Concepts of bias and appointments to the Governing Council of the Canadian Institutes of Health Research.

CMAJ • NOVEMBER 23, 2010 • 182(17) © 2010 Canadian Medical Association or its licensors E793 In October 2009, the academic health research community and the pharmaceutical industry were brought closer together with the appointment of Dr. Bernard Prigent, vice-president of Pfizer Canada, to the Governing Council of the Canadian Institutes of Health Research (CIHR). This bridging of the two worlds has stirred up considerable debate before the House of Commons Standing Committee on Health, in letters to CMAJ and in an online petition that garnered more than 4400 signatures. There are at least two distinct and vocal camps in the debate: those categorically in favour (including the federal minister of health and the president of CIHR) and those opposed to the appointment of someone from the pharmaceutical industry (including several senior Canada Research Chairs with a specialization in ethics and senior persons within CIHR). There are also some who support the appointment of a person with professional ties to the pharmaceutical industry, but not to this particular company (Pfizer) because of its history of ethical and legal violations. An important precept borrowed from administrative law may aid in illustrating some of the issues in this debate: the concept of reasonable apprehension of bias. When applied to these circumstances, it cuts through the various arguments to suggest the appointment is indefensible. I’ll explain why. But first I will briefly summarize the roles of CIHR and its Governing Council, as well as the arguments made thus far. CIHR is a statutorily created corporate agency of the federal government. Its objective is “to excel ... in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products and a strengthened Canadian health care system.” The Governing Council oversees the direction and management of CIHR by developing strategic directions, goals and policies, evaluating the agency’s overall performance, and approving its budget. CIHR is in tended to function at arm’s length from government. The first argument of those in support of the appointment is that the voice of the pharmaceutical industry will be an invaluable enhancement to the ability of CIHR to meet the needs of the Canadian public. It is important that CIHR be seen to be serving Canadian interests in commercialization and economic development, which are indeed parts of the agency’s mandate. There may not have been enough attention paid to these matters, and this appointment will help to fill the gap. Second, Dr. Prigent has great credentials: his qualifications are strong, and he is highly respected. He has considerable experience in commercialization and in pharmaceutical development. He chairs the Scientific Advisory Committee of Canada’s Rx&D Health Research Foundation, an association of research-based patent-holding pharmaceutical companies; he co-chairs the research working group of Montréal InVivo, the life sciences and health technologies cluster of the Montréal metropolitan area; and he serves on a number of national health-related committees. He has been appointed as an individual because of his skills and experience. Third, Dr. Prigent will be one voice among many at the Governing Council and will not promote his personal agenda or that of his company or the pharmaceutical industry. Moreover, he will be enjoined from doing so by the need to observe the federal Conflict of Interest Act, the Ethical Guidelines for Public Office Holders and the Guidelines for the Political Activities of Public Office Holders. He will be required to remove himself from discussions at Governing Council in which he, his company or the pharmaceutical industry has a vested interest. Critics, on the other hand, argue that having an active employee of a health-related commercial entity appointed to CIHR’s Governing Council presents an unmanageable conflict of interest. The appointee’s primary obligation to shareholders Concepts of bias and appointments to the Governing Council of the Canadian Institutes of Health Research