Defending Conflicts of Interest and How eSapience Was "Shaping the Debate"

Last week we posted about a prominent commentary, entitled "Drug Crazy," by Richard Epstein, a Professor at the University of Chicago, in the Wall Street Journal. We noted that Prof Epstein seemed to rely on a number of misconceptions about clinical research to defend how the US Food and Drug Administration (FDA) allows people with conflicts of interest to serve on its advisory boards. The WSJ subsequently published a letter by Marcia Angell making similar points, rather more succinctly.

Now it turns out, as the Boston Globe reported, that Prof Epstein seems to have been part of an unusual enterprise that offered to "shape the debate" in return for fat fees from well-heeled clients. Per the Globe,

A high-powered academic team's work for a billionaire executive facing charges of improper accounting has raised questions about the appropriate relationship between academic consultants and the businesses they advise.

Business ethicists are questioning why the academics, affiliated with some of the top business and law schools, joined a campaign to repair the image of Maurice R. 'Hank' Greenberg , who was forced to resign in February 2005 as chairman of American Insurance Group Inc., billing him at rates of $400 to $1,000 an hour.

The academics, working with eSapience, a little-known Cambridge company calling itself a new media and research firm, included Richard Schmalensee , dean of MIT's Sloan School of Management; David S. Evans , adjunct professor at University College London; and Richard Epstein , a University of Chicago law professor.

The lawsuit identifies Schmalensee as managing director of eSapience, Evans as chairman, and Epstein as an affiliate.

The eSapience plan summary ... lists several other academics as members of what it calls its 'core academic team and network,' suggesting 'they are ready to begin the development of the papers, articles, opeds, books, monographs, and other content related to our key themes,' such as the onerous insurance regulatory environment.

eSapience's website, no longer apparently working, but cached by Google, advertised that the company "shapes the debate on issues that intersect law, economics, and policy. Through its global network of academics and other public intellectuals, the firm publishes leading journals, organizes high-level briefings and closed-door sessions, and creates a variety of other on- and off line venues...."

Ethics experts interviewed by the Globe were not amused.

'Academics are supposed to be independent thinkers,' said Jim Hoopes , professor of business ethics at Babson College in Wellesley. 'Once academics start getting paid for their opinions in this way, there is less confidence in the integrity of their ideas.'

'Resurrecting the reputation of certain people who deserve a plaque in the hall of infamy because of past wrongdoing is not proper,' said W. Michael Hoffman , executive director of the Center for Business Ethics at Bentley College in Waltham. 'That these are professors within universities that should be the last bastions of integrity is cause for question.'

Of course, we have blogged quite a bit about medical academics working part time for pharmaceutical, biotechnology, or device companies, and speaking or writing as academics in ways that seem to aid the companies' marketing objectives (for example, here and here.) However, I don't recall hearing of medical academics forming their own company and then soliciting marketing work from drug companies. An article from PRWeek about the case noted,

The case is also notable for the way in which eSapience brazenly touted its ties to respected academic institutions as a selling point that could be leveraged on behalf of paying clients. In its plan summary, the firm promised to 'leverage our relationships with important and highly credible channels, including [think tanks], MIT, University of Chicago Law School, and The Federalist Society, among others. Those organizations will work with us to host conferences... co-author papers' and on other work.

It makes you wonder whether some of the many other arguments that regulation of high-flying health care corporations would stifle life-saving innovation were similarly based on "leveraged relationships," forged by firms that used ostensible academics to "shape the debate" in ways favorable to those paying their fees.

In any event, this case certainly does nothing to increase the credibility of Prof Epstein's arguments defending the FDA appointing advisory board members with conflicts of interest. It does provide yet another reason to better disclose and regulate the financial dealings of academics in medicine and health policy with organizations that have vested interests in these areas.

ADDENDUM (18 April, 2007) - In Epstein's WSJ article, he disclosed consulting "frequently with pharmaceutical companies," but not which ones. In a 2007 article on conflicts of interest [Epstein RA. Conflicts of interest in health care: who guards the guardians? Perspect Biol Med 2007; 50: 72-88.], Epstein revealed he has "served as a consultant to the Pharmaceutical Research and Manufacturers of America (PhRMA) and to Pfizer...."

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