Should a senior executive of a large pharmaceutical company sit on the governing council of an institution whose role is to fund health research on behalf of taxpayers?
That is a fiercely debated question in the corridors of health research, and one that belongs in the public realm.
Bernard Prigent is vice-president and medical director of Pfizer Canada, a division of the world's largest pharmaceutical company, Pfizer Inc.
On Oct. 5, he was appointed to the governing council of the Canadian Institutes of Health Research. The CIHR, which funds more than 13,000 health researchers and trainees, has a budget of $973-million, money it gets from the federal government.
For some, Dr. Prigent is the personification of evil, a Big Pharma operative who has infiltrated a body that Canadians depend on to finance unbiased, independent health research in the public interest.
For others, the Pfizer Canada vice-president will bring a much-needed private-sector voice to the table and help ensure that CIHR invests tax dollars wisely in innovative and beneficial research and gets more bang for the buck.
The truth probably lies somewhere between those extremes, but the reality is that the underlying issue matters to researchers and, by extension, to the public that benefits (or should) from health research.
Like all members of the CIHR governing council, Dr. Prigent has impeccable credentials, with a distinguished career in international health before joining the pharmaceutical industry. His particular area of specialty - and what led the CIHR to recruit him - is the management of research and development of commercial products.
"In Canada, we have some of the best health researchers in the world," Dr. Prigent said at the parliamentary committee that is reviewing his appointment. "Where we are less successful is in moving health research results out of the lab and into hospitals and clinics where they can improve health outcomes."
While it is hard to argue with that statement, the concern is that, by appointing a pharmaceutical company executive, the CIHR is sending a message that it is going to overtly and aggressively promote research that is profitable ahead of research that is merely useful. (All other members of the board are eminent researchers and health-care administrators in the public sector.)
The governing council of the CIHR does not actually dole out research funds. There is a complex system of open competition and peer-review for that function. But the governing council sets the strategic direction of the CIHR and that affects what is funded.
The overriding mission of the CIHR is "to improve the health of populations and promote health equity in Canada and globally through research and its applications to policies, programs and practice in public health and other sectors."
The legislation governing the institutes, the CIHR Act, also sets out that one of its objectives should be "… to excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improve health for Canadians, more effective health services and products, and a strengthened health care system, by … encouraging innovation, facilitating the commercialization of health research in Canada and promoting economic development through health research in Canada."
The president of CIHR, Alain Beaudet, said that Dr. Prigent's experience in innovation and commercialization will "fill a major expertise gap" on the board.
While that gap needs to be filled, how it is done matters. Perceptions matter a whole lot, too.
The perception over this appointment was perhaps best enunciated by NDP health critic Judy Wasylycia-Leis, who said: "Having drug companies advise the government is like having the big bad wolf advising the three little pigs on how to build their homes."
Critics of the appointment have also underscored some of the major ethical transgressions of Pfizer in recent years. In September, for example, Pfizer Inc. was ordered to pay a record $2.3-billion (U.S.) in fines and penalties because it marketed four drugs for conditions for which they were not recommended. While there is no suggestion Dr. Prigent was personally involved in the malfeasance, ethicists argue that his association with the company could breed cynicism and compromise the scientific integrity of the CIHR.
For its part, Rx&D, the organization representing research-based pharmaceutical companies, argues that the attacks on Dr. Prigent are spurious and "threaten to derail Canada's efforts to improve health research in this country."
There are serious allegations and legitimate concerns at both ends of the spectrum.
At the very least, there should be public discussion and debate about the role of private-industry representatives on government bodies and about the wisdom of government-funded institutions jumping on the commercialization bandwagon.
But the parliamentary committee has, to date, heard only two witnesses on this appointment: Dr. Prigent and Dr. Beaudet.
By hearing only one side of the debate, they are hardly carrying out their watchdog function as elected representatives.
However accomplished Dr. Prigent may be, his appointment should not be a fait accompli .