A word from your sponsor?

February 23, 2007

Growing distrust of medical histories funded by industry could ultimately help to improve scholarship and encourage a more healthy public critique, argues David Cantor.

Recently I had a somewhat bizarre conversation with a medical colleague at the National Institutes of Health (NIH), the US federal government biomedical research agency in Bethesda, Maryland, where I work as a contract historian. This colleague saw himself as a proponent of a new approach to cancer that would initiate what he called a Kuhnian revolution in the small area of oncology in which he worked: a new paradigm was about to be born, if only his fellow physicians would recognise it.

Unfortunately, he explained, most physicians were wedded to an outdated paradigm and narrow-mindedly opposed the new way of thinking. He hoped that history could help to show them the error of their ways and was willing to support a historical project to this end.

Physicians often expect historians to tell stories of biomedical progress, to venerate great men, women and institutions, and to communicate the wonders of modern science and medicine to an uncomprehending world. It is rare that we are seen as midwives of a new scientific paradigm. I decided not to pursue the proposed historical commission.

I am still not sure why my colleague thought a historian might succeed where he, a physician, had failed. He was a mixture of pessimism and optimism: pessimistic that he could achieve this paradigm shift and optimistic that it would come about at some point, and that in some mysterious way historians could help in its emergence. More disturbingly for someone working at the NIH, he seemed blind to the issue of conflict of interest that his offer of support raised.

Studies suggest that clinicians and scientists who accept gifts from corporations are more likely to choose the companies' products, and that corporate-sponsored research studies are likely to favour those sponsors.

NIH scientists have recently been investigated for their connections to pharmaceutical and biotechnology companies. But my colleague seemed remarkably unaware of the parallels between his own offer of support and the support that physicians and scientists receive from industry.

The NIH believes that commercial sponsorship can undermine the credibility of scientific research, but my colleague found it difficult to believe that medical sponsorship might undermine the credibility of historical research.

It is unlikely that he imagined historians to be less susceptible to persuasion than physicians, or that he disagreed with the view that the purse strings of contract work could tighten to strangle findings a sponsor dislikes. Somehow, these issues did not apply to the historical project this physician proposed to commission.

Anyone working in commissioned medical history will be familiar with the issues raised by this story: the conflict of interest involved in sponsored work, the sponsor's apparent blindness to it, and their implications for the credibility of the history produced. But, for many years, these issues were of limited interest to anyone outside a small group of specialists.

The sponsors of commissioned medical histories might have hoped for immortality or a paradigm shift, but what they often got was tired institutional history that nobody wanted to read.

Recently, however, medical historians have been hired to write a new sort of commissioned history, one that is as much about issues as institutions.

These issue-driven histories explore much more politically and socially contentious topics than the older institutional histories and so tend to attract a broader readership. Their subjects have included the role of German medical and biomedical organisations in the Nazi regime, biomedical involvement in radiation and other human experiments, and the health issues associated with the tobacco, asbestos, nuclear and lead-paint industries.

Such works bring new attention to concerns that commissioned historians may be tailoring their tales to fit the needs of their sponsors and raise, once again, questions about the credibility of commissioned histories.

Nowhere are these concerns more evident than in the recent involvement of medical historians as expert witnesses in litigation. In many instances, contract historians have come to remarkably different interpretations of the historical evidence, raising questions of objectivity and ethical standards.

Those paid by one side provide interpretations that support their case; those paid by another provide evidence in favour of the opposite interpretation. It is easy for commentators to point to the financial rewards of legal work as providing an incentive for historians to slant the story one way or another, especially as some historians had no research interest in the subject before there were hired.

Critics have focused especially on industrial and commercial sponsorship. For example, the historian Robert Proctor has recently noted that the tobacco industry far outspends its opponents in supporting historical research on smoking and health. According to Proctor, such spending is part of a broader effort by the industry to manipulate historical scholarship to further its own interests and create a body of scholars and scholarship that it might draw on in litigation. Moreover, he notes, it is difficult to spot this manipulation because some historians have been reluctant to mention the source of funding in their scholarly publications, leading one New York Times journalist to ask: ought this trend towards litigation mean historians should declare whose wallet is behind their research? In his 2004 expose of such doings, Proctor suggests that history journals might go further than requiring a declaration of funding. They might, he proposes, follow the lead of the American Medical Association and consider rejecting publications funded by the tobacco industry.

The tobacco industry is not alone in seeking to rely on scholarship. The asbestos and lead-paint industries have also funded scholarly work related to litigation. In certain respects this is a remarkable turnaround. In the past, company histories tended to downplay health issues associated with their industries. These new histories tend to bring them to the fore.

Compare, for example, Peter Bartrip's The Way from Dusty Death (2001), an industry-funded account of the British asbestos producer Turner & Newall (T&N), with Geoffrey Tweedale's Magic Mineral to Killer Dust (2000), a history of the same company. While Bartrip argues that T&N did all it could to address the problem of the health hazards of asbestos, Tweedale argues the opposite case: that T&N knew about the hazards of asbestos very early and did less than it might have. Similarly, compare Peter English's Old Paint (2001), an industry-sponsored account of childhood lead-paint poisoning, with Christian Warren's Brush with Death (2000). English portrays the lead-paint industry as a pioneer in prevention against the health hazards of lead, yet Warren and others argue quite the opposite: that the industry did less than it might to promote awareness of the hazards of lead paint.

It is such stark differences between industry-sponsored and non-industry-sponsored histories that encourage distrust of commissioned histories and that have brought the issue to a wider audience. Professional historians have long treated the older institutional commissions with caution. But the emergence of issue-driven commissions has encouraged a broader cultural scepticism. Recent commentaries in The New York Times, Nature, The Lancet and other publications have highlighted the social, political and commercial interests behind commissions and how they shape the nature of the history they sponsor.

These commentaries are concerned primarily with industry sponsorship, and they say less than they might about the sponsorship of other organisations or the ideological (as opposed to financial or opportunistic) motives that might encourage a historian to seek a particular sponsor.

Nevertheless, they have begun to sensitise a broader readership to the problems of commissions. The silver lining on the cloud of issue-driven history may be the emergence of a sceptical, critical reader.

It is here that I begin to question Proctor's call for journals to reject the publication of certain commissioned histories. While he is correct to point to the ways in which the tobacco industry seeks to manipulate history to promote its own ends, his call betrays a pessimism about the readers of commissioned histories, as if they cannot be educated to treat what they read with a healthy scepticism.

Yet, paradoxically, Proctor also provides readers with tools to read critically: his articles highlight the interests behind histories commissioned by the tobacco and other industries and the reluctance of some historians to admit to their funding. Surely this is a way forward. Rather than reject the publication of certain commissioned histories, we need critical reflection on how the conditions of commission shape historical writing.

We need to ensure that readers are aware of the wallet behind the work, and that funding it is a factor in peer review. We need to welcome scepticism among readers and reviewers. It opens the possibility of a public that is critically engaged with history, and it forces commissioned historians to address the issue of credibility: why should anyone believe what they write?

David Cantor is a historian at the National Cancer Institute and the National Library of Medicine in Bethesda, Maryland. This article is based on a longer paper on the politics of commissioned histories that appears in The Historiography of Contemporary Science , edited by Ronald E. Doel and Thomas Söderqvist.

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