Saturday, December 17, 2005

The Topol - Merck - Cleveland Clinic Case Gets More Complex, and Gets More Attention

The Cleveland Plain Dealer and the New York Times are continuing to uncover new complications in the story of how Dr Eric Topol lost his academic leadership position at the Cleveland Clinic. We most recently discussed the story here.

The Times suggested that what is going on at the Clinic "goes far beyond a simple power struggle between strong-willed men," but has "focused attention on the many longstanding corporate ties at the clinic." It suggested that Topol first made himself unpopular with the rest of the Clinic leadership when be publicly criticized Merck and its handling of Vioxx in 2004. Soon, "Dr Topol soon found himself under attack. He was the subject of the Fortune magazine article, which contended he had a conflict of interest." Furthermore, "Dr Topol soon found himself under fire at the clinic.... The Clinic investigated Dr Topol's business dealings, according to people briefed on the inquiry." Dr Topol's response was to "cut all ties to industry." That made him even less popular. "When his contract came up for renewal at the clinic at the end of last year, the clinic put Dr Topol on a form of probation, giving him a six-month contract rather than the usual yearlong agreement...." Thus, the Times implies that Dr Topol lost his academic leadership positions because he renounced the sort of industry ties that other Clinic leaders cultivated.

These ties were even more complex than previously reported. The Times reported these new examples:
  • Malachi Mixon, the Chairman of the Clinic's Board of Trustees, is the CEO of Invacare, a major home health care supply company. Invacare does about $200,000 worth of business with the Clinic yearly, although Mixon dismissed this as "peanuts."
  • Dr Bernadine Healy, the first women to head the US National Institutes of Health (NIH), the former President of the American Heart Association, the former head of the Red Cross and wife of the former CEO of the Clinic, Dr Floyd Loop, is a Trustee of Invacare, and owns 41,570 of its stock options.
The Cleveland Plain Dealer also disclosed more possible conflicts of interest affecting the leadership of the Clinic:
  • Via a report in the Wall Street Journal, Clinic CEO Dr Toby Cosgrove publicly praised a heart lung machine made by a company called CardioVention without revealing his or the Clinic's financial interests in it. CardioVention was sued in 2002 after a patient on whom its machine was used at the Clinic died, and the company ceased operations in 2003.
  • Harry Rein, founder of Canaan Partners, who helped the Clinic set up and run its own venture capital fund, Foundation Medical Partners, was revealed to be a member of the Clinic's Board of Trustees.
The Times quoted Dr Jerrome Kassirer, former Editor of the New England Journal of Medicine, saying that the potential conflicts of interest at the Cleveland Clinic are "extremely serious," but that in having such conflicts, the Clinic "is not unique at all." Thus, the case of Dr Topol's dispute with the Cleveland Clinic is becoming emblematic of how leaders of large health care organizations are increasingly affected by more and more severe conflicts of interests. Such conflicts may undermine their organizations' missions and the core values of their physicians and other health professionals.
There is one bit of good news here. The national attention this case has received is a sign that the anechoic effect is ending.
The anechoic effect is our term for how cases of ill-informed, incompetent, conflicted, or even corrupt management of health care organizations, and how they threaten health care's core values seem to vanish without any wider echoes. For example, some of the biggest whistle-blower cases of the 1990s, those of Dr David Kern and Dr Nancy Olivieri, were hardly noticed in the national media (US and Canadian, respectively) despite aggressive reporting in regional news outlets.
But, now the New York Times and the Wall Street Journal seem to be sticking with the case of Dr Eric Topol, not just leaving it to the Cleveland Plain Dealer. And it has attracted the attention of Paul Krugman, one of the Times' national columnists, who is now warning of a "medical-industrial complex," and corruption as a systemic problem in health care.
Maybe this will make physicians, policy makers, and the public at large recognize conflicted health care leadership, and the larger issues of concentration and abuse of power in health care as fundamental threats.

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