Sunday, January 13, 2019

Memorial Sloan Kettering in Bed With Industry


Is there corruption in the medical profession?  Recall Captain Renault’s iconic rejoinder to Rick in Casablanca.

“I’m shocked, shocked to find there is gambling going on in here!”



In any enterprise with billions of dollars at stake, and when different players have competing interests which may not coincide with the public’s interests, there will be skullduggery.  How do you think our Defense Department and its relationships with vendors would look if we were able to shine a bright light on all its faces?  Do you think it’s possible that a weapons manufacturer might argue, through lobbyists and salesmen, that its weapons are essential to national security and superior to those of a competitor?   How about when a congressman argues for the continued purchase of military equipment manufactured in his district that military experts state is no longer needed?  And, there’s the quintessential and craven corruption of legislators refusing to close military bases in their districts that the military want to close down.

And, so it is with the Medical Industrial Complex where the arena is filled with jousting pharmaceutical execs, hospital administrators, insurance companies, the government, medical device companies, physicians, pharmacy benefit managers, politicians and the public – all competing to protect their interests.  Does this system seem optimal to achieve a greater good for society?

Recently, the Chief Medical Officer of the Memorial Sloan Kettering Cancer Center in New York City ‘resigned’ in the wake of disclosures that he failed to disclose financial relationships with outside health care companies.  In other words, it was a failure to disclose that ousted him, not the conflict.
 
Here’s my riposte to this.  The obvious weakness in our current disclosure policy is that the emphasis is on the disclosure and not the conflict.  Following nearly every medical article that I read, appears a long list of disclosures, often in small font, listing the various business relationships that the authors have with various companies.  Apparently, in the authors’ and the editors’ minds, the disclosures have provided them with adequate ethical insulation.  They argue that readers can weigh the disclosures when they assess the authors’ credibility. For example, if an article is extolling a new diagnostic test, readers may be informed that the author is a paid speaker for the company that manufacturers the test.  The actual conflict, however, remains. 

Over the past 10 years or so, practicing physicians and scientists have been so deluged with disclosures in our journals and at our professional meetings that we have become numb to them.  (How carefully do we listen to the safety presentation given by flight attendants prior to take off?)  The ongoing tsunami of medical disclosures have vitiated their potency, and as I stated above, do not address the actual conflicts. 

The connections between medical science and medical industry can create great benefits for humanity.  I accept and encourage this.  And, I’m all for full disclosure.   But, personal and institutional integrity must be paramount.  Oftentimes, the conflict itself should be disqualifying and no simple disclosure should be permitted to cure it.

Addendum:  The Chief Medical Officer who 'resigned' was immediately hired by... yes, you guessed it, a pharmaceutical company!  And, Sloan Kettering (SK) now prohibits its leaders from serving on corporate boards.   Can we assume this to be an admission that SK now recognizes that such business relationships are improper or did they simply feel the optics were uncomfortable.

Comments, confessions, and disclosures welcome. 


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