Friday, December 16, 2005

The "Whiff of Corruption": Update on the Topol - Merck - Cleveland Clinic Case

There are a number of developments in the Topol - Merck - Clevleand Clinic case.

We have previously discussed, most recently here and here, the complex story of how Dr Eric Topol abruptly lost his academic leadership positions at the prestigious Cleveland Clinic shortly after he testified about Merck, its handling of research about and marketing of Vioxx, and its attempts to intimidate him; and just before a report came out alleging serious conflicts of interests affecting the Clinic's leadership, conflicts which Topol had been investigating.

First, excerpts of an interview with Topol appeared in an article in theheart.org, (here, subscription required), a web-site edited by Topol, and were picked up in an article in the Cleveland Plain Dealer. On the timing of his dismissal, Topol said:


It's a little hard to believe it was a coincidence. I'm not trying to say that the Vioxx/Merck thing was the only reason this occurred; I'm just saying it contributed and certainly the timing of it had to play a role, unquestionably.

Furthermore,


All I can say is, if you have a table of organization changed, it doesn't need to be done on an immediate basis like this. My appointment naturally would have run out at the end of the calendar year, so ti could have been set up that, in January, we'd start off with this different configuration .... The emergency action is very peculiar, and the fact that it was not even approved first by the board of trustees - you'd have thought that this would have been approved before they told me. So this is what's troubling about this whole thing: why did this have to be such a rush?"
Meanwhile, the Plain Dealer also reported that the Cleveland Clinic was going to do an "independent review" of the conflicts of interest issue. The newspaper quoted James Unland, who consults for hospitals about compliance, "This is a house that needs to be cleaned." Furthermore, he stated that the review should be conducted by "someone with no hidden agenda or prejudice one way or another." We'll see how it actually is done.

Finally, New York Times columnist Paul Krugman took note of this case. He wrote,

The real story is bigger than either the company or the the clinic. It's the story of how growing conflicts of interest may be distorting both medical research and health care in general.
The essence is simple: crucial scientific research and crucial medical decisions have to be considered suspect because of the financial ties among medical companies, medical researchers, and health care providers.
The past quarter-century has seen the emergence of a vast medical-industrial complex, in which doctors, hospitals and research institutions have deep financial links with drug companies and equipment makers. Conflicts of interest aren't the exception -they're the norm.
The whiff of corruption in our medical system isn't emanating from a few bad apples. The whole system of incentives encourages doctors and researchers to serve the interests of the medical industry.

Krugman will be suggesting how to change the bad policies that lead to all this. I'm not sure I'll end up agreeing with all his suggestions. And readers of Health Care Renewal will note that the problems goes beyond research, and beyond the organizations he mentioned. But I do believe that in general, he gets it.

1 comment:

Russ Maulitz said...

The Krugman article, in particular, deserves closer scrutiny. I hope folks will read it before it is "aged off" the Times site and becomes paid-archive only.

Essentially, what Prof. Krugman has done has demystified the oft-quoted dictum from our good friend Pogo, "we have met the enemy and he is us."

Here, finally, we have the really underlying mechanism whereby academics are cowed into submission. The ugly little truth is that scientific medicine has come, in many cases, to police itself as it was always supposed to--but in a way that's topsy-turvy, inimical to its original core values.

The big org always has its man on the inside. (Yep, usually is a man.) When the axe falls and the knife goes in, the Topols of the world find it's "et tu, Brute."