At this moment in time, it seems as though there is nothing more important than developing a vaccine for Covid-19, the coronavirus that has launched a worldwide pandemic. The world hungers for such a vaccine that might enable us to return to some semblance of normalcy.
President Trump has named Dr. Moncef Slaoui to lead “Operation Warp Speed,” the federally-funded project to spearhead the creation of such a vaccine. There is much to like about this appointment. Dr. Slaoui spent much of his career as a top executive at pharma giant GlaxoSmithKline (GSK) where he helped develop many vaccines. Dr. Slaoui has served on the board and in other roles with many other drug companies and has invested substantially in those and other drug firms.
Although there has been some evidence of wrongdoing by Dr. Slaoui while he was at GSK[1], very few seem to believe that he is not well qualified for this role.
However, some have objected to perceived conflicts of interest, especially given that Dr. Slaoui has substantial investments in several of the companies in the chase to develop a vaccine, some of which could receive support from Operation Warp Speed. While Dr. Slaoui has agreed to assume his role for just $1 per year in salary, he has been approved to act as a “government contractor” and thereby is exempted from federal ethics disclosures and allowed to retain his current investments in pharmaceutical companies.
Supporters see no significant problem. Stanford Law School’s Joe Grundfest notes that conflicts of interest involving scientists are common, arguing that “[t]he challenge is to manage them appropriately, because if you try to avoid them altogether you often won’t be able to get the best people for the job.”[2]
On the other hand, Virginia Canter, an ethics lawyer in the Obama administration said: “If he retains stock in companies that are investing in the development of a vaccine, and he’s involved in overseeing this process to select the safest vaccine to combat Covid-19, regardless of how wonderful a person he is, we can’t be confident of the integrity of any process in which he is involved.”[3]
To minimize concerns, Dr. Slaoui has resigned from several of his positions in drug companies. He has also promised not to sell any GSK stock and not to trade some of his other holdings, and promised to donated extraordinary profits from certain investments to the NIH for research. Critics say this is not enough and that, at a minimum, disclosure of his stock holdings should be required even if total divestiture is not.
There is a lot at stake here. It is easy to argue that, given Dr. Slaoui’s qualifications, willingness to serve for just $1 and to resign several posts and divest from some firms, it is worth cutting a few corners ethically-speaking. Perhaps we should not let the perfect be the enemy of the good.
This situation is much too complicated to even attempt to resolve in this blog post. We make no judgment on it.
All we want to do is make four points.
First, there is a good reason that conflict of interest are universally viewed as problematic. It is difficult for even the most well-intentioned person to be fair, honest, and objective when one choice leads to riches and the other does not. Check out our video on conflicts of interest.
Studies show that “research physicians with ties to pharma companies are significantly more likely than independent reviewers to report findings that support the sponsor’s drugs and less likely to report unfavorable findings.”[4]
Second, one of the reasons conflicts of interest are so problematic is the overconfidence bias, the tendency we all have to be overly confident in our morality. We recommend our video on that topic as well.
The evidence is that “[w]hile individuals are typically able to identify other people’s susceptibility to biases, they see themselves as relatively immune to such biases.”[5] Bazerman and Tenbrunsel say “[i]t’s likely that most of us overestimate our ethicality at one point or another. Effectively, we are unaware of the gap between how ethical we think we are and how ethical we truly are.”
This is true of physicians as well. Dr. Peter Ubel contends “that physicians believe they are invulnerable to undue influence from industry.” Unsurprisingly, doctors think that their profession does not need conflict-of-interest policies, but that financial planners do. Financial planners, of course, think just the opposite.[6] Studies show that physicians are many times more likely to believe that other doctors’ judgments are affected by the blandishments of Big Pharma sales reps than to believe that their own judgments are so affected.
Very wealthy and successful people, like Dr. Slaoui, can be particularly susceptible to the overconfidence bias. We think of Dennis Kozlowski, former CEO of once high-flying Tyco, who from his jail cell admitted: “We believed our own press…With myself and others—even the board—you become consumed a little by your own arrogance and you really think you can do anything.”
Third, the self-serving bias can poison our attempts to ethically handle conflicts of interest. Anyone who thinks they can be objective when one choice leads to $5 in their pocket and the other leads to $5 million in their pocket suffers from the overconfidence bias and should watch our video on the self-serving bias.
Studies show that self-interest is “automatic, viscerally compelling, and often unconscious…the automatic nature of self-interest gives it primal power to influence judgment and make it difficult for people to understand its influence on their judgment.”[7]. The self-serving bias causes people in a conflict of interest situation to make biased judgments, but its automatic nature leads them to truly believe those skewed judgments.[8] They do not fully comprehend how their self-interest can unconsciously impact the choices they make.
Fourth, the evidence is clear that transparency encourages ethical behavior and lack of transparency does just the opposite, so a video on transparency and other situational factors that impact ethical decision making should be one of our next projects here at Ethics Unwrapped.
Morality evolved as a mechanism for societies to encourage people to conform to social norms. We relentlessly judge others (and are judged by others) regarding such conformity. “The effect is so strong that simply being watched keeps people mostly in line most of the time.”[9] There is overwhelming evidence that people act more ethically when they perceive that they are being monitored than when they don’t feel that way.[10] Therefore, “effective monitoring systems are necessary to reduce corruption.”[11]
Disclosure creates transparency, and requiring disclosure of conflicts of interest often leads the discloser to avoid them.[12]
Sources
Max H. Bazerman & Ann E. Tenbrunsel, Blind Spots: Why We Fail to Do What’s Right and What to Do About It (2011).
Jerome Kassirer, “Physicians financial Ties with the Pharmaceutical Industry,” in Conflicts of Interest (Moore et al., eds. 2005).
Klaus Lieb & Simone Brandtonies, “A Survey of German Physicians in Private Practice About Contacts with Pharmaceutical Sales Representatives,” Deutsches Arzteblatt International 107(22) 392-398 (2010), at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890067/.
Matthew D. Lieberman, Social: Why our Brains Are Wired to Connect (2013).
Christopher Rowland, “Chief of White House’s ‘Operation Warp Speed’ Vaccine Effort Can Keep Investing in Pharma Firms, under IG Ruling,” Washington Post, July 14, 2020.
Eugene Soltes, Why They Do It: Inside the Mind of the White-Collar Criminal (2016).
Steinman Michael A., Michael G. Shlipak, Stephen J. McPhee, “Of Principles and Pens: Attitudes of Medicine Housestaff Toward Pharmaceutical Industry Promotions,” American Journal of Medicine: 110:551-557 (2001).
Peter Ubel, “How Did We Get into this Mess?,” in Conflicts of Interest (Moore et al., eds. 2005).
Noah Weiland, “Chief Vaccine Scientist Will Not Be Forced to Disclose Pharmaceutical Stocks, New York Times, July 15, 2020.
Related Videos
Conflict of Interest: https://ethicsunwrapped.utexas.edu/video/conflict-of-interest
Overconfidence Bias: https://ethicsunwrapped.utexas.edu/video/overconfidence-bias
Self-serving Bias: https://ethicsunwrapped.utexas.edu/video/self-serving-bias
End Notes
[1] Paul Thacker, “The Sketchy Past of Trump’s Coronavirus Vaccine Czar,” Daily Beast, July 7, 2020.
[2] Sheila Kaplan et al., “Trump’s Vaccine Chief Has Vast Ties to Drug Industry, Posing Possible Conflicts,” New York Times, May 20, 2020.
[3] Sheila Kaplan et al., “Trump’s Vaccine Chief Has Vast Ties to Drug Industry, Posing Possible Conflicts,” New York Times, May 20, 2020.
[4] Leonard Mlodinow, Subliminal: How Your Unconscious Mind Rules Your Behavior (2012).
[5] Kathleen A. Tomlin et al., “Are Students Blind to Their Ethical Blind Spots? An Exploration of Why Ethics Education Should Focus on Self-Perception Biases,” Journal of Management Education 41: 539 (2017).
[6] Zachariah Sharek et al., “Bias in the Evaluation of Conflict of Interest Policies,” The Journal of Law, Medicine & Ethics 40: 368 (2012).
[7] Don A. Moore & George Loewenstein, “Self-Interest, Automaticity, and the Psychology of Conflict of Interest,” Social Justice Research, 17(2): 189-202 (2004).
[8] Don A. Moore & George Loewenstein, “Self-Interest, Automaticity, and the Psychology of Conflict of Interest,” Social Justice Research, 17(2): 189-202 (2004).
[9] Michael Tomasello, A Natural History of Human Morality (2016).
[10] John M. Doris, Talking to Our Selves: Reflection, Ignorance, and Agency (2015).
[11] Cristina Bicchieri & Deshani Ganegoda, “Determinants of Corruption: A Sociopsychological Analysis,” in Thinking About Bribery: Neuroscience, Moral Cognition and the Psychology of Bribery 179 (Philip M. Nichols & Diana C. Robertson, eds., 2017).
[12] Sunita Sah & George Loewenstein, “Nothing to Declare: Mandatory and Voluntary Disclosure Leads Advisors to Avoid Conflicts of Interest,” Psychological Science 25(2): 575-584 (2014).