The Recurring Problem Of Financial Conflict Of Interest In Academic Medicine
By
Leonard Zwelling
When is it great to be left out of a major article in The New York Times about American cancer centers? When the article is about conflict of interest.
As has been the case for months now, the NY Times is all over Memorial Sloan Kettering Cancer Center and its highest executives about their oh-so-close financial arrangements with the private sector which sets the interests of these executives squarely in conflict with the financial interests of Sloan Kettering, the financial interests of the companies, and the welfare of the patients.
This blog has written about this phenomenon many times in the past. The blogger was among the committee led by Paul Mansfield many years ago that developed the current conflict of interest policy for MD Anderson. It must be working to some extent. MD Anderson was not mentioned in the article while executives from Dana-Farber, Fred Hutchinson, the University of Utah as well as several from MSKCC were. Good for MD Anderson.
Many would like to make this an issue that requires subtlety. The companies cannot be denied the expertise of the best in academia on their boards. The individuals are able to put a firewall between their own interests and those of patients or the institutions they serve while they simultaneously advise publicly traded companies on drug development strategy. HOGWASH! They cannot. No one can and no one can be sure of what is in another’s mind when he or she makes a decision with far-ranging consequences for patients, academic institutions, or large drug companies. Simply put, institutional decision makers must stay away from any entanglements with companies who make products used in or bought by the institutions in which they serve. They cannot serve multiple masters, especially when patients are among those with interests in their decisions. Period.
The list of leaders with major paydays from the drug companies is like the Hall of Fame of American oncology—Laurie Glimcher (Dana-Farber), Gary Gilliland (Fred Hutchinson), Mary C. Berkerle (University of Utah) and of course the many from MSKCC including CEO Craig Thompson, Robert Benezra and Charles Sawyers. It is now up to the institutions to police themselves as it appears MD Anderson has done. There must be a purge of the conflicts or, if the individuals want to keep their financial interests in the private sector, they may step down from their leadership roles, disclose all their holdings to their institutions and the journals in which they publish, and count their money.
There is no being a little conflicted. Either you are or you aren’t. If you are, you must rid yourself of one or more of the holdings that put you in that conflict.
This is really simple problem. There is no half way. Personally, I think all of these executives should have known better than to do what they did. I had to face this issue as a vice president when the then-president of MD Anderson was conflicted with Enron and ImClone. Now the leadership of MSKCC has to face what I faced in 2002. Good luck. I was only lambasted in my hometown paper, the Houston Chronicle. The leaders of MSKCC were lambasted in theirs as well. Unfortunately for them, it’s The New York Times.
Sloan Kettering must clean up its act. Dismissing Dr. Baselga was only a start. The board and the leadership need a lesson in remedial ethics and perhaps some jobs ought to open up. It’s up to MSKCC. No one can do it for you. But as The New York Times has shown. They can sure do it to you.
