March 23, 2001
Volume XXXIV, No. 12


Of Note


Economics/ethics debate sparks discussion of research funding

Tom Kowalski, Dr. Henry Perkins, and Dr. Laurence
McCullough (Left to right) Tom Kowalski of the Texas Healthcare and Biosciences Institute, Dr. Henry Perkins of the UTHSC department of medicine and the Center for Ethics and the Humanities in Health Care, and Dr. Laurence McCullough of Baylor College of Medicine participate in a question-and-answer session with audience members during a March 7 ethics debate.

Two lively discussions on "The Promise and Peril of Academic-Industry Relations" were held on campus recently and played to full houses of faculty, residents, students and others who asked questions and contributed their own thoughts.

Using a debate format, Thomas Kowalski, president of the Texas Healthcare and Biosciences Institute (THBI) in Austin, represented the industry point of view, while Dr. Laurence McCullough, professor of medicine and medical ethics from Baylor College of Medicine in Houston, articulated the academic side of the issue. Not a contentious debate, both speakers agreed that an increasing role for industry in academia is coming and that academicians should proceed, but with caution.

The event was sponsored by the Texas Medical Foundation and organized by the university's Center for Ethics and the Humanities in Health Care.

Industry cooperation not new here

The Health Science Center has had relationships with private industry almost since its beginnings. Even before the university's Industry-University Cooperative Research Center was created to foster such relationships, patents were being pursued for marketable devices and processes, and drug companies were requesting that faculty assist with clinical trials of their new products.

According to Kowalski, the Health Science Center now ranks third in the state among medical institutions benefiting financially from intellectual property, much of that created with support from private industry. His THBI, of which the Health Science Center is a member, is a non-profit group aimed at researching, developing and advocating "policies and actions that promote biomedical science, biotechnology and medical device innovation in Texas."

Maintaining objectivity

"Federal law encourages academic-industry relationships, but in order to protect the integrity of the academic enterprise, we must have safeguards and firewalls to make sure that negative results are properly reported and that researchers remain objective when conducting studies and reporting their findings," said Dr. McCullough, who has authored nine books on ethics topics. For example, he noted, if a researcher has stock in the company for which he is conducting trials of a new product, the whole process of objectivity is upended.

He pointed out that although the well-being of the patient is considered to be the primary goal of today's health care, that wasn't always the case throughout history. He cited British physician John Gregory, who proposed a concrete set of ethical guidelines for physicians just 250 years ago. Gregory noted that self-interest is, and should be, blunted by a caregiver's concern for patients.

Dr. McCullough pointed out that many faculty in academic medicine are faced with the difficulties of being models of teaching as well as of research and patient care, while also being responsible for generating money for their departments. At the same time, they are asked to abide by layers of regulations including federal, state and, in the case of the Health Science Center, those of the U. T. System Board of Regents. In other words, he said, the productive, not to mention ethical, path for faculty is not necessarily clear and free from conflicting goals.

Industrial wave of the future

A larger and larger percentage of the research budgets at academic medical institutions comes from private industry. Projections estimate that in 10 years, 40 percent of research budgets will be funded by for-profit, private industry and only 30 percent by the National Institutes of Health, Kowalski said. The goal of his non-profit, 48-month-old organization is to promote the biotech industry as a viable new industry for Texas. A self-described lobbyist, he is watching the 77th Texas Legislature closely. Kowalski said he believes this new industry is going to need advocates, much as the old industries of oil and cattle did, if it is to survive and thrive. He estimates that it already has a $20 billion impact on the state economy. "We are in a competitive race with other states for this type of industry," he said.

To counter a view solely concerned with money, Dr. McCullough discussed a basic tenet of scientists -- that there is, and should be, such a thing as "pure" science, in which the scientists are allowed to learn as much from an experiment that fails as from one that succeeds, and that some valuable discoveries may be made by accident if the scientist is allowed to pursue his or her notions, free from the constraints of funded goals. But he admitted that the reality of this ideal falls short.

"Even NIH money and projects are not totally free from the need to show results," Dr. McCullough pointed out. "Sometimes we must describe the success of our yet-to-be-done research before we can get the money to try it. Congress doesn't want to allocate funds to projects that don't seem to have a chance of success."

While Mr. Kowalski views the Health Science Center as an engine for developing new, marketable technology, Dr. McCullough cautioned faculty to keep vigilant regarding their own objectivity because "markets are not neutral, they're predatory." He also quoted the lyrics of an old Bob Dylan song: "Money doesn't talk. It swears."