Sunday, February 13, 2005

The NIH: "We Have a Systemic Problem"

We have written a lot about the conflict of interest scandals at the NIH. (See below for links to related posts on Health Care Renewal, plus a citation of a newspaper op-ed.)

We have also noted several times how little discussion there was of this story in the medical and health care literature, and even what is now called the main-stream media (MSM). This appeared to be an example of what Russ Maulitz called the anechoic effect, the silence that greeted any story about concentration and abuse of power in health care.

Thus, I was gratified to see an interview published in yesterday's Los Angeles Times which provided a lot of support to our viewpoint on this scandal. Here are some particularly pithy quotes:

  • "If you are weighing in on behalf of the public, I want you to be there on behalf of the public. Don't tread [trade] on your prestige, position, in a way that pretends to be completely objective."
  • "I came to the conclusion that we have a systemic problem. They were not just isolated events. They reflected a complete set of rules that had been adopted over the years, which had transformed the culture..... if that's the case, let's bring back the culture to where it needs to be: that is, public first."
  • "No limits on stock. No limits on money. No limits. Where were all those holier-than-thou intellects?" "This issue was standing between the history of the NIH and its future."

What is most striking is that the interviewee was the current Director of the NIH, Dr. Elias Zerhouni. Clearly, having the public support of Dr. Zerhouni for unconflicted, ethical leadership of the NIH is a big step forward. The interview also marks a significant crumbling of the anechoic effect (to badly mix metaphors).

Dr. Zerhouni's approach also stands in stark contrast to how leaders of other major health care organizations have reacted to allegations of uninformed, incompetent, self-interested, or even corrupt leadership. The usual way of doing business has been to circle the wagons, deny the problems, and, if pushed very hard, purge the most visible culprit and then declare the problem resolved.

Concentration and abuse of power in health care are widespread problems, as perusal of recent posts on Health Care Renewal demonstrates. We need all the support we can get for informed, competent, honest and ethical leadership of health care organizations. We can now use Dr. Zerhouni as a good example, and hope we can count on his support for the reform of leadership of other organizations.

Previous Posts and One Article

End of the Anechoic Effect: Editorial Reaction to the New NIH Rules

Pogo at the NIH

NIH Seeks Higher Standard: Better Late Than Never

Ban on Federal Scientists' Consulting Nears

Yet More Conflicts of Interest at the NIH

Few Echoes from Allegations of NIH "Appearance of Corruption"

The Anechoic Effect and Conflicts of Interest at the NIH

More Outrageous Conflicts of Interest at the NIH

Poses RM. Corruption, incompetence in health care. Providence Journal, December 17, 2003.

1 comment:

Wallace Sampson said...

The "systemic problem" extends elsewhere as well. It is common knowledge that most Federal regulatory employees have options for walking through that revolving door and taking lucrative private positions after their Federal service, and sometimes well before retirement. This leaves employees and scientists vulnerable to commercial corrupting influences of future contracts while still in position of policy setting.
One former FDA official (a woman) left FDA to act as a private lobbyist for industries after pushing a conference on acupuncture needle removal from the Investigational Device list in 1995-6. She and the committee held a hearing at which only advocates were invited.
She subsequently has been involved in lobbying for industry with FDA officials, and just last month helped set up a conference on industry regulation of herbal supplements.
That is just one.
In the small world of "alternative medicine" research, the recipients of grants in the $millions sit on the NCCAM Advisory Council and Scientific Adv. Council, approving research projects and policies, and they serve as reviewers of one anothers' requests. The same people also serve on most commissions - White house Commission, Institute of Medicine committee, etc.
As bad or worse, the same people serve as peer reviewers for medical journals, approving publication of articles with false claims. They also hold review positions for the Natl. Library of Medicine for listing and abstracting on Medline, thus holding control of almost all publications in the field. They thus control content of research reports, student, physician and patient web searches, and content of education courses.
Meanwhile, experts who are critics are excluded from all governmental committees and conferences.
Talk about your sytemic problems.

Wallace Sampson MD