A recent paper from the CATO Institute, titled “Scientific Misconduct The Manipulation of Evidence for Political Advocacy in Health Care and Climate Policy,” highlighted how “science is increasingly being manipulated” based on the political choices and ethical preferences of those who are willing to suppress evidence of conflict between those preferences and the underlying reality.
Written by George Avery, PhD, MPA, an assistant professor of public health in the Department of Health and Kinesiology and the Regenstrief Center for Health Care Engineering at Purdue University, the article discusses how in health care policy, critics have long worried about the inordinate influence of pharmaceutical and medical device manufacturers on research to show the safety and viability of new products.
Interestingly, Dr. Avery brings in a viewpoint which shows “that government agencies may cause more problems in this area” according to recent information. A problem he calls “worrisome” because the Patient-Centered Outcomes Research Institute created by the new legislation, which would conduct comparative-effectiveness research, would allow federal agencies to punish organizations whose researchers publish results that conflict with what the agency feels is appropriate.
Dr. Avery noted that such a regulation “appears to be an effort in part to bypass the court order in Stanford v. Sullivan, an order, which held that such blanket bans are “overly broad” and constitute “illegal prior restraint” on speech.
He explains that such punishments would include withholding of funding to an institution where a researcher publishes findings not “within the bounds of and entirely consistent with the evidence.” Such “a vague authorization creates a tremendous tool that can be used to ensure self-censorship and conformity with bureaucratic preferences.” Dr. Avery also cited AcademyHealth, a professional association of health services and health policy researchers, which noted that “such language to restrict scientific freedom is unprecedented and likely unconstitutional.”
Accordingly, Dr. Avery acknowledged how these kinds of regulations “blur the differences between scientific and policy debates, and limits the role of science in policymaking. Just as some claim that working for industry can bias a physician’s work or create a conflict of interest, Dr. Avery noted that scientists in government too “can move from “skeptical evaluation” into advocacy due to “employment by an entity with a financial stake” in a particular outcome and “other sorts of strong policy preferences.” This can essentially turn scientists into “leading members of advocacy campaigns”—ones with the primary goal of saving money, instead of patients.
Consequently, although sponsorship of pharmaceutical research and drug trials by manufacturers is not a new topic, and adverse results have occurred in such relationships, Dr. Avery noted that adding more public funding as a solution “would only aggravate the problem.”
For example, he noted that in July 2007, AcademyHealth published results of a study of sponsor restrictions on the publication of research results. “Surprisingly, the results revealed that more than three times as many researchers had experienced problems with government funders related to prior review, editing, approval, and dissemination of research results.”
The study also found that “a higher percentage of respondents had turned down government sponsorship opportunities due to restrictions than had done the same with industrial funding.” In addition, the research found that “much of the problem was linked to an “increasing government custom and culture of controlling the flow of even non-classified information.”
In the end, the government censorship of science that Dr. Avery discusses is inconsistent with democratic ideals in that it denies venues for legitimate exchange of ideas through open debate. While some assert that drug companies have power to influence people, “no private organization—even large and wealthy corporations in the energy or pharmaceutical industries—possesses the power and resources of government.”
Accordingly, “given the higher propensity of government agencies to try to control the dissemination of scientific information,” Dr. Avery’s work highlights an alarming threat to the scientific process and to the utility of scientific research to inform good policymaking. Moving forward, health care agencies must not restrict scientific freedom and this threat must be addressed before the integrity of science is hurt.