A review of Assessing Corporate Bioethics: A Qualitative Exploration of How Bioethics is Enacted in Biomedicine Companies, by Jennifer Brian.
Jennifer Brian’s dissertation, Assessing Corporate Bioethics: A Qualitative Exploration of How Bioethics is Enacted in Biomedicine Companies, is an examination of the presence and impact of bioethics committees within industry. Taking as her three cases studies SmithKline Beecham (SB) (now GlaxoSmithKline), Advanced Cell Technologies (ACT), and Eli Lilly, Brian unpacks the roles of ethics committees constructed by these companies, and the impact they did—or did not—have on company matters.
Bioethics committees are part and parcel of the field, but the use of bioethics committees by business is a relatively modern invention. Moreover, bioethics committees operating for profit have been mired in controversy. Brian examines these critiques, but then posits that the current debate about bioethics within the context of corporate biomedicine (hereafter, “private sector bioethics”) lacks a detailed understanding of how bioethics fares within such an environment.
This, then, is Brian’s mission: a qualitative exploration of how bioethics is enacted in biomedicine companies. Brian begins with the assessments that how bioethics ought or ought not to happen depends on where bioethics occurs. A weakness in the critique of private sector bioethics, Brian argues, elides a “spatial dislocation” of bioethics itself:
Different models [of bioethics] are taken from hospitals, universities, and governments, and asked to act consonant with the model and the new space… there is no agreed upon criteria for evaluating federal bioethics bodies and yet criticisms of private sector bioethics committees import evaluative criteria without acknowledging any controversy (p. 16).
Brian then moves to the problem of payment. Some parts of bioethics possess “non-market dimensions” (p. 51): the academic mindset, rigorous and independent critiques, and the cultivation of a particular kind of skill. Yet the need for a bioethicist’s services are a kind of demand (though the nature of this demand is beyond the remit of Brian’s work) and with that demand comes the opportunity to provide one’s services to others. Brian then turns to the question of how bioethics committees navigate their position in corporate environments, by way of her three examples.
Each case example, together forming the bulk of the dissertation, is worthy of consideration in its own right, and what I present here is only a brief summary. SB’s Ethics and Public Policy Board (EPPB) comprised some of world’s leading philosophers, lawyers, and experts in biomedicine; yet possessed a staggering lack of diversity in the in terms of race, gender, and political affiliation. The EPPB acted at the behest of George Poste, an executive of SB, and primarily debated broad-spectrum issues to do with the role of science in public life (chapter 3).
This is in contrast to ACT’s Ethics Advisory Board, whose work investigated the emerging research at the company. This group was, according to CEO Michael West, granted the “power of the pen,” the ability to write on their experiences as long as they did not breach the confidentiality of the technical aspects of the research they were given access to. This ability, Brian argues, is a regulatory power in its own right—the ability to name misconduct or conflict as they see it. In terms of the company’s role in public, this represents a critical power that West hoped would moderate the company (chapter 4).
Eli Lilly, Brian shows, moved from using external bioethicist consultants to the establishment and maintenance of a full, internal bioethics review board, and corresponding in-house bioethics network. Brian details the tension between the need to give critical ethics advice to one’s employer, and the conflict that emerges by virtue of being a part of the company and thus wedded to its successes and failures. Combined with the bureaucratic structure enforced by Eli Lilly, the bioethics program and committee were isolated from some of the more egregious ethical failures of the company (those in drug promotion), and were limited in their ability to develop recommendations with a substantive ability to influence the corporate environment (chapter 5).
Brian’s analysis is revealing. She notes that senior management often drive the establishment of bioethics boards, but that corporate self-interest can hamper the board from acquiring members truly critical of the company’s aims and processes. The varied structures of the boards changed their effects: SB’s engaged in mostly high level ethics consultation on broad social issues; ACT’s board was more embedded in corporate life, but their effects were designed to project out into the community. Lilly’s, finally, was internal and bureaucratic, which undermined its impact.
In an interesting end to the discussion, Brian turns to how secrecy and transparency are expressed in biomedicine and private sector bioethics. Arguing that science and secrecy are not antithetical, as most might think, Brian notes that while forms of secrecy that suppress evidence of misconduct or obfuscate findings are worthy of critique, it is unproductive to claim that secrecy itself is uniformly wrong. Brian instead suggests that a more fruitful line of inquiry might be to ask what the ends and impacts of corporations are, and how secrecy can advance or pervert those ends. She concludes that by excluding the corporate world from direct engagement with bioethics, we lose the opportunity to critically engage with corporations and evaluate their impact.
This dissertation—as any good dissertation should—leaves more questions than answers. Brian notes some future directions for her project, and asks: do private sector bioethics committees represent a neoliberalisation of institutions of governance? That is, does the integration of bioethics into the corporate environment effectively privatize that element of the field under the values of efficiency within the marketplace? Brian claims that this points to a larger question—how and why are bioethics bodies authorized, and what is their role in the larger sphere of bioethics governance? This work provides fertile ground to begin to examine these and other questions.
As someone engaged in the more normative side of bioethics, I found myself constantly wondering about what the role of private sector bioethics might ultimately look like. This is not Brian’s central project, but she opens the way to an engaging program of research that bioethicists—regardless of their stance on private sector bioethics—should welcome. Private sector bioethics is likely here to stay, and the message I came away with was that the most productive line of enquiry was how they ought to be structured, rather than whether or not they should exist.
This dovetails with the increasingly demanding question of the role of bioethics as a discipline. When a field reaches a certain size, and earns a particular reputation, questions arise about the role of the members of that field in promoting their field’s goals. Bioethics has reached that point, and what follows are questions about how bioethics ought to be pursued in different environments. Brian’s dissertation represents a vital contribution in its presenting a clear view into the state of private sector bioethics.
A highly readable and informative piece, Jennifer Brian’s dissertation sets the stage for a much more ambitious project of understanding and shaping private sector bioethics. I do hope she continues, as the controversy and confusion about the role of the field today is in need of such clarity.
Dr. Nicholas G. Evans
Centre for Applied Philosophy and Public Ethics
Charles Sturt University
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Image: GlaxoSmithKline HQ taken from Kew Gardens, London. Photograph by Jared Preston, 24 May 2008. Wikimedia Commons.