia, science, health care and the public, they feel the need to make ad hominem attacks, in this case, charging "intellectual bias. " Let's hope they will soon feel the need to be even more defensive.


1. Eichacker PQ, Natanson C, Danner RL. Separating practice guidelines from pharmaceutical marketing [special letter to the editor, with reply]. Crit Care Med 35:2877-80, 2007.
2. Eichacker PQ, Natanson C, Danner RL. Surviving sepsis - practice guidelines, marketing campaigns, and Eli Lilly. N Engl J Med 2006; 335: 1640-1642. (see link here.)


MedInformaticsMD said...

'Drs. Eichacker, Natanson, and Danner accuse the SSC of being biased toward industry, yet fail to acknowledge their own intellectual (academic) bias. This form of bias can be defined as presenting personal, entrenched beliefs as scientific truth

An "academic bias" is "presenting personal, entrenched beliefs as scientific truth"? That is a rather blanket stereotype of academia, to say the least. I guess its proponents have talked to each and every academic and evaluated how they formulate their opinions and conduct intellectual discourse.

The "academic bias" argument is more risible, and represents more incompetent 'spin', than some of the arguments of postmodernism I've heard
(i.e., there is no "truth"; everything is relative; and "scientific truth is just a social construct."

Anonymous said...

An unrelated editorial in the Dec. 5th Wall Street Journal by a Mr. Jenkins highlights the 2002 Nobel winning work of Daniel Kahneman and the late Amos Tversky.

This quote is pertinent: "Scientist are human; they do not wait for proof; many devote their professional lives to seeking evidence for hypotheses (especially well-funded hypotheses) they've chosen to believe."

What I take away from this is that financial consideration do enter into our prospective and often will, and does, influence our support of ideas. It does a disservice to any profession to state otherwise.

Steve Lucas

Anonymous said...

The "academic bias" claim has a long and colorful history in arguments over climate change.

This claim of bias was created by the industry funded hacks as a way to put independent academics back on their heels.

It's laughable.

Anonymous said...

As a tree hugger I am concerned about global warming. This is not about global warming. This is also not about diverting the argument to an unrelated topic.

As a consumer I am concerned about the financial conflicts that are becoming more blatant, or at least more public, in the medical community. I do not see how highlighting the financial conflicts and their influence in medicine diminishes Kahneman and Teversky's work.

My understanding of their premise is; that widely disseminated information can become accepted as fact, even over the beliefs of people with contrary information. A cornerstone of this system is often those promoting these "facts" have a financial and/or professional stake in their beliefs.

Pharma has certainly spent decades and untold amounts promoting its "good" to society. Today, as information is being revealed, we learn they are not the towers of virtue they claim.

Doctors claim immunity to pharma's siren song, but we see moves to remove even the smallest temptation as pens and coffee mugs from some institutions. Medtronic is under investigation for payments and gifts to doctors. (WSJ Dec 5 article by Ed Welsch)

When all else fails doctors are willing to resort to legal suits to achieve their goals. In the Dec. 7th WSJ David Armstrong reports Dr.Yadav is suing the Cleveland Clinic stating financial conflicts are rampant and he should not have been fired for his.

My desire is for more transparency in medicine, and the recognition that financial incentives do modify behavior that may not always be in the best interest of the patient. What I found interesting is a 2002 Nobel was awarded basically outlining how one goes about changing public opinion to achieve a position that cannot be challenged, even by those with contrary information.

Steve Lucas