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Some readers (viewers/listeners) may find this next feature offensive. Analogous phrases are a daily occurrence today as we cower in fear of offending those with certain sensitivities. In the extreme case, good people have died over mocking cartoons. Graduation speakers have withdrawn in response to student groups expressing their contrary views. On my own campus there have been grumblings about speakers on climate change presenting a point of view prejudiced by sponsorship from fossil fuel interests.
In these columns I’ve suggested waves in science that came on too strong. For example, molecular biology overwhelming conventional mammalian pharmacology; high-throughput screening of enormous libraries overwhelming rational drug design; and genomics creating a tsunami, with expectations far out of reach. Meeting expectations is hard. Proteomics hasn’t done that either, falling flat with respect to biomarkers proven to be diagnostically useful. Laboratories and taxpayers invested a great deal in these topics, and we made good progress, typically within narrow contexts. Pointing out the fact that pharmacogenomics has not proven to be broadly applicable is not to offend, but to encourage adding back more clinical pharmacology, or what some call pharmacophenomics.
I’ve further suggested that the notion of conflicts of interest (incentives for malfeasance) is frequently misplaced and confused with the multiple good confluences of interest (incentives for good) that more often drive research to the benefit of patients. In my last column, I argued that it is equally specious to drive a minimum wage up or the price of a cancer drug down by rule or royal decree. In both cases the consequences are known to be harmful. Sure, there have been egregious examples of profiteering with drug pricing, but that’s not a reason to replace condemnation by arbitrary mandate. A few months ago, I enjoyed the book Pharmacophobia, How the conflict of interest myth undermines American medical innovation. The author, Tom Stossel, is a clinician and professor at Harvard Medical School and brother of the TV libertarian John Stossel.
My goal in presenting alternatives is to participate in debate, but often I’ve been attacked for being a contrarian and even accused of undermining research funding by creating doubt. The Stossel book supports the societal transition on these things from ‘you are innocent 'til proven guilty’ to ‘you are guilty until proven innocent’ to ‘don’t bother innovating, the compliance paperwork overwhelms.’ Transparency in disclosing relationships makes a lot of sense to me, but forbidding participation in research given a mere appearance of a relationship does not. After all, DTC advertisements of pharmaceuticals describe many adverse possibilities to a degree that has little consequence. It’s somewhat like the fine print that arrives with a retirement fund prospectus—most of us buy the product and accept the risk. You’d have to be retired to have time to read about it.
For the past few years in academia, in parallel with drug ads, some advocate that “trigger warnings” be issued before a course is taken or lecture is given that might damage a student emotionally. The sensitivity of various demographics seems at a fever pitch, similar to the sensitivity of autocratic governments to a free press. Some of us remember the “free speech movement” intended to enable political activity and antiestablishment speech on college campuses. Forty years later, this began to look like “the free speech only for those who agree with us movement.” The writer Jonathan Rausch has suggested a DTC warning statement for higher education. “WARNING. At this university, students could be exposed, at any moment, without warning, to ideas, comments, readings or other materials that they find shocking, offensive, absurd, annoying, racist, sexist, homophobic, discriminatory or generally obnoxious. We call this education.” Fortunately, the trigger warning idea engendered the University of Chicago statement on free speech adopted earlier this year. A few months later, we proudly accepted the concept at Purdue.
My New York education in the 1960s provided deep training in accepting and delivering insults of the worst kind. They bound my contemporaries together. It’s best to be civil, but that varies with perceptions. Garbage can be more productively ignored than forbidden. Those students who avoid exposure of this kind may have limited resilience later. The genome is not going to help sort this out. We also now know that pharmacogenomics will have utility, but very limited. Admit it and get back to work. The recent passing of Yogi Berra reminds me of the inflexibility of colleagues in contrary life-science cocoons. “It was impossible to get a conversation going, everybody was talking too much.” When the biology proves more complicated, the Yogi escape is brought to the fore: “I never said most of the things I said.” For one final trigger warning, the opinions expressed here do not imply endorsement by DDNews, Purdue University or the commissioner of major league baseball.
Peter T. Kissinger (who can be reached at email@example.com) is professor of chemistry at Purdue University, chairman emeritus of BASi and a director of Chembio Diagnostics, Phlebotics and Prosolia.