Corporate ethics: the Xigris example

Howard Brody has a post up about Eli Lilly's pulling the sepsis drug Xigris from the market and, of particular interest, the story (if the reports are accurate) of how the corporation had maneuvered to get it used:

The part of the Xigris story that especially caught my attention was how some of my colleagues in bioethics were caught up in the company's PR campaign without apparently realizing it--or else taking the money and not caring. As one prong of the marketing strategy, Lilly decided that since Xigris cost so much, and since so few ICUs were purchasing it (since the studies had been so equivocal), then there must be rationing of life-saving treatment going on. Of course one solution would have been to lower the price, but perish the thought. So Lilly instead forked over $1.8M to fund an "ethical" study of rationing in the ICU, with the intent of bringing pressure to bear on recalcitrant units with the dreaded "R word."

The part of the story that I did not cover in HOOKED, as Williams reminds us, was actually addressed in a 2006 commentary in the New England Journal (subscription required) by Eichacker and colleagues. Having managed to get the FDA to approve Xigris despite iffy data of efficacy and safety, Lilly bankrolled a big PR firm to do three things--set up the rationing "ethics" inquiry, and get major medical societies to write guidelines for sepsis care that included the use of Xigris (by funding the guideline panels and making sure that numerous docs with Lilly money in their pockets served on the panels). The third thing however was what made Eichacker and company worried. It was Lilly's subsequent effort to lobby the organizations that create quality indicators for hospitals and insurers to include those guidelines in their quality measurements. That is, if an ICU did not use Xigris, because they deemed it insufficiently useful and overly dangerous (a reasonable evidence-based position at the time), the hospital might get a lower score for quality of care and then have problems with insurance reimbursement as well as the bad publicity. Eichacker et al. very reasonably said this was a blatant hijacking of these quality indicators for commercial purposes.

...Why bother sending drug reps into thousands of doctors' offices if you can buy off the people who write the guidelines and the people who ding the hospitals for bad quality of care?

To reiterate: They hired a PR firm to portray the non-use of their drug as rationing, lure ethicists - ! - and guidelines developers into going along with this framing, and work to get the quality-rating organizations to favor the use of their drug and penalize those hospitals that weren't using it. For a drug with little evidence of efficacy and which in the end was withdrawn for a lack of it.

Brody quotes David E. Williams' advice to the drug companies:

--Industry: Feel free to market your products and services aggressively, but don’t take things too far. If you do you’ll end up killing the goose that lays the golden eggs. No one will trust doctors, guidelines or journals anymore

First, the idea that it's morally acceptable for corporations making medications to put the interests of their shareholders above those of the people taking the medications is a huge problem. Of course, that's to be expected in a corporate-capitalist system. They've been getting away with it, and indeed escalating, for decades, and moreover have other means of attaining their goals. They're not going to worry about this alleged long-term risk to reputations. Nor are doctors and medical organizations - in a situation in which these corporations are free to pursue their interests aggressively - going to counter them. Regulations, if they were passed and enforced, would make some difference,* but the real meaningful solution is to separate corporations from medicine entirely. Or, at the very least, to take out the worst offenders by revoking their corporate charters or holding their executives personally criminally responsible.

* In this specific case, a report on the drug's withdrawal notes that the study showing a lack of effectiveness was "ordered by European regulators in 2008 as a condition of the product's continued approval there."

The orca slavery lawsuit: a plea to avoid reflex ridicule

Strangely enough, none of my usual sites (including the Orca Coalition) mentioned the orca slavery lawsuit before I learned of it on the Colbert Report last night:

The Colbert Report
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PETA has a link to the suit, "asking a federal court to declare that five wild-caught orcas forced to perform at SeaWorld are being held as slaves in violation of the 13th Amendment to the U.S. Constitution," on its site. It involves some of the orcas that have been discussed here, and appears to have received its impetus from the Morgan case (Ingrid Visser is one of the Friends).

I can already imagine the hostility and mockery that will greet it: it's just another kooky stunt from PETA, rights isn't the appropriate framework in which to discuss the ethical status of animals, it's an offense to humans who've been enslaved to suggest that nonhuman animals are, everyone knows the Constitutional basis doesn't exist, and so on. I fervently hope, though, that people will take some time to read the suit and consider the case within a longer historical framework, and will not dismiss or reject the struggle of and for these orcas because of a dislike of PETA or animal rights arguments. (You can read some of the background by clicking on the "whales" tag below.)

I also hope people will consider the point made by Colbert - that we live in a country in which the argument that nonhuman animals can be "people" who can be enslaved is ridiculed but corporations are granted the legal rights of people:

Brave women: Tunisia and Uganda

Tunisia is at a crossroads. Fresh off of elections and embarking on writing a constitution, the country still has an opportunity for a (relatively) democratic secularism. Reading a call from HRW for the dropping of criminal charges against a TV station for airing a film claimed to "defame" religion, I learned that more than one determined filmmaker is critically commenting on religion there:

Laws that criminalize the “defamation” of religion or religious groups are not compatible with norms of freedom of expression, Human Rights Watch said. The United Nations Human Rights Committee, in its general comment on article 19 of the International Covenant on Civil and Political Rights, which Tunisia has ratified, stated that it is not permissible for “prohibitions of displays of lack of respect for a religion or other belief system, including blasphemy laws … to be used to prevent or punish criticism of religious leaders or commentary on religious doctrine and tenets of faith.”

Since the ouster of President Zine el-Abidine Ben Ali on January 14, there have been other attacks on artistic expression by groups claiming to act under the banner of protecting Islam. On September 26, protesters forced their way into the Afrikart Cinema in downtown Tunis to protest its screening of Secularism, If God Wills, a film about atheism shown as part of a cultural evening.

Intrigued by this description, I checked the link and discovered the following:

Online commentators, including on Facebook, have vilified the documentary under its former title, Neither Allah Nor Master (Ni Allah ni Maître) and its director, Nadia al-Fani, a Franco-Tunisian, largely because al-Fani has openly declared her atheism in interviews on Tunisian television and made it the subject of her film. Al-Fani has received numerous online death threats.

I found this interview with al-Fani, in which she argues: "I think in order to live together there must be this concept of secularism. I already had this position before the fall of Ben Ali, that to ask for democracy, is to ask for secularism."

In Uganda, Kasha Jacqueline Nabagesera, who recently won the Martin Ennals Award for Human Rights Defenders, is leading a different but related struggle - for LGBT rights. Here's a short video about her:

Martin Ennals Award Laureate 2011 Kasha Jacqueline Nabagesera from True Heroes Films on Vimeo.

Interlude - Ella

Interlude - yay cats

That is all.

Because after the tear gas, there's nothing you need like acupuncture

This is really a celebratory post about professionals involving themselves in social-justice movements. Social Medicine has run a few posts the past two weeks about medical workers at the Occupy protests, both as activists and as volunteer medics:

"Doctors for the 99%: Physicians Participate At the Wall Street Occupation"

"Doctors for the 99% out in force on October 15th"

"How to be a Street Medic (updated)"

The first two highlight the organized activism of professional medical groups fighting for just health care systems. The last is an updated version of a 2004 article describing the activities of street medics - professionals who attend to the medical needs of protestors. Overall, it's fine and informative. However, it includes this bit:

Who are street medics?

Street medics come from a variety of health care backgrounds including herbalists, nurses, EMTs, NPs, health educators, physicians, medical students, and acupuncturists. In fact, a medical background is not actually necessary to be a street medic as most receive additional training in first aid, the management of activist-specific injuries and such topics as scene control and pre-hospital assessment. A large amount of formal medical training is not applicable to street medic work [?], so additional training is always necessary.

Being a street medic requires more than just medical knowledge. The ability to work in non-hierarchical affinity groups, value non-western medical knowledge and work in stressful, and at times dangerous, situations are all equally important to street medic work. For many physicians and nurses, developing these skills will be the focus of their street medic experience. [my bold]

There is no such thing as "non-western medical knowledge." There is no such thing as Western medical knowledge. There is only medical knowledge. Acupuncture is placebo. This is an insult to the medical professionals participating in the protests, who are working to make the fruits of medical science accessible to everyone.

Developing a just system of health care means abolishing the corporate model of health care. That is entirely in keeping with, and in fact truly captures, the spirit of this movement. It is to create a system in which the powerful tool of medical science is participatory and serves human needs instead of corporate profits. Developing a just system of health care does not mean opposing science-based medicine in favor of woo. To throw the scientific baby out with the corporate bathwater is to unintentionally hand more power to corporations and their efforts at obfuscation in every sphere.

As I said, this one point irked me but this post is really a cheery one about how professionals can lend and are lending not just their voices but their skills and talents to movements for social justice. And it's not just medical professionals. I posted a little while ago about the National Lawyers Guild's web site for cyber-activists. They've now initiated a large-scale Occupy legal support program:

“We know from decades of experience in defending free speech rights that law enforcement agencies, absent competent and aggressive legal pressure, tend to run roughshod over the rights of those engaged in dissent,” [Carol Sobel, co-chair of the Mass Defense Committee] said. “We are taking a proactive approach to the defense of demonstrators.” “We don’t want to just defend protesters who have been falsely arrested—we want to head off the false arrests at the outset and send a message to local police agencies that suppression of free speech will not be tolerated,” Sobel said.

The page at my link provides contact information and a listing of the cities in which they're already operating.

This is all very exciting. So many people, it seems, think of activism as marches and protests only, and don't realize how their skills and talents - as artists, nurses, graphic designers, legal professionals, social workers, IT experts, scientists,... - can contribute to social movements, and in turn how their participation can expand their own consciousness and lead them to push for change within their profession.

Make Mine a Double

"I found my first real home during my second year in New York, at a bar in the East Village. Maybe it was the kind of bar you've loved, if you've loved a bar." - Kristen Dombek

Gina Barreca once happened into the book store where I worked. She was truly pleasant and gracious enough to sign all of our copies of her books, which left me with good feelings towards her. So when I read about a new collection of pieces about women and drinking - Make Mine a Double: Why Women Like Us Like to Drink (Or Not) - I was happy to discover that she was the force behind it.



I immediately added it to the large mix of books I'm reading at the moment. It's a delight. I'm only about a third of the way through, and already the essays have hit on drinking and feminism, religion, gender, race, class, and families. I laughed aloud several times reading Sarah Deming's "Against Mixology." Perhaps I'll post about it again when I finish them all, but I'd recommend it on the strength of the first several alone.

Interlude - Vineyard, fall

Radioactive Wolves!

This was fascinating.

I want to take pictures there.

Orca Coalition set to appeal Morgan decision

I reported last week that the decision had been made to send Morgan to Loro Parque in the Canary Islands. Encouragingly, the Orca Coalition quickly raised funds to initiate an appeal. There's hope yet!

“International regulations for the care of a protected animal have still not been followed. Only if rehabilitation is deemed impossible, other options are allowed to be considered. But the Dolfinarium has so far not been able to mention one action that shows that they are trying to prepare Morgan for a life in the wild”, according to Marq Wijngaarden, lawyer of the Orca Coalition. Because of the court ruling in August the Dolfinarium has to wait at least five more weeks before they are allowed to export Morgan. The Dolfinarium appears to have no intention to uphold this term, and again wants to violate the rules.

The Orca Coalition is still open for a meeting with the Dolfinarium. “We are supported by a group of international orca scientists who have experience with rehabilitating these protected animals in the wild. Their knowledge and experience is available for Morgan, and also for future stranded orcas. For a year now a detailed plan to return Morgan to her family has been available”, says Barbara van Genne, marine biologist and spokesperson for the Orca Coalition. The Orca Coalition continues to take efforts to implement this step by step release plan in order to return Morgan back to her family under expert guidance, according to international regulations.

Rorschach's post about the ERV comments

It's great that so many people have donned their hazmat suits and waded into the ERV pit to protest the threatening, misogynistic language by saying "No." Rorschach has posted about the matter, including email addresses for ScienceBlogs and National Geographic. He notes:

[T]his and other comments in that and the previous threads on elevatorgate hosted by Abbie Smith on her blog in the last 3 months seem to be in breach of Scienceblogs’ Code of Conduct :...

An understatement. They appear to have reversed the Code and used it as an instruction manual.

If any of the other remaining ScienceBloggers are still unaware that this is happening on the site they share, they should probably be informed as well.

The skeptical-atheist community needs to say: NO THREATS

This has gone on more than long enough. We don't have immediate influence on those outside our community, but we need to stand together against veiled threats of the sort directed at Ophelia Benson.

Let's give them the Geraldo treatment.

Two sex queries

So...I have two questions related to my post yesterday:

First, just after I saw Orgasm, Inc., I heard on the car radio an ad for some sort of herbal supplement for men (I wish I'd written down the name). The product was alleged to mimic or promote testosterone or something. The commercial acknowledged that the "condition" it supposedly treated was merely normal changes associated with aging, but focused - in addition to boosting vigor generally - on maintaining or increasing sexual desire.

I recalled at least one Roman writer* reflecting upon declining sexual desire with age and calling it a positive and enjoyable experience: men (I think they were writing specifically about men) are less likely to behave stupidly, and the weakening of those overwhelming physical drives frees them to focus on other aspects of their lives, especially their work. Now, I can see a specific situation in which a man's partner has a problem with his lack of interest in sex (not that this silly supplement would do anything for that beyond, potentially, the placebo effect). But I see the Roman writers' point, and don't really understand why people would want to artificially create desires in themselves, even if these can be satisfied. Why are some men interested in doing this?

Second, both PZ and Dan Savage have written recently about the mystery of the female orgasm, both leaning toward the "by-product theory" which sees the female orgasm as an evolutionary by-product of the male orgasm. This makes sense, but I've been confused about why the female orgasm is seemingly assumed to have no adaptive function because it's not needed for ejaculation. I could well be missing something important here, but I would think that the pleasure of orgasm, like other sexual pleasure, would incline women to have more sex. Is the assumption that female sexual interest/desire has played no evolutionary role whatsoever? If so, that assumption doesn't seem defensible in light of primate and human anthropological research.

With regard to the specific case Savage is commenting on, I think his advice to relax about it is good. We know that this can be strongly affected by psychological states, and being wound up about it can't be helping, even if it's not hurting. At the same time, cultural beliefs (and the feelings of shame that stem from them) and ignorance about sex (on both partners' parts) shouldn't be dismissed as possible factors because of an evolutionary hypothesis.

*(if anyone can remind me which specifically, please do)

CFI to take legal action against Wyndgate; O'Reilly to respond to Dawkins cancellation

The Center for Inquiry reports that they plan to take legal action against the Wyndgate Country Club for cancelling Richard Dawkins' talk after the club's owner saw Dawkins interviewed on The O'Reilly Factor and learned of his atheism.

O'Reilly is expected to comment on the matter on his show on Monday night (8 PM EST).

Media on media: a contrast

Today, I learned of three new books about media history. The first works featured in the New York Times' upcoming book reviews, under the title "Dynasts of the Daily Press," are about the Medill family, media tycoons: The Magnificent Medills: America’s Royal Family of Journalism During a Century of Turbulent Splendor by Megan McKinney and Newspaper Titan: The Infamous Life and Monumental Times of Cissy Patterson by Amanda Smith. Also, yesterday's Democracy Now! offered an interview with Juan Gonzalez (Democracy Now! co-host) and Joseph Torres, authors of News for All the People: The Epic Story of Race and the American Media, which looks at how the media has historically shaped views about race in the US and the role of technological changes and government policy, bringing to light the work of minority journalists and media activists in fighting for a more democratic media.


This is from the Times review:

Megan McKinney’s “Magnificent Medills” and Amanda Smith’s “Newspaper Titan” between them expend more than 1,000 pages chronicling the escapades of Joseph Medill and his family. McKinney’s book includes accounts of Joseph Medill and his offspring, on to the great-­grandchild Alicia Patterson Guggenheim, who came to own and run Newsday. Smith (the editor of Joseph P. Kennedy’s letters), at much greater length than Mc­Kinney, concentrates on Cissy Patterson, who was Joseph Medill’s favorite grandchild and led the gaudiest life of the Medill ­grandchildren.

...Contra McKinney, the Medills were not magnificent but neurotic, alcoholic, megalomaniac and inordinately unpleasant generally. Far from being a titan, of newspapers or anything else, Cissy Patterson was, in Smith’s own showing, capricious, spoiled, headstrong, snobbish, litigious, anti-­Semitic, a mean drunk and vindictive. Not, as we should say today, a fun family, Joseph Medill’s offspring.

They did spend grandly, though chiefly on themselves, living more like Medicis than Medills. They called on Stanford White to build them mansions on Astor Street in Chicago, on Dupont Circle in Washington, and had other architects build them mansions elsewhere. Vast sums went on clothes, jewels, luxurious travel, liveried servants, private railroad cars, horses, fox hunting and buying off ex-husbands and -wives....

...The Medill grandchildren viewed journalism as purveying entertainment while enhancing their social positions and spreading their political views. “Never overestimate the intelligence of the American people” might have been their motto, and in their newspapers they rarely did. They gave their readers what they thought they wanted. This included large photo spreads, stories of sex and violence, advice columns, lots of gossip, strong opinions, contests and comic strips. (Joe Patterson was especially adroit at developing new comic strips for The Daily News.) The formula worked. At one point the family owned and controlled the three largest-circulation dailies in the three most important cities in the United States.

From Gonzalez' description of News for All the People:

So we’ve tried to outline how that developed, from the early Post Office for newspapers; the rise of the telegraph, that gave rise—that really made possible the wire services that dominated news throughout the late 19th century; the rise of radio, then of cable television, because television was really just an extension of radio, the rise of cable television; and finally the rise of the internet. Each of these new technologies has created a huge debate over what is the role of the media in a democracy and what is the role of the government in establishing the rules of operation by which all the different groups in society will be able to have access or be heard or produce news.

They talk about the work of several minority journalists, and then media reform movements:

JUAN GONZALEZ: ...We point out in the book that between 1970 and 1973 there were more than 340 license challenges to the licenses of television and radio stations across the country. As thousands of African-American and Latino community leaders—forgotten—people like William Wright in Washington, D.C., Emma Bowen in New York, Lonnie King in Atlanta—all marched into the television stations and the radio stations and said, "We are fed up with your failure to cover our communities. We want you to hire more African Americans and Latinos. We want you to have shows that speak to our communities." And they launched a massive movement all across the country challenging licenses. And as a result of that movement is when you had the newsrooms opened up to people like Ben Bradley—I’m sorry, to Ed Bradley—

AMY GOODMAN: 60 Minutes.

JUAN GONZALEZ: —and to Geraldo Rivera*—

AMY GOODMAN: Fox.

JUAN GONZALEZ: —and to all of these first generations—Gil Noble, Gloria Rojas. The first generation of African-American and Latino journalists came into the newsrooms as a result of this massive community movement of media reform in the 1970s....

The contrast between the Times' and Democracy Now!'s assessments of the interests of their respective audiences is pretty stark: for the former, the fox hunting, backstabbing, and marital problems of narcissistic media magnates; for the latter, an analysis of the history of media democracy, racism, and reform movements, taking us through the net neutrality struggles of today.

*I admit I have another motive for quoting this particular portion of the interview, and that is to show this video (the segment leading up to this, also at the link, has Cornel West referring to "our atheist and agnostic brothers and sisters"...on Fox):



Cuttlefish should like it. :)