Friday, March 19, 2010

Gruber at MIT to Senators: "I Promise To Be Good ... Next Time"

Frequently expressed on this blog are concerns about conflicts of interest and their corrosive effects upon healthcare (query link). We also have expressed concern about the mental gymnastics used by the privileged or those in positions of power to rationalize these COI's and/or justify keeping these COI's from the public's eye.

In a stunning display of academic arrogance, MIT economics professor Jonathan Gruber, who promoted and defended the administration's health care policies before the U.S. Senate Committee on Finance as well as the Health, Education, Labor & Pensions Committee, while collecting $400,000 from HHS for his services, literally blew off a letter of inquiry from Senators Grassley and Enzi regarding possible conflicts of interest. (See this Google search on the terms "jonathan gruber conflict of interest HHS".)

The professor has been a source of support for what many consider improbable arguments of the impact of current health care reform efforts, while being on the HHS dole.

Sen. Grassley and Sen. Enzi have thus written Dr. Susan Hockfield, President of MIT, to "encourage" the professor to be a little more forthcoming in his replies.

The letter to Hockfield and a copy of the original letter to Prof. Gruber can be downloaded here (PDF).

On Jan. 26, 2010 Gruber was asked some very specific questions by letter (summary below, see full letter at link above for details).

He was asked by the Senators:

  • To identify each contract, grant or cooperative agreement he has executed with the federal government, including the White House and HHS and its operating divisions, during the past five years. For each contract, he was asked to respond to a series of detailed questions on: specifics of work performed, federal official serving as contact, start/end dates, amount of compensation, plus a request for copies of the contracts, grants, cooperative agreements, and a copy of the deliverables;
  • To identify which of the contracts are "sole source", and provide the reasons the contracts were sole source, what official made that determination, and who is the federal official with whom he negotiated the sole sourcing;
  • To answer similar questions about contracts with state and local governments and private entities and individuals he had executed in the past five years;
  • To identify all interviews or statements made to the media on healthcare reform since the federally funded work began, and if asked during the interview or if he did so voluntarily, to state if he revealed the HHS relationship; and
  • To answer similar questions on all speaking engagements.

To these detailed inquiries, the response was this (emphases mine):

February 23, 2010

Dear Senators Grassley and Enzi:

This letter responds to your letter to me dated January 26, 2010.

I appreciate your commitment to the principle of transparency in government and can assure you that I never intentionally withheld my two HHS contracts from Congress. Indeed, my contracts were publicly disclosed on the federal government website,

[Prof. Gruber seems to confuse the passive "publicly disclosed" with active "public disclosure," and apparently misses the point that a possible conflict of interest is an obligation of the principal(s) to disclose when they publish or speak, not an obligation of the audience to discover ex post facto via governmental or other websites - ed.]

As you know, my professional research focuses on public finance and health economics and throughout my career I have worked with Democrats and Republicans alike on the critical issue of health care reform. I served as a consultant to then-Governor Mitt Romney in connection with health care reform efforts in Massachusetts and have also testified before the Congress on these issues.

[That worked out rather poorly, according to Massachusetts Treasurer Tim Cahill - ed.]

I was invited to testify jointly by the Majority and Minority Members of the Senate Finance Committee in the Summer of 2008 on the interaction of health insurance and the tax code and have testified more recently as well. In addition, over the past year in connection with my economic analysis work for HHS, I have worked closely with the staffs of both the Senate Finance and the Senate HELP Committees in evaluating various health care reform proposals and assessing how such proposals might be scored by the Congressional Budget Office.

To the best of my recollection, during the course of my health care reform work with Congress, no Member or staffer ever asked me whether I held any government contracts. Given that the staff saw the time that I was devoting to this effort, in retrospect, I suppose I assumed they understood I was being paid for that work.

[Assumed you were being paid ... to the tune of nearly half a million dollars? - ed.]

Both my congressional testimony and the health care opinion pieces that I have authored reflect my longstanding policy views -- and were in no way influenced by my contracts with HHS, which related to technical economic modeling designed to determine the costs of various health care reform policy options.

[Which raises another question: was that 'modeling' influenced by the HHS money? - ed.]

It certainly did not occur to me that anyone would view my HHS contracts as relevant to my independent, long-held opinions regarding the economics of health care reform. [Really? - ed.] I regard the contract work I performed for HHS and my public speaking and writing as being independent and unrelated. But I do recognize the public interest in these disclosure issues and will certainly consider them in the context of future appearances on the Hill or in the media.

[I note that "I will consider them" (i.e., disclosure 'issues') is an ambiguous statement, as opposed to "I will disclose my possible conflicts" - ed.]

Thank you for your work on these issues.


Jonathan Gruber

In other words, I guess the public does have a right to know about my possible conflicts of interest when a major portion of the US economy's about to be up-ended, and I'll be a good boy and team player - next time. By the way, regarding your detailed questions, you do good work, but get lost.

Academic contempt for disclosure of conflicts of interest seems to know few bounds. I doubt the letter to the MIT President will accomplish very much.

Let's hope the responses from the healthcare IT vendors to Sen. Grassley's inquiries are more forthcoming than this academic one.

Finally, it occurs to me that profligate spending of almost a half million dollars for the sole-source consultation of a single (already salaried) professor raises a concern about cherry-picking for theories supporting a certain point of view, and shows questionable governmental fiscal responsibility.

That is the size of a research grant that could support, say, a significant fraction of the time of a half dozen academic collaborators with a diverse set of theories and views.

-- SS

Disclosure: I have not received a penny from HHS, government, academia, industry, or even Tinkerbell or the Tooth Fairy for these views.


Anonymous said...


Steve Lucas

shadowfax said...

Holy smokes. Talk about molehill->mountain. They guy has been entirely consistent through his career in his approach to health care economics, and the "discovery" that he has also done some work for HHS is now being used to discredit him. I call BS, specifically on the use of weasel phrases like "The professor has been a source of support for what many consider improbable arguments of the impact of current health care reform efforts, while being on the HHS dole." talk about the loaded innuendo. He's a highly respected technocrat and academic, and the fact that "some people" disagree with him (common in economics and politics) is not valid cause to impeach the quality of his work as "improbable," with the clear implication that he's just making shit up to please his overlords in the Obama administration.

I agree that it would have been wise for Gruber to be more active in disclosing other government work he had done. I think you are way off the reservation in attacking his work or his advocacy, especially in the absence of any evidence at all of anything other than an "appearance" of conflict of interest. You want a scandal, give us evidence of wrongdoing. And I see no reason on earth why he should be under an obligation to play along with a partisan witch hunt from peeved Senate Republicans.

MedInformaticsMD said...


You completely missed the point of my posting about academic arrogance and failure to disclose/failure to reply to an inquiry from two Senators.

The professor has been a source of support for what many consider improbable arguments of the impact of current health care reform efforts, while being on the HHS dole."

I'm not sure what part of that google-backed statement you are refuting. Please elaborate.

This and your other comments are interesting, but are basically deflections from the topic of academic arrogance regarding COI.

I agree that it would have been wise for Gruber to be more active in disclosing other government work he had done.

Just "wise?" So you too think such disclosures are optional? Perhaps you are reading the wrong blog.

I also find your comments about "witch hunts" by Grassley and Enzi frankly appalling.

For instance, Grassley strongly supported progressive drug safety activists who came under fire at FDA, one of whose opinions forced about ten unsafe drugs off the market, i.e., David Graham, and others.

See for example Dr. Roy Poses' post here.

He's also been about the only elected official who's challenged the health IT industry.

Please offer more than accusations of partisan "witch hunts" that you feel academics should be free to ignore ad libitum.

-- SS

Anonymous said...

shadowfax's profile included this:

I am also interested in Health Policy and Progressive Politics.

true 'progressives' have no real moral sense, they're like the chameleon. ends justifies means.

makes no sense to have discussion on ethics.

Anonymous said...

This epsiode raises more questions.

For instance, might it just be possible that the minions who are trumpeting the need for HIT at any cost of life and finance are on the HHS dole?

Would HHS pay consultants who advise of the dangers of HIT?

Would well paid HHS consultants trumpet the need for FDA regulation of HIT because of the abuses of the industry and HIMSS?

There are many more.

MedInformaticsMD said...

Re: anonymous March 19, 2010 11:10:00 PM:

I consider ideology irrelevant to my discussions. In medicine, the issues I discuss are non partisan.

Conflicts of interest and corruption afflict humans, not merely ideologues of one flavor or another. In other words, I don't really care if you're to the right, to the left, a "respected professor" or anything else. You act corrupt, or even allow the appearance of impropriety, you deserve sunlight.

Re: Anonymous March 20, 2010 4:29:00 PM:

Good questions. I think my more recent post "Study: Researchers with Glaxo ties favored Avandia" is relevant. I wonder how many authors of rabidly pro-health IT articles are written by people with industry conflicts of interest, and how many that point out the industry's inadequacies and the deficiencies of the technology as it is in 2010 lack those ties.