Baselga, DePinho and Mendelsohn: None Of Them Gets Conflict Of Interest

By

Leonard Zwelling

The headline above the fold in The New York Times on Sunday, September 8 could not have been clearer. “A Top Doctor Didn’t Disclose Corporate Ties: Sloan Kettering Chief Was Paid Millions”

Jose Baselga is the chief medical officer at MSKCC and a very prominent figure in world cancer research. But then again, so were John Mendelsohn and Ron DePinho when they were correctly accused of conflict of interest during their tenures as president of MD Anderson. The only good news about the latest story was that at least it didn’t happen in Houston.

It’s the same old, same old. Wealthy, powerful academic physicians put their own financial welfare above that of patients and the public, not to mention the institutions in which they held high positions, in order to enrich themselves through the largesse of the pharmaceutical industry. Essentially they were playing judge and jury as well as CFO for an industry which banks on the desperation of cancer patients. They are supposed to be the arbiters of truth, not make money off of their positions. They were all paid handsome salaries. How much is enough?

Each of these men had a fiduciary responsibility to use all his efforts toward advancing scientific truth, not to enlarge his personal bank account. None of them did that.

The latest may not even be the most egregious. At least Baselga kept it under wraps and seems to have informed the institution about his income, even if not the readers of the articles he wrote about the drugs in which he held a stake. DePinho actually pushed his own company on national television.

These guys tend to flout their own rules. In that, they are like the current occupant of the White House reaping financial benefits from his hotel down the block in direct opposition to the Constitution’s emoluments clause.

Let’s try to go over this once more.

If you have a stake in a drug company or take anything from that company or can use what the drug company gives you to make a boat payment or sate your hunger (free lunch), you cannot prescribe their drugs for your patients or test their efficacy or safety in a clinical trial. What could be simpler?

Essentially, you may think that the financial rewards don’t influence your thinking, but why should I believe that? I don’t. Every time it has been examined objectively, conflicts alter the prescribing behavior of doctors. The only way to convince me (or anyone) that you did this for the right reason is to have only one reason—benefitting the patient not your checkbook.

How far would I take this?

When I was the VP signing the contracts with big pharma to sponsor the trials at Anderson, trials over which I had virtually no control and in which I had no stake, my wife and I sold all of our stock in drug or biotech companies so as to eradicate any traces of even the appearance of conflict of interest. That’s what we had to do and we did it.

The three people named in this blog all took large amounts of money and/or stock from companies whose drugs they were testing or were being tested at the institutions they lead. That’s simply not right.

Is it illegal?

No.

Is it unethical?

Yes.

Is it against the rules of the institutions they purported to lead?

Each institution has to determine that for itself as the government gives no real guidance here as it does in the areas of human subjects research, animal care and use, and research misconduct.

It is clear from the NY Times article, that Dr. Baslega went way too far and ought to be dealt with accordingly. Loss of stature, loss of job and loss of financial gains all seem appropriate to me, but that’s up to Sloan Kettering. The institution will be judged by how it deals with this crisis of confidence.

What is obvious is that the pubic ought to be very suspicious of the “breakthroughs” they read about in the lay press or even in the medical literature.

The first question shouldn’t be “is it too good to be true?” The first question ought to be, “who got paid, how much and by whom in association with these fabulous clinical trial results?”

What’s at stake? Only the credibility of academic science. Am I being too dramatic?

You decide.

Leonard Zwelling