Medical Academics Consulting for Industry: Riding the Tiger

On the Hooked: Ethics, Medicine and Pharma blog, Dr Howard Brody dissected the complex relationships among GlaxoSmithKline (GSK), and its physician consultants regarding the drug rosiglitazone (Avandia).

We had previously posted about the report of a US Senate committee implicating top GSK executives in an attempt to silence a physician who was one of the early critics of Avandia. Dr Brody went through the report in depth, and found that things were more complicated. The physician involved was simultaneously a consultant to GSK, and to the company that made a competing drug. Brody wrote,

I agree that it is bad when companies try to intimidate scientists to keep quiet about potential drug risks. But what about the academic physician-scientists, who think that they can ride the tiger and still stay in control? Dr. Buse, it appears, thought that on the one hand he could pocket his consulting fees (and perhaps speaker fees as well; we are not told) from these drug companies; and on the other hand could freely speak his mind as an academic scientist. His new owners told him in no uncertain terms that once the business deal had gone through, he had better remember who was calling the shots. Buse himself seems to have gotten the message as to who owns his opinion--when the press approached him recently to say something nasty about GSK, he refused, saying that the matter was over years ago, that they had apologized to him, and he was eager to let bygones be bygones.

My central message in HOOKED is: when we physicians are lacking in our own professional integrity, pointing fingers at the bad drug companies is hardly an adequate ethical response.

It's clearly an important point, and a reminder to us physicians that too often in health care, the old quote from Pogo applies: "we have met the enemy, and he is us."

These days, a lot of academic physicians and other medical school faculty are trying to ride the tiger. They may end up doing this because what counts most to their academic bosses is how much external funding they bring in (or, as one medical school dean said, whether they are "taxpayers.") Since health care corporations (pharmaceutical manufacturers, biotechnology companies, device manufacturers, etc) now are the largest collective source of medical research money, they are thus under great pressure to collaborate with these companies. An academic trying to raise research money from one such company might find it hard to resist offers of consulting fees, speakers honoraria, advisory board positions, etc from that company. But once the academic thus starts to work part time for the company, who knows where his or her interests lie? And how the academic has to try to stay on the tiger.