Abstract
There is overwhelming evidence that the opioid crisis—which has cost hundreds of thousands of lives and trillions of dollars (and counting)—has been created or exacerbated by webs of influence woven by several pharmaceutical companies. These webs involve health professionals, patient advocacy groups, medical professional societies, research universities, teaching hospitals, public health agencies, policymakers, and legislators. Opioid companies built these webs as part of corporate strategies of influence that were designed to expand the opioid market from cancer patients to larger groups of patients with acute or chronic pain, to increase dosage as well as opioid use, to downplay the risks of addiction and abuse, and to characterize physicians’ concerns about the addiction and abuse risks as “opiophobia.” In the face of these pervasive strategies, conflict of interest policies have proven insufficient for addressing corporate influence in medical practice, medical research, and public health policy. Governments, the academy, and civil society need to develop counterstrategies to insulate themselves from corporate influence and to preserve their integrity and public trust. These strategies require a paradigm shift—from partnerships with the private sector, which are ordinarily vehicles for corporate influence, to a norm of separation.
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Notes
The Sackler family’s arts philanthropy has attracted much attention. I focus my analysis here on relationships with entities in health and policy spheres because they appear to have most directly contributed to the opioid crisis. But I recognize that arts philanthropy also merits ethical scrutiny that I cannot provide in the space permitted.
Although university gifts made by Purdue Pharma and the Sackler family have attracted the most public scrutiny, the conviction of the former CEO of Insys, John Kapoor, drew attention to his gifts to the University of Buffalo’s School of Pharmacy and ultimately led to the removal of his name from the school’s building (McNeil 2019).
For a thoughtful critique of this definition, see Rodwin 2018. Rodwin argues that the Institute of Medicine’s 2009 definition of conflicts of interest “neglects the actor’s compromised loyalty to the party or mission she is supposed to serve” (70) and that, by referring to conflicts between primary and secondary interests rather than conflicts between obligations and interests, this definition “diminishes the conflict’s significance” (70). Rodwin also expresses concern that “[e]fforts to include so-called intellectual or nonfinancial conflicts as conflicts of interest blur the concept” (75).
Although widely publicized investigations revealing opioid company payments to PAOs and health professional associations led to withdrawals of funding and, in a few cases, to the recipient organizations ceasing to operate, industry funding of patient advocacy groups remains pervasive. One recent study found that 83 per cent of the 104 largest groups received funding from drug, device, or biotechnology companies (McCoy et al. 2017). We should not expect disclosure alone to lead to the widespread elimination of these relationships, especially if the pervasiveness of these relationships reinforces the (problematic) view that they are acceptable or unavoidable.
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Acknowledgments
The author is extremely grateful to Michele Mekel and to all the student and faculty participants in the Penn State Bioethics Colloquium for their invaluable feedback on an earlier draft. This article also benefited from the author’s discussions with several colleagues at other institutions—among them, Marc Rodwin, Sunita Sah, Genny Pham Kanter, Susannah Rose, and Lisa Cosgrove. He is also grateful to Quinn Grundy and another (anonymous) reviewer for their extremely helpful comments and suggestions. Please excuse any errors and omissions—final revisions to this piece were made during the COVID-19 pandemic.
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Marks, J.H. Lessons from Corporate Influence in the Opioid Epidemic: Toward a Norm of Separation. Bioethical Inquiry 17, 173–189 (2020). https://doi.org/10.1007/s11673-020-09982-x
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DOI: https://doi.org/10.1007/s11673-020-09982-x