And Americans wonder why drug prices are so high.
4
We can trace the origin of this entire narrative back to Nixon’s 1973 HMOA73 (I think) bill which transformed the practice of medicine into the industry it is today.
Two things that should not be exposed to the market pressure if our capitalist society, one is health care which no longer seeks to cure diseases but to simply “maintenance our health” and education which seeks not to teach so much as to indoctrinate.
7
I work for a company that has many medical experts who participate in the type of research collaborations this editorial describes. Without exception I have found these medical experts to be sincerely interested in solving medical issues on behalf of patients. Most of these people are nerdy geeks who are passionate about their work. I suspect part of the problem is they forget to consider optics. Also keep in mind there are only so many experts in a given field so these collaborations can be inherently incestuous—unless you don’t want the best minds working on the therapy that might save your life some day
5
We are seeing how truly corrupt our nation's businesses are, abetted by legislative failure.
1
ProPubica's excellent website, Dollars for Docs, shows Dr. Baselga took over $3,375,000 from pharmaceutical companies and device makers in the years 2013-2016, a warning sign if there ever was one. I caught on to a neurologist's efforts to get me on a regimen of Botox for migraines (which a subsequent neurologist found I did not have) by researching her name on Dollars for Docs and discovering that she had taken nearly $900,000 over three years. People should check out their physicians on this useful website to see whether their doctors can be trusted to provide good care.
7
Is this a problem of modern medicine or modern American medicine?
4
As much as I loathe this sort of quiet crookedness, I wonder if folks are really all that willing to see their taxes cranked to pay for that complete independence?
And I'd like to suggest a parallel article on the quack nostrum, homeopathic, organic cures, holistic medicine, and supplement industry, which is at least as crooked and doesn't even offer actual benefits.
2
Greed Trumps ethics. One need not wonder why regulations are necessary. Those who rail against regulations are often the ones acting most unethically, immorally or illegally. Greed is the everpresent undoing of democracy.
Good luck getting money out of American Capitalism. Good luck getting it out of the medical profession, that camel is in the tent!
2
The question is how can we stop this un-ethical behavior by the top tier of our medical professionals and also the companies who bribe the doctors. If we don't stop this corruption, we will become victims of own negligence. I think we have done talking, and the government should start acting to curb this corruptions.
1
NYT, please don't call this a "lapse". Non-reporting, by a senior physician administrator of one of the largest cancer centers in the world, is no accident nor an accidental "oversight". It is what it appears to be.
5
resign is not enough, jail time.
2
The problems with the pharmaceutical industry go well beyond their relationship with researchers and prescribers.
Most drug research is now funded by pharmaceutical companies which reserve the right to bury negative studies.
Not only researchers and doctors are being bought - the pharmaceutical industry has spent approximately a quarter BILLION dollars annually over the past several years buying our legislators through lobbying
High drug prices are often justified to fund R&D. Yet, in reality large pharmaceutical companies spend significantly more on marketing than R&D
Direct to consumer advertising of prescription drugs is certainly profitable for the pharmaceutical companies but has been opposed by the American Medical Association as harmful to patients and to healthcare cost containment. Indeed this practice is permitted in only two countries in the world, one of which is of course the USA Lobbying congress obviously is effective.
It is laughable that almost every pharma company mission statement lists commitment to patients as their primary goal, while commitment to shareholders and executive salaries is in fact primary.
5
In condemning the doctors involved we shouldn't forget that the decline in public funding of medical research by governments and promoted by conservatives, set the stage for this kind of corruption. It is no different from the general belief that "The Market" solves all of society's ills.
We saw it in England when Margaret Thatcher's government reduced funding to the Medical Research Council , insisting on industry involvement and "public-private" partnerships supposedly "good" for capitalizing on the fruits of industry-funded research.
The same trend has proliferated in most Western countries mesmerized by free market dogma. Big Pharma has exerted undue influence on scientific journals which often don't publish negative results - to all of our detriment.
The whole enterprise becomes circular and self-serving with Drug Companies recruiting medical academics to promote their products as they further their careers with the assistance of ghost-writers to help them churn out "research" which bolsters their academic credibility and in turn that of the flawed studies they promote as payback to their paymasters.
This has all been documented but especially by Ben Goldacre in his excellent book "Bad Pharma", which should be recommended reading for all medical students and physicians.
Restoring public money to fund dedicated researchers and paying them properly and excluding drug companies from universities would solve this problem in a heartbeat.
7
As a medical researcher I have to file conflict of interest forms annually with my institution, and declare conflicts every time I publish in a scientific journal. There are penalties for lying on these forms. Yet our president is not held to even a modest approximation of this standard. Trump makes decisions that affect the health and safety of the entire country, if not the world, and we know that he is personally profiting from at least some of these actions and nobody seems too concerned about it. He's put people with industry ties in charge of agencies that regulate those industries... COI anyone? People are shocked that doctors exhibit corrupt behavior, but no one is bothered that our elected officials shamelessly do the same thing, in plain sight.
7
The underlying problem is that medicine in all its forms is BIG business, really big. As long as we, as a society, believe that providing medical care is best done through a market, with money as the key incentive, such financial entanglements will continue to be a challenge. It's like having a flower garden: fertile soil makes for pretty flowers, but is also good for weeds, and thus requires constant vigilance and action to avoid overgrowth and corruption.
6
Dear editors,
Medicine has been corrupted on many levels.
How about an article on medical fantasy billing and collections? Why won’t anyone address the fraud in bills based on the AECOM codes (which codes are not publicly available to consumers) or the incentivized lying collectors of those fraudulent bills?
4
Disclosure be damned! Why it is not strictly illegal for any company to pay a medical professional for doing research, drug trials or any other association with potential medical treatments? That type of practice seems to be a direct conflict of interest, and could result in skewed results that might well endanger the health of Americans.
Surely if outcomes of medical research are "clean" of all financial interference, we would have a far more reliable and accurate set of values concerning modalities and prescription
drugs.
I would think Congress should take a far greater proactive role in writing laws that strictly forbid any and all financial influence in any aspect of the medical profession, research included--or has that body been bought by the medical profiteers as well?
2
As CEO of a preclinical pharmaceutical company the Times' recommendations are a concern. We look to develop a Scientific Advisory Board of thought leaders to help advise us and guide our efforts. Initially we have only shares to offer as compensation. But, do a nine figure deal or go public, and the SAB member will have a financial windfall. Let's not move to a regime where companies like ours lose access to vital US clinical/research knowledge and experience needed.
2
Has anyone considered asking for repayments, or docking retirement funds of the criminals bureaucrats?
3
A few years ago I worked for a medical non-profit. It was a 2nd or 3rd tier institution, not nearly as well-known as Sloan Kettering. The corruption at all levels of medical "research" establishment was breathtaking: stealing work from others, falsifying results to get grants, silencing and firing critics. If this happens in an typical provincial research center no one pays attention to, I am 100% sure it's widespread in the industry. After my experience I have zero trust left in any kind of medical research or in medicine in general as practiced in this country. All I see is greed.
4
Thank you NYT for the investigative articles on this topic!
2
The problems of conflicts goes beyond money. The belief in a therapy that a physician offers and the distorted view they have of the results of that treatment can go far beyond reality. Add money, prestige and academic advancement to the mix and the vision of researchers can become something akin to a Dali painting. Take the recent example of a trial (CABANA) of ablation treatment for atrial fibrillation. Even before publication the authors were hard at work explaining why their own trials results (generally negative for benefit) were not to be believed.
2
A prominent doctor in NY prescribed a medicine that caused me to faint for the first time in my life...then my blood pressure became erratic jumping 60 points in minutes...the stuff almost killed me. When I told the doctor he became furious and said my symptoms were impossible. Except they were common according the internet and a government agency. My wife researched this doctor through his hospital attachment and found he was receiving six figure "speaking fees" per year from the drug manufacturer.
6
There are many good points in this editorial. I wish to point out that the opiod epidemic was also fueled by a decision by the medical profession to optimize pain control for patients. In my state it was required to take a minimum number of hours of CME training in pain control in order to maintain one's license. Physicians prescribed these medications to manage pain, and probably the vast majority had no financial conflict at the time.
1
It is of course a correct interpretation that financial gain can bias behaviors of even the most ethical individuals, including physicians and scientists. But please, do not disrupt the incredible good that comes from the associations of physicians and scientists with drug companies.
It is very disturbing, and perhaps irresponsible, to read an NYT editorial that fails to point out that federal support for innovative clinical research has been eroded over several administrations. Without the financial incentives of drug companies to invest in research there would be little progress. As it stands now, drug companies are the only way real progress in can be made for final applications of the work in vital basic research to human clinical trials.
We need transparency. We need to weed out those that lose sight of the goal of clinical research. But we need to keep the wheels of progress moving forward. There is incredible opportunity now to make a meaningful difference in human health. Lets not waste it by incomplete and one sided opinions.
6
This editorial displays a woeful ignorance of the distinction between the academic discipline of scientific discovery and the commoditization of the products of that discovery. The article also assumes an inherent corruptibility of the scientist and physician. In its most ludicrous assertion, it assumes that a cold sandwich noon time lunch conference will create legions of physician-drug pushers so enamored of tuna fish.
Science occurs both in the laboratory and in the board room. They are remarkably separate. Unaware observers imagine that both bench and clinical trial results are simply subjective variables that bear no relation to statistical evaluation, peer review , debate, and an inherent degree of uncertainty. The sad truth is that there is not truth and just the hope of progress, often marginal , in bending the curves described by lethal disease.
Cancer doctors and cancer research people have death as their currency. Thought leaders in both are key to informing the direction and practicality of investing billions of dollars into a basic or clinical line of investigation. Such leaders may , as all other corporate board members, be overly compensated but they serve a critical oversight function. In short, there are often the honest brokers in the room.
Writing editorials assume that much homework has been done. Dispassionate interpretation of the seemingly " obvious" may not be popular but it is necessary. You got this wrong.
5
As a retired academic physician I am well aware of the complexity of choosing health care when so many of the so-called breakthroughs are soon shown to do more harm than good. In general, our patients are well advised to be cautious about intervention. (There are spectacular breakthroughs in health care, such as immunization for poliomyelitis, small pox, measles and diphtheria. But not all purported breakthroughs stand the test of time.) My profession is not immune to the natural incentives, even perverse incentives of financial gain. Ultimate Health, Finding It includes an overview of this important dilemma.
3
The financial challenges and waste in healthcare are vast and complex. Take a closer look at how much money health systems are spending on EHR systems. Epic EHR has cost the University of California health system BILLIONS of dollars for 5 campuses. This is tax payer money! Have health or financial outcomes improved due to their usage of Epic? Publicly funded health systems need an extra level of scrutiny. Imagine what could be done with 2 billion dollars in public health and charitable care. It’s time to take a hard look at serious reform with healthcare becoming more regionalized and yes REGULATED.
29
The Federal push for EHRs is just another example of government welfare for corporations. The initial concept of integrated data became the victim of the usual greed. There's no regulation, no standardization, just piles of cash to the few lucky winners. I knew it had become a joke when Newt Gingrich showed up as an "expert speaker" to dip his big ladle into the cash fountain.
1
@Andrew Murray
Healthcare is one of the most heavily regulated activities in the United States. Electronic medical records are mandated by law, and widely disparaged by clinicians. The heavily information dependent practice of medicine, as with business, would not be possible without modern information technology.
Take this with the proverbial grain of salt or perhaps two aspirin.
A PA on a forum told us that every time a doctor does certain things, like prescribe a statin, Medicare will pay the clinic a spiff. I guess the thinking that such things will encourage statin use. Said PA said that at her very small clinic, the payments essentially paid her salary.
I noted this after my doctor prescribed a statin w/o any discussion other than he was going to. Nothing more said, I get to the pharmacy to pick up something else, and there it was. I refused it.
My lipid panels have been TO die for for years. High HDL, very low LDL and Trigs. Total about 143, IIRC.
I can't figure any other reason than pressure from the (giant) clinic management to prescribe. It certainly isn't because I need it.
So, just like car dealers got performance award kickbacks from the manufacturers that consumers never used to know about, the same thing is happening in medicine.
16
Her's a thought: maybe it was a mistake.
Of course I agree that physicians should be completely transparent. But the talk here is absurd. What happens when the financial industry goes haywire? The government bails them out and tolerates misbehavior. We even tax them less (carried interest anyone?). Lawyers get referral fees for doing no work but for sending business to someone else. But god forbid a doctor uses their brain to make money in medicine?
22
What do you expect in a 'free-market' system?
8
No different than Medicare fraud and abuse, the payoff defrauding research is high; the risks are low. Gaming medical research by copying others work and cheating on results all in the spirit of the profit motive has been throughly encouraged by Big Pharma.
Not satisfied with corrupting research and eliminating the elan of academic medicine, Big Pharma's prowess to dominate the practice of medicine has now metastasized into community medical practices; in particular, oncology.
As CMS capped reimbursement in cancer care, especially on drug profits, Big Pharma was there to offset the hurt by paying practitioners to conduct, attend marketing panels, or, just listen to research; while enjoying dinners, trips. As a result, Big Pharma has thoroughly penetrated its tentacles into medicine to corrupt the integrity of its practice, and research.
As the AMA has long shown an unwillingness to set the standard, and academic medicine turns the other way, how are we to protect the sanctity of research when noted physicians are so anxious to shelve their integrity for the payoff?
As the "fish rots from the head," the key is to corral Big Pharma's free wheeling attitude towards monopolizing the free market; advertising to push demand of prescription drugs as tobacco once did; and its attempts to throttle generics. Yet, until Congress removes its feedbags around its necks to collect campaign donations from Big Pharma, who is there to protect the patient?
13
The potential damage to the public as a result of undisclosed compensation to physicians or researchers may be high enough to be criminal.
10
In both disclosure and regulation of conflicts of interest, Financial services industry is way ahead of medicine.
In a bank, a stock analyst cannot have investments in a company on which she publishes research. It is not enough to disclose conflict if interest. She cannot have a conflict of interest.
Banks also prohibit employees from taking a second job. These medical researchers are effectively on multiple payrolls.
We need these rules in medicine. Those who want to make big bucks should work full time for pharmaceutical firms.
7
I am a physician, now retired. I take my Hippocratic Oath very seriously, which means I have sworn to put my patients' interests above my own. Among the consequences of obeying that oath was the decision not to invest in any pharmaceutical company or other company involved in health care.
Physicians who do so should not be practicing medicine, and should give up their licenses. Prominent violators like Dr. Baselga should have their licenses revoked by the state's medical disciplinary board.
People with an MD degree can work, if they choose, in pharmaceutical or medical device making businesses, but they should not be licensed to practice medicine, or see patients in a professional capacity.
My remarks do not deal with the greed factor, which is contaminating not only the medical profession but much of American business and politics. Another time....
27
@swimdoc
So are you suggesting that a physician cannot own stock in a publicly traded company? If so that would seem extreme in a free market society. Physicians are already subjected to a mass of regulation and restriction by law (Stark, anti-kickback, ownership restrictions, etc.). Industry is also subject to a list of regulations on marketing and advertising.
The vast majority of physicians receive almost nothing from industry. Additionally, a larger share of physicians are employed. Support for meetings and seminars is sought by ALL professional groups and meeting planners. The kinds of soft support referred to by a number of commenters essentially no longer exist.
11
Speaking as a specialist surgeon in full time practice since 1991, please don’t forget that the vast majority of rank and file clinicians do not accept bribes from the medical industrial complex.
Under federal “Sunshine” laws you can look up any doctor and see what industry payments they have received, by the year. This all just distracts from the real crimes.
Insulin is over 100 years old and costs on average $1200/month. Doxycycline is 50 years old and costs about the same. Both cost pennies/dose in other wealthy countries with 1st World Healthcare. Almost all designated “Essential Medicines” are generic.
If your gasoline went up 1000% overnight, someone would go to jail. So why is generic drug gouging allowed?
Doctors have no control over any of this. Please direct your outrage where it can make a difference.....
63
In the early 1980s I was a medical student at Tulane which was 1 of several med schools chosen to test Minoxidil (now called Rogaine) for its hair growing properties. Problem was that it's 1 of the most powerful drugs to treat hypertension to the point where it can cause a patient's blood pressure to plunge if he/she takes too much. As we were starting the months long research project, it was disclosed that the drug company (whose name I can't recall now) had begun selling Rogaine to the public before the research was complete. That taught me that money is the only thing drug companies care about. Thankfully no one died from rubbing it on his head to grow hair and "cure baldness" but that could have happened. And another good aspect of the drug for the drug company is that if the patient stops using it for several weeks, all the new hair falls out. So you're hooked on the drug once you start unless you figure out that there is nothing wrong with being bald.
35
@c-c-g Wasn't minoxidul initially developed as an antihypertensive? It was only after it was found out that "systemic" administration (ingested or injected) often led to unwanted hair growth that its topical administration for baldness was explored. That being said, even topical use can lower blood pressure rather quickly, which can be unsafe.
1
This is one of the ways that money corrupts medicine. There are others. Look at the way research grants are awarded in some fields by NIH. The in-crowd is picked when the agency has decided whose view will be encouraged, and whose will discouraged. Some reviewers in secret reward the ones they want, these grants give great prestige to the grantees, they get tenure, are selected for journal boards and reviewers and so that view is now impregnable. Other views don't get published, their chapters in books disappear in revised versions.
This is the way medicine fails to move forward and the public suffers.
If you think academic researchers cannot be corrupted by the federal grant process, you would be wrong. One congressman said some years ago that it was a closed process with no outside influence. So NIH appointed ombudsmen and nothing changed.
Why would a federal agency do this, you ask? Maybe you should ask them. A lot of sick people would like to know the answer.
7
I am the mother and legal guardian of a 56-year-old son who suffers from long term mental illness through no fault of his own. A few years ago I moved him from a nursing facility in a small Illinois town to Chicago where I now lived. I observed excruciating changes in his behavior and unsuccessfully tried to communicate with the psychiatrist attached to the facility. Researching on-line about the main medication my son was placed on, I became concerned with how high the dose was. Also researching this particular psychiatrist, I found he'd been accused of over-perscription of the drug and implicated in a death or two. If I recall correctly, he wasn't found guilty on those charges. But some long time later after my son was no longer in his care, I stumbled across a small newspaper article stating that this psychiatrist had been found guilty of accepting kick-back payments from the drug company for prescribing this medication. I add this information to the current discussion, as well as my fervent prayer for all those who suffer from the avarice of the very people the ill person is forced to rely on for help.
18
Patients should have full knowledge if the hospital, clinic or Physician has an employment or contractual relationship with any drug, device or procedure being recommended.
Up front and in plain language.
9
As dire as the corruption of Pharma on physicians' prescribing practice (worse is their marketing divisions cooking the evidence of drug trials)--it is broader fiscal pressure that threatens good care.
Even non-profit hospitals have turned into empires, steered by MBAs seeking profit margins to cover costs and pay big$ to administration. Risk managers design electronic records to minimize litigious exposure but corrupt accurate actual clinical observation and meaningful notes, let alone engaging w/ patients.
Meanwhile, the care provided to hospitalized acutely ill patients is fragmented.To save $, one patient can be visited by an aide, LVN, RN, nurse practitioner, physician assistant, fellow, resident, hospitalist and attending MD-all strangers, rarely assigned to a patient beyond one 8 hour shift-with zero continuity.
So while the efficiencies of an assembly line strategy, maximum patient volume and digitized records make the administrators feel good, quality of patient care is undermined. Everyone is rushed and distracted with no time to think.
Creating a rational healthcare based on the largest risk pool (Medicare4All) to fund a sound clinical culture is remote. Fiscal conservatives fear of the poor swamping services at great cost so a market solution persists as hospital empires, medical devices/suppliers, pharmaceutical companies and huge insurance companies oppose losing the market model.
A few corrupt MDs receiving gifts is trivial compared to the problems we face.
14
@Sara
All of this begins with the health insurance sector. The only way to maintain a private health insurance market is to treat them as we would a regulated private utility company. The simplest solution to much of coverage issues would be to at least expand Medicare to match the same age as early Social Security, age 62. This might be politically & economically feasible over the short to mid term.
5
Medicine and Capitalism. Avery bad combination. No wonder the rest of the "Civilized World," shudders when they look at the compromised medical field in the U.S.! When one sees a commercial where a woman m.d. is covorting on a stage with a bag of money from her "private practice," one must wonder where patients rank in their priorities. The whole American medical system reeks of hypocrisy and greed. One would hope someday they are supposed to be Healers first; and Greedy dead last.
3
Salaries in much of (strict) academic medicine are below that of private practice.
It's so prevailing that when the mandatory disclosures before a talk goes up no one really cares.
What's surprising is that Dr. Baselga hid it. That was the crime. No one would have cared if he just disclosed it.
2
@beskep People would care if he disclosed it because they would wonder if he had suppressed recording several patient's outcomes to skew results in vavour of the drug company. As it stands I am a beneficiary of Dr Baselga's research with Herceptin and always wondered if a year of treatment was necessary. The drug is cardiotoxic and so entire year of treamtnet presents future dire consequences for some patients. A recent study in the UK found that 6 months of Herceptin is as effective as 12 months. Now I start questioning Dr Baselga's initial research since I know he is money motivated and Herceptin is an expensive drug.
9
Physicians educated in the 1960s by clinicians educated and professionalized in the 1930s were taught that medicine was a profession based on care of the sick.
We learned that The great ethical temptation that all physicians were to shun was to base their care on the principles of free market business. Under no plausible scenario were treatments commodities which were sold to patients who purchased them as if they were shoes or cars. Patients simly were not customers.
Any treatment recommended was to be based on the patient’s best interest. Physicians had a fiduciary obligation to place the welfare of the patient above their own. Personal reputation for excellence , not profit, was to be the ethical physicians highest goal.
Today, as the fall of Dr. Baselga reveals, the practice of medicine generally ,and in its most respected institutions in particular , has become a business. A “professional “ physician is now defined as a businessperson who sells care to the sick for money.
The ethics of medicine at the bedside has been transformed into a business run to maximize the physician’s and hospital’s self-interest. The physician’s moral categorical imperative no longer is “Primum Non Nocere”. It has become “Caveat Emptor”.
11
Baselga and Sloan will feel it where it matters most to them: in the wallet. The lawsuits for medical malpractice , individual and class action, will rightfully hound them for years.
5
A friend of mine is a surgeon. He's German and practices there, but he attends conferences and seminars to discuss and learn techniques and methods with his international peers all over the world. When he was here visiting for one such event I asked him how it went. He said "oh well, you know, in America these things take twice as long because every five minutes they stop to discuss how much they can charge for the new procedure and the perks, and all that financial stuff is useless for me to know."
What for him seemed a wierd and irritating pointless quirk in the american way of life for us is a living hell. Americans have been dying for 50 years because they can't afford the treatments that in Europe they would simply be given. Many more have their lives ruined by medical bankruptcy. The ACA didn't stop that - it prolonged it. The whole world isn't wrong, we are. VOTE for the candidate who supports universal healthcare every chance you get, because your life depends on it.
45
It’s not that we did not suspect that before and clearly the corruption also extends to academic research and even the curricula. This article is really shocking nevertheless. I have zero trust in the American health care system and should I ever get seriously ill I will get on a plane back to Europe.
21
@heinrich zwahlen You really should read Bad Pharma by Ben Goldberg. It is about corruption in the European Drug industry. The problem is global and you're no better off in Europe.
We don't have the worst health care system in the world while being the most expensive. This has what us "regular" people have been screaming about for over two decades to the deaf ears of our shoddy media.
Keep this in mind folks. Our current health care system is in of itself the 3rd leading cause of death, the number one cause of infant death and the number one cause of bankruptcy. So why would anyone want to fight to keep this system unless they are the corrupt of the corrupt. Look at it this way our vile gov't has spent a trillion dollars fighting the stupid war on non big pharma drugs but left out big pharma who is the biggest and baddest drug dealer mankind has ever known. Yet we never see SWAT going to any of their businesses or their homes to arrest them.Why? Why don't they get thrown in regular prison and have their lives destroyed? Why is the media giving them a free pass?
6
What about he conflict of interest our own government specifically the CDC, who holds a patent on certain vaccines and makes money every time someone is injected.
I was shocked to find out hat the cervical cancer vaccine that has injured thousands of young girls and and women is a profit maker not only for Merck but our CDC as well.
Talk about lack of transparency!
7
Financial contamination is just one part of this particular story on greed, corruption and ethical failure in the medical professions. Taking advantage of often fatally ill patients with cancer doesn’t get much lower, but I couldn’t help notice the fact that, according to the original article in this paper,the good doctor failed to disclose his financial conflicts of interest in 183 papers published since 2013. So, in the little over 4.5 years at Sloan Kettering this guy published 183 papers? As a biomedical scientist, I just have to wonder how one does this while: serving as chief medical director of a major medical center, sitting on maybe a dozen corporate boards, ‘supposedly’ seeing patients, doing administration, consulting, lecturing and so on. Again, 183 “peer-reviewed papers”? Who was minding the store here? How many of these did he actually author or co-author? The so-called ‘prestigious’ medical journals and his peer reviewers, might of at least wondered about this. In most research institutions, “honorary” authorships are not at all considered appropriate and are discouraged as an ethical violation. Did anyone on the NYT ever check this as part of the problem? Putting out or signing on to articles that one hasn’t even read or that are just poor science, can pose an even greater danger to health than just being greedy.
25
Anyone taking Lupron is told very little of the side effects and devastating consequences it has by the doctor and yet the social media groups, such as Lupron Victim (the original), do....and the side effects can be permanent and cruel.
1
People before money, anyone? I hope they put a woman in there now.
We need to put the same rules/regs into place for medicine that have worked so well to clean up money in politics. Oh wait...
3
I only hope that the NY Times will do more stories about people like Dr. Beselga at Sloan Kettering, as well as the whole corrupt alliance between drug companies and the medical profession. This has to be brought to light, examined and changed. It's disgusting beyond words. I will never go to Sloan Kettering. In fact, I don't think I'll be going to any doctors in the US anymore. They are dangerous and can't be trusted.
2
Still waiting for anyone from the Sackler family or Purdue Pharma be indicted, sentenced and jailed for killing more Americans than the 9/11 hijackers. I won’t hold my breath. Incarceration is for the Little People.
8
My father, a physician, went to a NY Ivy League Hospital for a knee tendon repair. He was old but very active and healthy.
He developed fever shortly after discharge to a rehab center. Return to the hospital was too slow. The orthopedic surgeon was not to be found. My father had developed MRSA (multi-resistant staph aureus. On vancomycin my father developed DRESS, a life threatening hypersensitivity reaction with liver and renal failure. Despite his age he survived. The ID service told me this was the ‘usual’ MRSA found in the hospital.
He was in hospital and rehabilitation from around March 4 to mid July 2006.
His orthopedic surgeon was nowhere to be found. So that he could not waste his time another anonymous team took over. They too were slow. I had to resort to calling after hours (posing as a staff physician) the ID fellow on call to move on the DRESS.
On at least one occasion, October 2, 2014, this surgeon was featured The NY Times for his outside commercial income into the hundreds of thousands of dollars. The CMS Open Payments Site checked today reveals that this top orthopedist now makes well over half a million dollars per year in outside income.
We did not sue. I believe this surgeon may well have been doing well-paid orthopedic equipment marketing elsewhere when my father needed attention in this Ivy League hospital. But this physician and American medicine need to be taken into the court of public opinion.
Bohdan A. Oryshkevich, MD, MPH
21
Bad, very bad! How about those doctors and hospitals and “pain management organizations” who enriched Purdue Pharma and the Sackler family by campaigning for Oxy? Come on, how about a column devoted to clawing back enough profits from Sackler and Purdue to pay for funerals, rehab, and personal injury, hospital costs, Medicaid costs? Maybe there are a few lawyers and a few doctors, and a few reporters interested in tackling the biggest medical murder for profit corporations in history?
2
It is hard to imagine Baselga was the only bad apple at Memorial Sloan Kettering. Was this widespread within MSK?
For example, Robert Benezra, an investigator at MSK, is also the CEO of Angiogenex. How is it possible to have a full time job at MSK and get paid as a CEO of a company ?
Craig Thompson, CEO of MSK, was also sued and had to settle a case for not disclosing his conflicts in the past. He has founded Agios Pharmaceuticals and is on the board of many pharmaceutical companies. If he is serious about transparency and he cares about patients at MSK, he should set an example and provide the list of financial disclosures he made in publications, meetings, presentations since he became CEO on the website of MSK. He should ask all doctors and investigators at MSK to disclose their financial conflicts on their webpage.
What about other institutions?
Shain Rafii, a professor at Weill Cornell Medicine, is a founder and stock holder of Angiocrine, a regenerative therapy company, but he failed to disclose this in a 2017 article titled "Targeting the vascular and perivascular niches as a regenerative therapy for lung and liver fibrosis."
Lewis Cantley, Director of Meyer Cancer Center at Weill Cornell Medicine, is also a founder of Agios Pharmaceuticals and recently founded Petra Pharma. Will he disclose his financial ties publicly?
This culture of deception and corruption will continue unless the people at the top act like leaders and set examples for everyone else.
16
From sexual abuse of subordinates right through larceny of equipment and time, my profession is at the head of the class. Bribe taking like this is part of the job whether the payoff is a foot long sub for the office staff or multiple memberships on corporate boards whom may also be well represented on governorships of alleged not for profit, tax exempt healthcare organizations. People like Balsega were not created in medical school or subsequently. His propensity to this kind of behavior existed when he applied for admission for medical training. I would bet dollars to donuts that Sloan Kettering knew more about this man's character than they would ever let on. Such organizations use a large portion of their Medicare money in the establishment and staffing of their administration. Information systems, human resources, professional and community contacts are just a few of the functions at which they excel. Baselga and Sloan are saprophytic. Their uncompensated hosts are their patients, trusting, needy and ignorant of the inbred endemic dishonesty of the Healthcare Industry. Don't cry for Baselga. Like many of his role models, he is financially set for life.
7
Isn't this just the capitalist system-greed, greed, greed.
2
Lets’s understand this. The Times receives revenue from advertising but that’s ok, journalists can write and market books and receive speaking fees and that does not impact their judgment, Marcia Angell for years edited the NEJM that literally relied on Pharma ads to pay her salary, and she has no conflict. What makes these groups incorruptible and not physicians? And why shouldn’t companies consult with the best and brightest and pay them?
6
@NYTimes: Consider that the graphic accompaning this article undermines the otherwise important discorse. Depicting a surgeon with a dollar bill slipped into the mask is surely intended to alleogirize the doctor as stripper/prostitute. You can do better.
2
You can't legislate integrity in any line of work whether you are a Colombian farmer being paid to produce cocaine rather than coffee or you are a doctor being paid to recommend a drug of questionable value.
2
I’m old and perhaps a bit confused, yet in the old days TV drug advertising was mostly for Alka Seltzer, Annicin, Pepto Bismol and Geratol. Today I see drug advertisements for every condition under the sun. Since when did society decide that patients should advise doctors which drugs they need ? Something’s screwy and scary!
15
This article speaks to perception of many medical professionals of Memorial Sloan Kettering Cancer Center as a behemoth corporate entity, akin to the Amazon of oncology. MSKCC is not a charitable organization. It is a bully in the cancer care landscape of the tri-state area. It seeks to expand its kingdom far beyond Manhattan, but only to affluent neighborhoods within and outside of NY.
In the NYT article on 9/8/18 on this topic, MSKCC spokesperson Christine Hickey defends Dr. Baselga and her institution: "the cancer center cannot fulfill its charitable mission without working with industry. " Charitable mission? I work with underserved, socio-economically disadvantaged within the city, and have clients who have needed cancer care. Some have sought "the best cancer care anywhere" that MSKCC says it provides. Unfortunately, due to being un- or under-insured (read: Medicaid only) none of my clients have been able to get appointments to see these world class cancer experts at MSKCC. While their website speaks of a "financial assistance program," none of my clients could get appointments, in spite of serious cancer diagnoses.
On the bright side, they were able to get excellent cancer care at Harlem Hospital, St.Luke's-Roosevelt, Mt. Sinai, NYU, Bellevue, Montefiore, Elmhurst, and NY Presbyterian. They were not turned away from these institutions before entering.
No surprise that the culture at MSKCC is focused on where the real money is (e.g., pharma/biotech).
270
Despite sustaining zero losses from charity care, they received $12 million from the state indigent care pool. The state actually had a $1.1 billion fund to assist hospitals with charity care. But I’ve never heard of any uninsured patient receiving care from Sloan Kettering. They’re focused on the national and global elite. They’re known in the Chinese American community for drawing billionaires and millionaires from China - not for treating poor and working class New Yorkers.
And they’re constantly concocting fundraisers for themselves in the name of “curing cancer”. Seth Meyers was plugging their Cycle for Survival money maker on his talk show. They got Stop & Shop into asking customers to donate to “pediatric cancer research”. All while CEO Craig Thompson gets $4 million a year and other senior administrators are rolling in the dough.
It’s unconscionable that they’re allowed to continue to pretend to be a nonprofit charity. They’re nothing more than a reverse Robin Hood. An investigation by the State Attorney General is merited.
24
@JBJ
I take exception to the portrayal of MSKCC as a "bully." Over the last three years, MSKCC and Dr. Baselga in particular, have spearheaded an effort to bring unparalled cancer care to indigent communities in CT, PA, and FLA.
Yes, taking money and not disclosing is wrong, But that doesn't erase all the good that he did.
I'm aware of many indigent patients who have been referred from the Hartford Healthcare system to MSK for stem cell transplantation, CAR T-cell therapy, and treatment with promising new therapies. Many of these patients are alive today because of the efforts of scientists, physicians and nurses who dedicate themselves to the advancement of cancer care.
Today, there's such rush judgement. A person should be held to account for indiscretions, but those shouldn't tarnish his/her entire life's work.
3
Thank you for this comment. Excellent.
1
This is sad but instructive. Gordon Gekko rides again! The oversight of Institutional Review Boards seems to have slipped. I recall a chairman of the IRB at MSKCC whose acidic demeanor, helped to keep researchers honest. We should all remind ourselves of the reaction to the horrors of the Nazi doctors that gave impetus to the codification of ethics rules in research involving humans. And that included protection of patient data.
3
Doubtless some of these payments are made directly to the scientist in the form of stock options or grants and these certainly can be corrupting.
But many of these payments are research funding from public and private grants. They go to pay for graduate students and postdoctoral fellows who as a necessary part of their education conduct the scientific research the lab produces. There is nothing nefarious here.
Scientist are judged by the quality and quantity of the results their lab produces; this entails the need to fund the people and activity in their lab. It’s not in their best interest to be wrong about Nature. ‘Doctoring’ results is professional suicide because people find out when they can’t reproduce your data.
The real issue is how we fund scientific research which benefits society and, of course, the companies that fund it. If we want to hold our scientists to the standard of not ‘having the appearance of corruption’ then we need to replace all corporate sources of funding.
This is very unlikely, however, when you consider that NIH grant funding has been flat since 2000 (save for the temporary Obama stimulus after 2008) and with no signs of any improvement in sight. With scientists it is not so much greed but rather need that drives them to seek and accept funding from corporate sources.
3
For profit healthcare. Side effects may include: kickbacks, profiteering, gaming of the system, corruption, loss of integrity, loss of trust, over prescribing, excessive lobbying, and opioid addiction. If problem persists for more than 20 decades, do not consult a medical professional.
3
It is about time that someone placed the blame squarely where it belongs---on the physicians who have aided and abetted the modern equivalent of snake oil salesmen.
Health care spending consumes 15% our our GNP. Whenever that much money is involved, Wall Street will smell an opportunity. This is why we have seen the rise of big pharmaceutical companies, chain designer hospitals, urgent care centers. The people who run these businesses have a fiduciary duty to their companies to make money. And therefore, they act like Pharmacy Bro--they make bad medical decisions that make (good) profit. As one such individual said recently, he had a "moral" obligation to make money. He is a businessman. That is what he does.
Physicians, on the other hand, are professionals. That means that society allows them a great deal of autonomy to make decisions that are often difficult--often involve life and death. In order to qualify for this public trust, physicians must adhere to the rules of medical ethics which include making decisions based on the well being of the patient rather than their own well being.
When a physician accepts a payoff in return for corrupting a research study or promoting bad therapy that makes business (good) profit, they violate the tenets of medical professionalism. They are no longer good doctors. They can no longer be trusted. The hurt the entire medial profession and they hurt the people who rely upon us--and yes, I am a physician, myself.
4
I like to believe that, as researchers and 'people of the mind', we should have developed the maturity to not be overly interested in money, but in knowledge and truth instead - almost a bit like a monastic order.
I'm too idealistic, I know, but I try holding on to that. No Porsche for me, I guess.
52
Past press attention to such unethical behavior by medical researchers (typically physician-researchers) led to new requirements for training in and disclosure of financial conflicts of interest (FCOI) for ALL researchers receiving funding from NIH. That has led to huge increases in paperwork for ordinary researchers like me even though most of us have no FCOI to report.
Yet somehow these rules seem to have not prevented continued abuse by medical researchers. The money corrupts, even as the researchers involved rationalize taking it by telling themselves that they 1) earned it and 2) can still be objective in their jobs. They didn't and they cannot.
31
Unfortunately, this precedent comes from the top and we are all aware of the extraneous payments/gifts that our politicians receive. This has only been magnified by ongoing payments to the Trump family and their holdings. In a culture where there is no respect for others or fair play it is no surprise that this immoral behavior exists.
21
My son is a doctor who is running a research project. He got a grant for his practice and from that work, he got a raise. There should be no direct payments to individuals for this work--their institution should get the money. That's not a perfect system as the institution could encourage fudging the results, but that's less likely and the doctors running the research would likely call it out.
1
This is what happens when you're the only country in the world that has allowed health care to become a business as opposed to a public necessity.
149
I once accidentally received an email meant for an obvious medical professional - it was advertising 'a week in gorgeous Hawaii at the Hotel xxxx, along with 10 hours of Continuing Ed credits' - all of which could have been accomplished with 10 hours on Skype, no Hawaii vacation necessary...
One wonders what passes through the head of the docs who come down with their own cases of cancer. Do they trust the recommendations for pharmaceutical interventions or do they vaguely realize that their own corruption may now be their personal physical undoing?
44
@signalfire
You may be mixing apples and oranges. Continuing medical education is payed for by the physicians employer, as a benefit, like vacation, retirement, etc. If a doctor wants to go to a nice place on his own dime, there's nothing wrong with that. I get flyers and emails like you describe all the time; but I pay.
In the distant past, pharmaceutical companies would organize junkets under the guise of education, but this practice has long ago been prohibited.
Many comments on medical topics in The Times refer to practices which have been defunct for 20 years. Pharma companies are now prohibited from giving anything to doctors greater than a box lunch. The issue of academicians profiting from their relationship with pharma is a separate issue.
The fact your comment received a Times Pick makes me wonder if the medical editors themselves understand this distinction.
1
This type of behavior is far worse than insider trading which just causes people to lose money. Here, people lose lives. Something like SEC disclosure requirements and laws should be imposed on this type of behavior in the medical profession. We can see how little good norms, ethics and rules do in the Trump administration.
4
Excellent editorial. The methods of corruption described in this editorial can also be applied to many large university research programs. Of course, the methods are subtle, typically not a direct cash payment. University administrators create "slush funds" from indirect costs (often as high as 90%) associated with grants. They use the slush funds to support travel, special perks for themselves, etc. They also divert funds back to their home departments or to "reward" friends and supporters in the system. This is only one example, there are many others. The "template of corruption" outlined in this editorial also, of course, applies to government contracts. If you want to learn historic examples of corruption study military contractors - weapons programs like the F-35 (trillions of taxpayers dollars to corrupt contractors) or Blackwater (Betsy DeVos's brother) type "war contractors" in Afghanistan, Iraq and virtually anywhere U.S. forces are based overseas.
5
Money has worked its way into the whole of medicine with the intentional pressure over the past 30 yrs. to bring medicine into the profit model of business in order to make it less expensive. It obviously does not work. The morals and ethics of the medicine of the mid 20th century have been ground into the ground by the almighty dollar, whether talking about academic research medicine, the 'nonprofit' clinics or the massive for profit hospital systems.
Welcome to the most expensive medicine in the world with the 17th ranked results.
6
Everything in our society is blemished with money. Greed is a nation/world wide disease. Is there any business or profession NOT influenced by monetary incentives or rewards?
4
How is Roche's payment to Dr. Baselga legal? Itis basically buying praise. The suggestions made by this editorial are a good start, but more needs to be done to disincentivize companies making these payments. If the the costs to them for making these payments were higher (fines, jail time for executives that make these payments, etc), then they wouldn't happen.
Who am I kidding! Regulation is apparently evil and 'job killing' or so I hear...
4
Oh come on now. Medicine is merely doing what they, and the health industry in general, have been doing for centuries, and that is gouging the sick and the ailing for as much as they can because they know the poor souls have no choice but to pay them if they want to be cured or free of pain.
One of the biggest myths ever visited on humanity is the one that purports the medical industry to be a caring one. It is no accident that Hippocrates made as the beginning of his famous oath. "First do no harm". Because he knew of course, that many of them would do harm.
3
"Larger payments have been shown to affect the design of clinical trials and the reporting of trial results, among other things. "
This assertion is wildly over the top. Click on the links to the articles in the piece. The outcome variable, whether a trial is 'favorable' or not, is quite naive. The article under the 'results' link itself cites several reasonable contributory factors other than bias due to funding source that could explain the results. As a former statistician in the pharmaceutical industry, I can sense the misuse of "statistical significance" lurking in the background. e.g. Trial size is one of the main determinants of statistical significance and the authors themselves rightly point out that industry trials tend to be larger.
As for the article under the 'design' link, contrary to the assertion in the editorial, it "shows" nothing. It is merely an evidence-free restatement of Dr. Angell's well-known anti-industry opinions.
7
The situation is actually much worse than the way it is presented in this article. Doctors no longer diagnose but sit before a computer following procedures that, according to JAMA, have been written by doctors who are lavished with money and gifts from all aspects of the medical industry that have a product to sell. These corrupt institutions include device makers, pharmaceutical companies, you name it, they do it. Many hospitals are now teaching hospitals where doctors get paid to teach while students perform the actual procedures and not always to the benefit of the patient. I had cataract surgery in one of these hospitals, and evidently the doctor and student thought I had been put out, but I was fully awake, and the conversation I overheard was my grossest experience I have ever had in a medical facility. It was all about how much money they could make doing this, and all the time the doctor was all over the student as he continually berated him for going too deep or not deep enough or was cleaning out the wrong part of the cataract. He couldn't get the new lens in either and eventually the doctor had to do it for him. The procedure took one and one-half hours when it should have been no more than fifteen minutes at most. I was blind in the eye for three weeks. Doctors no longer have any feelings for their patients or even view them as human beings. Their condescension is palatable, and they only view the patient as a money pump.
13
@David Sheppard
And my brother had surgery for blockage in leg vein, incision not closed correctly, got infected, took months to heal, could have killed him. He has never really regained his health. The probable cause was a student closing the incision and the doctor did not check it. Probably was long gone to next surgery at that point. Should have been sued. This was the nearest hospital in an emergency situation, and one known to have above average hospital acquired infections.
2
this is the problem of having a private sector that is unregulated. all of these payments inflate the costs of drugs and equipment which are then passed on to insurance and then patients.
4
The issue is transparency. His failure to disclose is the key issue and it is hard to believe he was unaware of that responsibility. Because of his high rank at a prestigious institution and the large sums involved his dismissal/resignation was necesssry.
Industry should be zealous in demanding that any research reported via lectures, seminars or publications have full disclosure. So should the sponsoring entities (universities, hospitals, journals, etc.).
Physicians and scientists are not required to be uncompensated intellectual slaves for the private or government sector. They should be compensated as any consultant or advisor would, just as those in ALL professions are. The key is disclosure and transparency. Almost all US medical societies have full disclosure requirements.
Once transparency occurs one can use a more objective lens to view any data reported and the public is better served.
5
Whenever something becomes a business, there is the potential for corruption.
Medicine and health care should be a basic human right in a civil society, not a vehicle for shareholders to make money!
We don’t privatise other services such as police protection or fir protection. Why should medicine be a profit making venture?
11
@William R. Greene, MD
True regarding human labor or physical buildings. However, all the equipment and accoutrements attached to these municipal entities are purchased from the private sector. So innovations and advancement in design no doubt have input from individuals in those ranks.
Also, municipal expenditures are not solely funded by local sales and property taxes but by the investment markets via capital raised by municipalities selling bonds on the market.
So in your example the public sector (taxpayer funded) and private sector (investor/shareholder funded) are quite linked.
1
I wrote an article on the practice of healthcare industries writing articles in favor of their treatments, devices and diagnostics and finding healthcare professionals to be the "author". This ended up being read by Dr Adrienne Fugh-Berman, and we both being in an article reported on the front page of WSJ in 2005. Adrienne continues her valiant and difficult fight against unethical issues in healthcare at Georgetown University. The problem with this practice is that the healthcare professional is rewarded many times, by promotions, funded grants, accolades. I am highly in favor of professional writers with professional health science training writing journal articles and anything connected with health, in fact, I recommend this. I looked at Dr Baselga's CV and wondered how many of his journal articles he prepared himself. Any? Did he hire a medical writer to work in his lab to prepare manuscripts - this I recommend for any serious and well-funded scientist - or did he accept honoraria and being an author from healthcare companies? I am guessing the latter, but would be delighted to discover it is the former.
5
@Susanna J Dodgson
Apologies, I spelled incorrectly Dr Adriane Fugh-Berman.
What is really amazing is that some still believe that money doesn't corrupt every aspect of life.
8
The fundamental problem here is glorification of money in our society. Money has become the most important metric of success. This notion has even been elevated to a perverse kind of religiosity exemplified by prosperity churches.
The absurdity, dangers, and real harm of this worldview is obvious in politics, medicine, education, and many other spheres.
15
‘The Fugitive’ exposed this practice 25 years ago and its only gotten worse.
4
It is probably not widely known, but medical journals which used to be operated by the profession and held to a high standard of content, have now become fee demanding organs in which if you are prepared to pay, virtually any nonsense will be published.
The solutions outlined in the article may seem drastic, but clearly drastic measures are required. Attendance at conventions has become a "give away" scene -- no longer free drinks they used to offer but all kinds of "goodies" and I am amazed at how cheaply a doctor will sell his soul. Maybe the leaders are paid in millions, but the followers are seduced by trivia.
15
This looks more like a conspiracy between the FDA, Pharmaceutical industry, the Hospitals, doctors and independent medical journals to defraud Insurance companies and their customers.
The Justice Department should get into this.
11
@HL What ‘justice’ department? This fish stinks from the head and the apple is rotten at the core. It start with money in politics and will end with corruption and fascism.
Our form of capitalism does not work amd fosters corruption.
2
Money doesn’t corrupt medical research any more than easy access to guns causes school shootings. Researchers make choices about what limitations to their freedom to publish their results they will accept and whether they will selectively report them to please their funding sources. And while it’s true that some compromise the integrity of their work, the vast majority, in my opinion, remain true to scientific principles. The cost of research has increased enormously because living systems are much more complex than expected, requiring the development of new technologies to probe them. Yes, we should make sure we expose those who fail to reveal their funding sources, but let’s not risk stemming the flow of much-needed research funds because of a minority of transgressors.
12
"Speaking fees" in the tens of thousands of dollars to implant/device surgeons paid by implant/device companies. Stock options to "opinion leaders." "Teaching Hospitals" that look the other way while residents provide most or all of the care, even surgery. Physician groups that are owned by leveraged buyout firms. Medicaid recipients that are "mined" to death by the healthcare system. An institutional review of research process that is so complicated that for an IRB member to actually read a single application would take a hundred hours yet IRB members are unpaid. Ethics, you know.
This is what happens when medical research, education, and the clinical line are all privatized under a "fee for service" model, federal healthcare funding is cut year after year while politicians claim it is being expanded, and medical students are loaded with hundreds of thousands of non-dischargeable debt (to for-profit banks) "guaranteed" (to the bank) by the taxpayers.
No amount of ethical training, oversight, or consequence can make this system work. Time to re-think.
8
Disclosure rules don’t seem arcane at all.
Futile, perhaps, in our society, where almost anyone who can be bought is bought, but that doesn’t mean we shouldn’t try.
9
We accept for-profit health care and then chastise people for making money. The problem is, we have no government option.
My doc is on salary at an HMO. His pay doesn't depend on what he prescribes for me or what tests he orders. And I can make an appointment to see him in a day or two. And if he orders lab work, I can drop in at my convenience.
Health care needn't be too big or too scary for most people. But it is. Someone has to pay for all those TV ads for drugs and catheters.
We can fix this if we want. We can mandate public campaign financing.
6
How'd you like to be prescribed a newly minted, not adequately tested, extraordinarily expensive medication (pill) only to find out that, among the limited known side-effects, the FDA just warned that it probably will cause genital infections (aka genital rot).
I will not ingest that drug, of course, and cannot wait for the first class- action lawsuits against the manufacturer. The only restraints, now, to the avaricious drug companies releasing under tested new drugs are the courts of law. That is until the current federal administration ends the drug companies' liability.
3
I recently read a book, "Sickness in America," by Elizabeth Rosethal, a Harvard-educated MD and journalist. In it, she referenced a study on persons with Tuberculosis. During the study, the researcher noticed that the drug being tested seemed to affect members of the study that also had diabetes. Their diabetes was "cured." She has attempted to raise the $25-30 million needed to study the effects of the drug on folks with diabetes. None of the drug companies would support the study because, if successful, they could no longer sell insulin.
Another problem with big money and greed influencing medicine......
7
@WdennisT
Legitimate studies by legitimate researchers obtain grants from the Federal authorities -- the drug companies are not the major source of funds.
1
Healthcare, another price bubble and corrupted business about to pop in America.
2
This has been going on forever at every campus with a medical school & foundations like Rockefeller. 30 years ago a writer who'd covered medical issues for Time was sued to stop his book. At UCSF a researcher friend was hounded out for not complying with doctored results. I had a bad time at Columbia where Lithium was being pushed on any one with a family member with manic depression as their research dollars needed to prove a genetic link. My family has that history & I had a pattern of high performance alternating with depression since childhood so seemed perfect for their genetic study. It literally poisoned me & left me with narcolepsy. What did they do? They upped doses & added anti depressants that left me manic by induction or catatonic. When they started talking shock, I quit all cold turkey. I have since gone back on antidepressants, but as a prophylactic twice a year for short 6 week intervals & in very low, supposedly non therapeutic doses that are what my biochemistry can handle. It took a Dr. with a knowledge of pharmaceuticals, body chemistry, extensive blood work & the courage to suggest a narrow, tailored approach designed for me. Pharmaceuticals fund the research & expect a quid pro quo. I don't know how this biased interaction can be stopped. Pharma needs to test & schools & foundations need subjects for trials. Patients need to be aware & demand or seek 2nd opinions from separate hospital entities on medications they are given.
6
How are these people going to get rich if they can’t be on their payroll and boards?
5
In some places, doctors are known as "Merchants of human suffering"; most of them profit from sick people in many ways.
I was a laboratory representative I a foreign country before coming to the States and becoming a Ph. D. I know: they tried to extort money from the laboratories "to build their doctor's club": all the doctors in a city. Shame!
2
I wrote a novel (“In Jake’s Company”) about how medicine and Big Pharma are corrupted by money, and how the commodification of diseases is a technique that drives much of the corruption. It can’t be reined in. The FDA and the American Medical Association have been co-opted into that commodification, and corporate greed - in Big Pharma and in the insurance companies - will continue to fuel the corruption, which is almost never reported.
6
@James Murrow
In my state, the leading newspaper did a survey on what jobs paid the most. Almost all of them were medical. In my town, a surgeon had so much money piled up that he bought a big shopping center as an investment.
A group doctors practice in town that had been in business for years was recently sold to an out of town for profit hospital. This guarantees that costs will go up.
There are still a some good doctors who do their best for patients, but this is not rewarded or adequately compensated. They too have had to sit facing their laptops as they type in what you are saying. Few anymore even touch patients, putting all their faith in lab tests which take less of their time. How else will they get in the basics in the short time allowed by insurers?
My real-world example of "financial contamination" in health care. My elbow had become persistently sore. I called to make an appointment with my doctor, and was told she had left the practice and was assigned to someone else. That doctor examined me for a minute or two and prescribed Vioxx, the heavily advertised designer drug of the moment that was no doubt being peddled to doctors. I took it for a couple of days, and just felt "off." I stopped taking it and then realized my elbow was under particular strain at work, where it was extended using the mouse all day (the doctor had never asked about potential lifestyle causes). I installed a drawer for the mouse so that my arm could be in a bent, relaxed position and the problem eased and was gone within 6 months. Just weeks after I was prescribed Vioxx, news emerged that it had been withdrawn from the market because it caused people like me with no history of heart trouble to have heart attacks. I still shudder that I could have died of a heart attack from taking the drug of the moment to treat apparent simple tendinitis.
8
Doctors are not gods. Nor are they angels nor denons. They are human beings. Medicine is part art, business, science and technology. Our use -by mortality date is our fundamental reality.
The ethical obligation of the legal profession is to avoid even the appearance of impropriety. The medical profession would be wise to heed that advice.
14
Bribery is bribery. While I would like to see bribing doctors to lie made illegal, that has about as much chance of happening in this current political environment as fairness in election finance. We are truly living in a never-ending hurricane of corruption.
8
That is not the only area in medicine subject to abuses. Physician credentialing is another area subject to fraud and abuse. I have had physicians fraudulently represent to health insurance carriers that they were a part of my group. The result of this was diversion of monies meant for me, submission of bills (with payments) to insurance carriers under my EIN’s and access to privileged patient information (HIPAA violations). . I notified the carriers who refused to do anything about it. The carriers preferred to absorb millions of dollars lost to fraud rather than work to correct this or expose themselves to negligence. They changed the system that allowed this to happen and did nothing to the entities who did this. Everyone seemed to think that physicians were honest and they are not always so. I am requesting assistance in my personal matter as it is proof of an endemic problem the system allowed and is now trying to cover up. CAQH now changed the questions they ask to try to prevent this. This is all a result of the carriers allowing physicians to link or attach their participating contracts to EIN numbers whether or not they belong to that physician or not.
4
Money has the POTENTIAL to corrupt medicine. There are many doing it the right way, delivering value for many patients
6
Great article but a little late in coming. This, as the article say's, has been going on for a long time. The entire healthcare, drug, and medical 'industry' is a mostly noncompetitive playground for corruption and greed.
1
@Smoke'em If U Got'em Well, better late than never. At least the NY Times is stepping up. I have been disillusioned with doctors for decades now. They are lowest on my list of what I would want my child to be when he/she grows up. That is a sad, sad statement.
We all have our medical/insurance/big pharma stories to tell. For me the horror of being diagnosed with a catastrophic disease and then being pummeled half to death by the bills coming in (which are basically unreadable - what on earth are "administrative costs?) and descending into poverty in order to get well again - what a great and peculiarly American idea. And then the flip side would be not getting well but dying and leaving my family with the unpaid bills and knowing that my treatment might have not been based on good science at all, but on some paid grifter putting money into his/her pocket from big pharma and prescribing drugs that might not work or actually make me even sicker. How on earth have we tolerated this scenario for so long?
14
MSK patients, as well as ALL cancer patients, are brazenly abused by people like José Baselga. This unethical, elitist behavior in medicine blatantly abuses patients who suffer real consequences of the greed, even their lives. This doctor should be stripped of his medical license. Maybe that would be the start of a powerful message. Maybe Do No Harm will regain its full meaning.
16
An opinion piece questioning targeted gene therapy for cancer appeared in the NYT on 9/11/18. The byline identified the author with Kaiser Health News. Kaiser Permanente sells health insurance and supports the foundation that funds this health news publication. Some flags waved for me - perhaps unfairly, but one must always ask who benefits.
6
As a retired physician, it shames me to see the perversion of a noble profession...in the service of a most jealous god named 'greed'. Can't we see that human beings, however high their aims to transcend their shortcomings, cannot be trusted without basic regulation and supervision, given we all are corruptible when given the chance?
78
"Decades of research and real world examples have shown that such entanglements can distort the practice of medicine in ways big and small." Indeed. But why stop with the physicians? Medical care is distorted to a much greater extent when the medical institutions receives large sums of money from industry. And, while we are focused on how money distorts our institutions, wouldn't it be horrendous if our elected politicians - who we used to expect to serve citizens - instead served mega-corporations? Yes, physicians should forgo such payments; we are paid sufficiently (Baselga certainly was) and, thus far, have been a highly trusted profession. But this type of legal corruption of the system has invaded our entire country. Vilifying Baselga is justified, but it is akin to removing a splinter from a patient with a metastatic cancer.
4
@Bruce Lanphear It's good to look at the opensecrets database where you can see where your senator and congressmen and women get their campaign money. It's also good to walk into the doctor's office armed with a copy of Elisabeth Rosenthal's "An American Sickness." It's like hanging garlic around your neck in the presence of a vampire. I think we need to start asking our doctors, at every office visit, "Which pharmaceutical companies are paying you? Which boards do you sit on?" We still treat doctors like gods, we trust them and look up to them. I think we're looking in the wrong direction.
2
This is not unexpected and not isolated, even though the medical field is one of the most regulated industries in America. The underlying problem is that there is so much more money in the for profit industries that surround medicine - pharmaceutical, medical device companies and insurance companies, that there is in the actual practice of medicine itself. Most physicians derive almost all of their income from the actual delivery of care, but there are quite a few that are paid for the services that they provide, consultative, research, design, marketing, but outside companies promoting some drug or product. In some cases, the amount of money generated from these outside activities far exceeds the income generated from the practice of medical care - sometimes by a factor of 10 or more. Indeed, today you can make much more money as a consultant for drug and device companies than you can as a physician, and the companies paying them rake in billions, so the "consulting" fees they pay physicians are a proverbial drop in the bucket. Granted there is much good that comes from these arrangements, new drugs, new devices and sometimes better medical care, but these types of arrangements are going to also result in some shady ethical practices. These physicians have done bad things but they are not bad people. All of us must consider what our answer truly would be if we were offered 5x our annual salary just to promote a product or device that works.
6
Who pays? Who benefits? Do we expect every researcher to give away his discoveries a la Dr. Salk. Our present model of how we fund health care,science,and education is set up to create these kind of problems....well intended or not
8
Yes we need the experts involved in advising drug development. But it can be done without creating financial conflict of interest. Simply demand that each persons potential conflicts of interest are made available in prominent ways (listed on institutional and national web sites). Furthermore, make sure that contracts for the individuals work are compensated to the employee. It should be given to relevant charitable foundations (University or disease focussed comes to mind) - and again with prominent full disclosure of amounts.
3
As a mental health care provider I am deeply aware that mandatory use of psychiatry's Diagnostic and Statistical Manual, the DSM, by ALL providers even non-physicians is at the heart of insurance reimbursement to set limits and reduce benefits but most perniciously to determine treatments linked to techniques that arise from BIG PHARMA. ARNPs are especially impacted serving as physician alternatives. They are slaves to protocols mandated by DSM. Individual psychotherapy arising from training as a psychoanalyst offers greater emphasis on developmental family narratives, attachment, relational and subjective experience manifest in the ongoing process with the treater. That mode is nowhere to be found in DSM although such links have been explored. Psychiatry supported by BIG PHARMA rose to displace psychoanalytically trained psychiatrists as department of psychiatry chiefs with massive infusions of money radically shifting the role and function of psychiatry away from relational modes to ten minute med checks. That focus on symptom remediation immensely impacted the profits of psychiatrists and BIG PHARMA. The relationship mode suffered as a consequence robbing patients of the essentials of the healing process. Profit displaced/erased compassionate healing and effective treatment processes. Many of the psychiatrists in whose training I participated at Menninger came to understand this dilemma as they grew in their compassion and capacity to relate therapeutically.
6
There is a way to partially address this. Physician researchers who are federal employees are not permitted to accept payments from from for profit entities that do business with the government. This would include essentially all pharmaceutical companies. This ban should be extended to any physician who receives NIH funding, or who works for an institution that receives NIH funding. This would exclude nearly all medical school affiliated researches. There are some pretty obvious ways to circumvent this, e.g. setting up non profit foundations to "launder" the money, but these loopholes could be closed.
5
How very interesting. I agree completely with the editorial, but still wonder why the Supreme Court put it's imprimatur on, and enhanced, and worsened, our system of campaign finance. Remember Justice Anthony Kennedy, who wrote for the 5-4 majority in Citizens United, “And the appearance of access or influence will not cause the electorate to lose faith in this democracy.”
7
I think this editorial is excellent-- as is Dr. Angell's op-ed. But I have come to believe that the problem is far broader. Over the time that I have been involved in health care, there has been a sea change in the finances of medical practice, hospital management and health care delivery. The community hospital, once viewed as a public-spirited endeavor, has been subsumed by health care giants motivated by making as much money as possible. The "health business" has as its first goal not making people better but making money. It matters not that this is labelled "non-profit"-- the goal is still wealth acquisition and this displaces patient care.
I don't know if health care is a right but it is a need. The delivery of health care should not be controlled by the profit motive. Those who have coverage get care they don't need that is vastly over-priced. Those who are medically indigent usually don't get any care at all. That this should include children is our deepest shame. "Socialist" or not, health care delivery needs to be swept clean of profiteering. As loathe as I am to see federal intrusion, there is no other mechanism to accomplish this.
32
Kind of makes one think before contributing hard earned money to big research if it is siphoned into personal bank accounts instead of furthering good ends.
10
The investigation of Dr. Baselga was not a surprise to many physicains like myself. Not because I personally know Dr. Baselga, but because this type of practice is so common. And this is just the tip of the iceberg of medicine's dirty little secret--the corruption by drug and medical device makers. In medical culture, this is not overtly talked about much although it has existed for many years. Perhaps finally the chickens have come to roost.
18
Condense all of the preceding comments, all the bluster from editors of medical journals, all the talk from medical centers, and all the dishonesty from some academic MDs and what you have is a major lack of medical ethics.
It is said that much research could not be done without industry support. However, much research is tainted by that very money and by the pressure to publish and get rich ( not perish as the saying goes).
The good doctor in this discussion resigned. Good. But where are the editors of the medical journals who are his colleagues and of course know where the funding derives (open one of these “peer reviewed” journals to see more pages of drug ads that research results). Where are the other leaders of the academic medical centers who know where these doctors get their income? Where are the FDA regulators who are also peers of these doctors. Where are the active physicians( I was one of them) who do not aggressively study the medical literature to discern all the garbage and or tainted research each one of us buys.
These medical leeches should not only resign but should lose their medical licenses; laws should be changed to make this fraud AND malpractice in a grand scale. They should be barred from the corporate world of drugs. Me Manefort is going to jail for failure to disclose his connections. That is minor compared to what this physician has done.
6
I suggest you look into the wrist slaps that Harvard, Stanford and Emory administered to leading psychiatrists who were even more greedy and grasping than this man. Your own reporters and reporters at the Wall Street Journal have exposed just what went on. Baselga was fired because Sloan Kettering couldn't abide by the damage his behavior did to their reputation once his corrupt actions were exposed. But it is difficult to believe, to put it mildly, that they had no idea of what was going on till your reporters latched on to the story. As least Baselga was fired in short order. Look at what the universities I mentioned did (or rather didn't do). That's an even worse scandal. Chuck Grassley's committee exposed all this, but really to no avail. How disgraceful.
11
How about an expose on the torture of animals? That is medicine's REAL dark underbelly. I try not to use Rx medicine because I know all the horror and cruelty that lie underneath it.
2
IMO our de facto criminal for profit health care system is the new civil rights issue of our day.
It is right up their with slavery, discrimination, gender rights, union rights, etc. etc. of the past.
We are just about the only peer country that has a system of be rich, don't get sick and/or don't have a bad life event while billionaire HMO/Big Phrama execs make obscene profits off of sick Americans.
We are in the Middle Ages re health care compared to our peer countries.
9
It's all the same...
corrupt practices everywhere.
Washington, Wall Street, and Medical Science...
We will never get all the money out of it, but we can apply legislation and legal systems to keep the brute caged.
term limits, tight campaign financing limits...
controls on banking- investments or savings...
criminalize pharma kick-backs completely...
It's a real mess out there.
7
Corrupting influence of money in politics is curable through law and the voter consciousness, but the financial contamination of medicine and medical research leaves little room for the correction as it shakes the very foundation on which the noble profession of medicine rests I. e. the abiding faith of people in the doctor and his/her prescription.
2
For a very long time, our corrupt Congress and state legislatures have used legislation to legalize various forms of bribery. These types of payments to doctors are standard operating procedure and they are legalized bribes.Corrupt medicine is a natural byproduct of our corrupt system starting with our politicians. When a President can leave office after serving the interests of the 1%"deeply in debt" and 8 years later be worth more than $200,000,000 , with no visible , legitimate means of support, something is rotten in our system. Politics, medicine, business - corruption and bribery, both legal and illegal, are the order of the day. Hence we have a person of Trump's ilk as President.,
6
Two things came to mind as I read this article. One is that it can give the impression that most of the medical profession is like Dr. Baselga. My own experience with doctors is the opposite. Including the fact that I was married to an honorable physician who would not only have declined any outside compensation for his work but would have reported the bribery. And I believe that most of the medical profession is honorable as he was. But there is no press about honorable doctors. Second, why are there no sanctions against the drug companies who offer these bribes? Public harm is always the potential outcome. Shame on the doctors who do this, the drug companies who offer the bribes and the medical and government agencies who take no legal action against either the doctors or the drug companies.
9
@Writer/Reader
Great comment!
2
"Disclosure" just floods us with so much material, we are drowned by it. It takes a single-payer to police the abuses of the health care industry.
8
"Contamination" is the right word. As a physician over many decades, I have watched health care grow into a huge chunk of the economy. It has evolved into a "medical-industrial complex" as New England Journal editor Arnold Relman warned in 1980. The industry is a potential treasure trove for conflict of interest --or worse. To prevent these misdeeds, many restrictions have been imposed on health care providers and their suppliers. These measures have been effective but imperfect. Like laws, regulations are only as good as the institutions that monitor and enforce them. This case demonstrates a failure of that process. The result has been a "contamination" of an admired institution's reputation. Patients count on their health care providers to be trustworthy. We must earn that trust every day.
4
@JBJ. Years ago I made a court application seeking instruction on distribution of the remainder of a small trust ($330,000). Memorial Sloan Kettering was named as an interested party because it was a contingent remainderman that would only receive a distribution if there were no living descendants. It was highly unlikely that Memorial Sloan Kettering would have ever received anything. In similar situations charities rarely appear or object. Not Memorial Sloan Kettering, it retained high priced counsel and made a shocking money grab for a pittance. The legal issue was technical but there was not enough money at stake to engage in costly litigation so the matter was settled with Memorial Sloan Kettering receiving something at the expense of the family of the creator of the trust, who were in dire need of the funds due to very sad circumstances of which that so called “charity” was well aware. Needless to say this revelation completely changed my opinion of Memorial Sloan Kettering as it showed what a venal, greedy organization it actually is.
46
Unconscionable greed. My sympathies to you.
3
Money may corrupt but the problem is deeper: there must be legal rules that ultimately protect patients from abuse. Cancer research and treatment must not be tied to influence. Medicine is only contaminated because there are few rules that protect its integrity. The average doctor accumulates insane amounts in educational loans and by the time they are ready to practice, they are already saddled with enormous debt after spending decades in education. Medical schools and residencies lack appropriate teaching of medical ethics. Mr. Basterra comes from Spain, where there have been many cases of egregious corruption of officials. In the US, we can say things are not much different. We have allowed money to infect politics and the politicians to disregard the need for robust healthcare in all its aspects. Who are we kidding? We cannot even agree on basic, common sense approaches to fundamental problems that affect every American. We should not expect much when no one is outraged about the contamination of air, water and food in the US and the lack of supervision/enforcement by the FDA and EPA. We are already poisoned from the start. It should not be surprising to find out medicine is also poisoned, it is only a logical step in a chain of deception.
6
American journalism has failed to understand the extent to which the for-profit, entrepreneurial model of health care research, education, and delivery, enabled by a corrupt political system that "legalizes" it all, has fundamentally corrupted the "product" most persons receive when they seek health care.
The article, such as it is, is basically correct, but, such as it is, is like reporting on the arrest of one mid-level operative in a massive criminal cartel, and failing to report on the existence of, and activity of the cartel. The first step is to destroy the existing system that rewards profit and greed, and punishes a commitment to excellence. The quality and availability of compassionate health care in the U.S. has become scarce and hard to find for those who need it, and compassionate physicians are finding themselves in health "care" systems that punish excellence, and measure "quality of care" by net revenue. There is no transparency, and the "sensible" politicians who wonder at the rage of the progressives, should know that lousy, exploitive health "care" is the greatest single concern of "average", aka "low-life" to the billionares, people.
8
@riverrunner Well said. This is rotten from the top down. Doctors are not doctors, they're corporate CEOs of their own brand. Horrible that that they take their 30 ( or 30 million) pieces of silver and then betray their patients. What could be sicker?
1
I am deeply grateful for this article.
The problem is widespread as you point out and hideous.
Just one example: the new class of anti psychotic drugs were vastly more expensive than prior off patent drugs but according the statements by the national institute of health they were not really more effective. However, large numbers of corrupted psychiatrists, relying on corrupted psychiatric organizations made billions for the drug companies prescribing these drugs preferentially.
You can assume the apparently kind psychiatrists were just duped, but frankly all they had do do was read the research to know better and they did not do that.
2
I am from India, and have been a surgeon for the last 35 years. I can confidently say that doctors here have been given gifts ranging from house hold goods, personal items, flat screen TV’s, to foreign trips and hard cash. The only condition is that they have to prescribe drugs as per the pharmacy company, use implants , pacemakers, catheters, stents and anything else which the company representatives want you to move. Even if the doctor starts off with high ideals, he is thoroughly corrupted by the inducements offered by these companies. The poor patient is the one , having approached a doctor with hope, is reduced to penury, while the doctor has made money from all sources. What is the solution?
10
As some comments and another article in the NYT have pointed out just disclosure won't solve this problem. Research and its funding should be fully separated from the companies that potentially would make money from it. Perhaps Pharma and bio-medical companies should pay a tax to be distributed to research centers (e.g through the NIH grant system) rather than paying directly to the researchers involved.
1
@Bruce: Research the public pays for should be owned by the public and licensed to providers.
8
@Steve Bolger
Agreed.
The problem is the current mix of private and public money financing biomedical research probably made worst by the Bayh–Dole Act
https://en.wikipedia.org/wiki/Bayh%E2%80%93Dole_Act
1
I find it somewhat telling that even an editorial denouncing the blatant corruption that taints the medical research world, there are no calls for new legislation and criminal prosecutions of doctors guilty of such behaviors.
When the article talks of real consequences, it evokes publishing bands which, while better than nothing seems exceedingly tame.
Make no mistakes, the behavior of these people kill patients just as surely as a knife in the back. The process may be slow and convoluted, but the end result is the same.
12
@Baptiste C.: The industry insists that it is unethical to charge less for a medicine than what the market will bear.
1
@Steve Bolger: And prescription drug advertising is one of US media's top cash cows, right up there with car advertising. Only one other country in the world allows this kind of leverage on its media.
1
This comes as absolutely no surprise to me. Several years ago "rules" were established to prevent this type of thing. But doctors and drug companies find ways around it because the rule makers tried to make it look like they were addressing the problem, when all they were doing was creating cover for the doctors. Watch....this guy will wind up working for a drug company and then wind up in government making sure this type of behavior is never stopped. And the patient never makes it to the position of top priority.
6
Why is there no mention of sanctions on the outside organizations that make these inappropriate and (nearly always) forbidden payments? Surely the culpability of the corrupter is at least as great as that of the corrupted.
3
@DavidV: When corporations are fined, the shareholders pay for management malfeasance, not management.
1
It is indeed unfortunate that doctors take money to say good things about bad drugs. Perhaps the answer lies in getting doctors to take money only with respect to good drugs. Oops. Maybe that might be too difficult, in terms of distinguishing between good and bad drugs.
Maybe taking any money at all to endorse a drug might be the issue. If a drug company offers large amounts of money as inducement - is that a possible indicator that the drug might not be good for the patient?
As the amount climbs, should the doctor's suspicions escalate? Should the doctor say, at least internally: "Wow, this drug must be real garbage, given the amount they're offering"?
There are 4 alternatives in terms of consequences. #1 - the doctor gets to keep practicing but has to give the money back. #2 - the doctor gets to keep the money, but is suspended from practicing medicine. #3 - the doctor has to both give the money back and is suspended from practicing medicine.
Or #4 - the doctor keeps the money and keeps practicing medicine (though the doctor might have to occasionally resign from prestigious boards).
Looks like #4 is the option that the medical profession has chosen for itself.
1
Capitalism has no place in healthcare. Profit and healing cannot overlap on any Venn diagram. When a compassionate people (us) come together to decide the most effective care for its population, those people get the care they need when they need it. This is already happening in America in the VA system. Perfect? No. But the evidence shows that it works well. The main problems I see in the system now are lack of funding, not enough well trained staffing, and those who provide the care (many of the the compassionate people) aren’t given any input as to processes and improvement. That said, it’s an excellent platform on which to continue building. Socialized medicine anyone? It’s time.
22
Maybe it's time that capitalism had no place anywhere. It has no place in gov't where it buys votes, either. It's time to get rid of capitalism, period.
5
@Stephanie Wood Now we're getting to the bottom of this swamp! Rules can be made and, as many people have pointed out, these doctors (if one can even call them that anymore) and pharmaceutical companies will always find their way around them. This hydra has to be cut off at the heads.
1
Thanks for writing an article that feeds into the Luddite masses the conspiracy theory that all doctors are for sale and that doctors, hospitals and drug companies conspire to keep people sick so that they can profit from their illnesses. I'm sure this will kill a few people who will seek out "alternative treatments" to cure their cancer and other illnesses.
Should not this article have included an investigation of the verity of the actual RESEARCH of the bad Doctor? Or lack thereof? Or pointed out that his published studies were peer reviewed? And valid? Or not as the case might be.
I agree that any monies received by researchers should be disclosed and that, probably, And I agree with your suggestions. And I agree with the AllTrials movement that there should be a requirement that all trials should be published along with the data for those trials.
But, writing an opinion piece that implies a Doctor's research has been corrupted without actually providing any proof that it has been corrupted does not serve the public's interest. Note that his comments on blogs and at meetings are NOT a part of his research. If his research is corrupt, you need to prove THAT and not just imply it.
25
@Oldfart That sounds difficult to do, no? Especially for as complex a field as Dr. Baselga’s? I interpreted their tone not as implicitly accusatory but as saying that the mere possibility of corruption should be enough for us to disapprove of his actions.
While very sad to read, these conflicts reflect the same mindset and behavior that exists today among many of our leaders in Washington. Until we, the people (voters), put in place leaders that establish a more ethical, less conflicted standard of behavior, these types of ethical breaches will continue to be tolerated.
8
The last chunk of my career was spent writing for communications firm whose accounts were largely big (and sometimes small) pharma.
I got to witness the excess, and the self-dealing that governed these industry "grants," from those for continuing medical education to advertising and promotion of approved products.
As much as I denied it while working, today I can say, pharma owns the medical establishment. Doctors are human, and the enticement of fees for joining speakers' bureaus, writing pro-pharma articles, and essentially serving as marketers for new pharmaceutical products is irrestible.
Like everything done to excess, if professionals can't exact self-discipline and erect effective firewalls between the interests of science and the self-interest of industry well, the government may have to step in.
It can't come soon enough. What potentially groundbreaking research and cures may fall through the cracks because some doctor, working with pharma, is distorting the marketplace?
30
@ChristineMcM Of course, "the government may have to step in" means our legislators, who are even deeper in the pockets of big pharma than the doctors.
1
Elizabeth, you are correct but at some point voters are going to demand accountability. Both parties are in bed with big pharrma, but if enough people care about all this lobbying, and enough candidates make this a priority, some day the people will take back our government and Congress and change some laws.
3
@christineMcM
And there you have the problem. Those voters are not paying attention, too lazy to read even the shortest explanation of any issue, or learn the qualifications of candidates. Slogans is about all that gets thru. There was a statement made on public tv news that an educated public was necessary for the survival of democracy. Well, people have to be open to education, and clearly we have a lot of people who aren't, and will deny forever that they made voting mistakes. Too bad the consequences are felt by others too.
1
Not reported here, and certainly left out of Marsha Angell's piece, is the practice by prestigious medical journals of selling "reprints" of favorable articles to pharmaceutical companies for their salesmen to use in conversations with doctors. They charge $6 to $8 for each reprint in small quantities. Undoubtedly there are volume discounts, but I know of one major pharma who bought more than one million copies of a New England Journal of Medicine article that reported favorably on a product that was later removed from the market by the FDA as unsafe. Reprints are a great idea to get the scientific version of information to physicians, but publications should sell them for 25 cents, or so, not treat them as a profit center.
18
@Kelly and yet the scientists that wrote and published that paper did not got one dime from the journal. If the public doesn’t want scientists (particularly PHD’s without a clinical practice) they should support adequate NIH funding and should ask why a university gets another 50% or more of funding from their grants. Study sections, journal articles, lectures, etc. all done without extra compensation. So of course when a consulting opportunity comes along who isn’t going to jump on it?
A structural problem underlying this: academic medical centers, labs, and research hospitals are routinely producing technology and molecules that seem to hold significant promise in healing the sick or preventing disease. But the mechanism to develop these ideas and models, put them through clinical trials, and bring them, if successful, to market, is staggeringly expensive and does not exist within the institutions themselves. Our health care system relies on the private sector to step in and push these potential breakthroughs as far as they will go. When the science is licensed, lead investigators and clinicians are invited to serve on the board to help oversee the further development of a potentially very good thing. This is generally a good-faith move: the people who know the most about esoteric technologies, patient groups, treatment modalities, and so on, should be turned to for counsel. Sometimes, the drugs and technology thus developed work true miracles. Far more often, they fail. But without that investment from private enterprise, the tools and ideas would languish in research labs. In this way, non-profit research and clinical medicine are yoked to biotech and “big pharma,” who ultimately are the only players with the hundreds of millions of dollars it takes to bring promising science to the marketplace over and over again. Greed is not the underlying motive of the great majority of players at all stages here.
6
@L David, sure it does. It just happens above your pay grade.
1
When I was in school back in the sixties, I had a lot of friends who became doctors. I would visit them in their apartments and be astounded by the number of expensive medical satchels and other freebies they had accumulated from drug companies. I still have one of them myself. I keep my prescriptions in it.
8
After a clinical career and working on these issues in the pharmaceutical industry for a long period of time, about 10 years ago I created an organization that would have served as a buffer between industry and academic physicians. I visited the institutions that had suffered reputationally to discuss their collaboration. I was turned away by all but Emory, the University of Michigan and the University of Minnesota. Everyone else said there was too much money to be had. I was told that this was a brilliant idea whose time had not yet come. We need legislation in place that ensures better practices. It can be done.
58
Researchers need better funding.
Drug companies need legal restrictions.
Only a trained Dr. Of pharmacy should be entertaining drug
Companies.
2
Money corrupts medical practice now, from the hospitals (where they are, who they accept, what they do, how much they charge) to the specialist (where they are, who they accept, what they do, how much they charge) to the general practitioners (where they are, who they accept, what they do, how much they charge). The corruption of research is damaging to the future of our health but for those that need it NOW, it's damage from the influences of finance to the practice of medicine that concerns me most.
7
To me you all seem so naive. I know little of cancer. I do not even trust Western medicine, but I have been preaching for quite a few years a cure for cancers would be so devastating to our economy it just cannot happen. A few successful treatments leak out here and there by some caring researchers and facilities but greed is in control.
14
@Deanna Ray
"greed is in control"
There are many actual cures for chronic diseases that conventional medicine ignores, while we suffer and die.
Big Medicine is a parasite on sick people. they should be trusted only for acute interventions - surgery and the emergency room.
The cure is to take responsibility for your health - just consult Dr. Google.
If the arrogant MD (Malpractice Doctor) tells you, "if it were important, I'd know about it," or accuses you of "playing doctor," simply ask why American healthcare quality is at the very bottom of the industrialized countries while costing twice as much as top-ranked France.
If that doesn't stop him cold loudly say, "Quack, quack, quack." That always works.
2
Capitalism's dark under belly playing to human greed. Pretty ugly stuff.
13
The Editorial mentions Oxycontyn, but the problem with doctors financial involvement with the industry is the last problem in a long chain of collusion and lack of checks in the drug approval process.
In its application to the FDA Purdue pharmaceutical made ridiculous claims about the non-addictiveness of Oxycontyn. Claims that any expert in drug kinetics would reject without any need for clinical tests, but that the FDA incredibly believed. And we have a perfect example of the Fox watching the hen house:
Purdue runs the clinical trials that are used to test its own drug
The FDA rubber stamps the results
By law nobody else can actually check the results, they are secret, forever
By law Purdue is free to spend millions marketing to doctors
It is is the whole system that is corrupt.
But even more incredibly:even today by law we cannot access the data used in the approval process for Oxycontyn. And this is true for all drugs: all data used in the approval process are, incredibly, secret, for ever.
It is the Fox that is guarding the hen house.
22
If only the NYTimes reporters and editors could follow these same standards...they've had many conflicts of interest over the last few years without any disclosures.
6
False equivalency.
Even the National Institute of Cancer now acknowledges cannabis has "possible direct anti-tumor effects," but research on this--or any other aspect of the medicinal benefits of cannabis on humans is blocked by Congress, NIDA, the DEA and pharmaceutical companies. Shame on all of them.
13
One of the first lecture our Dean gave us on our first day at medical school... He said medicine was the noblest of professions & meanest of the trades. He urged students to leave medical school if their main aim was to make money. This was long age but it seems to ring true today at the state of medicine in our country. Hospitals systems, Hospital Administrators, Pharmaceutical companies, Insurance companies are all equally responsible for this corruption in medicine. Doctors who are lured into this are also contemptible but really are victims of the system. If by some miracle, medicine could be inoculated against financial contamination we would be much better off. CEOs of big hospital systems behave like God Almighty & make huge salaries & pressure doctors in their respective systems to generate more & more money by up coding, testing etc. One could go on & on....there is no end.
Masters make the rules.
14
As the editorial states, other officials at Sloan Kettering were well aware of Dr Baselga’s Financial entanglements. When he failed to list those conflicts of interest in the articles published in the new England journal and elsewhere, their silence over so many years made them complicit. You’re not hearing anything about them stepping down, are you.
41
Corruption abounds
3
The medical industry just drips with greed and big, quiet money, all readily extracted from grossly inflated patient bills.
There seems no social, institutional or corporate sector unaffected by such toxic monies.
Too often, issues of money arise around medicine, universities and the church which once seemed so sacrosanct.
16
At the core of the matter, or at least what should be at the core of the matter, is human life.
Did my doctor recommend XYZ med because it's best for me, or most profitable for him? Without transparency and some semblance of real oversight, we'll never know.
At the heart of this heartless matter is the almighty dollar. As long as the government dodges the issue of medical price gouging and clandestine pay-offs, we will be mugged by pharmaceutical companies, distributors and healthcare providers.
10
Very good suggestions and nice article. Researchers are looked upon by people as their guides in science , who enable them to live better. When people like Baselga indulge in malpractice of mega scale, people’s faith gets shattered.
How does resignation help ? That’s not the only solution. He should be made to monetarily penalise heavily because he will simply getaway by resigning. No doubt his reputation is comedown to nought. That itself won’t be sufficient.
Researchers’ sole motto should be devotion towards science and mankind. If not what is the difference between a rogue politician and a scientist ?
Researchers and Doctors are someone special because of their professions since these are revered professions. A blot on these professions is heartbreak for mankind.
5
The key problem here is greed, and the lack thereof of any incriminations should the culprit get caught. There definitely was a conflict of interest that Dr.Baselga had as the chief scientific officer of MSKCC and with his taking money from medical companies. Worst of all, it's plausible that people suspected or knew that he was paid by the medical companies. Baselga, I'm sure will continue with these medical companies, and who who knows how these companies and MSKCC will now interact with each other. MSKCC needs to have a policy that specifically spells out that this "interaction" simply cannot happen - period. For a million plus dollars that Dr. Baselga received from MSKCC, if that wasn't enough, he should have resigned on his own. Of course, that was the honourable thing to do, and as it's now being shown, there's no honour in quitting if the "extra" money is available, and everyone turns a blind eye!
11
And it works the other way too. Years ago I was a principal investigator in a clinical trial for a definitive treatment for Parkinson's Disease. The drug seemed to work, the statisticians advised the sponsor to go to phase III, but the senior vice president cancelled the study, presumably, in retrospect, because the sponsoring corporation had learned that their patents on the drug were not valid.
The study bwass buried with a paper that was basically written by the corporation.
23
This case - which is the tip of an enormous iceberg - is particularly egregious only because of Baselga's arrogant and flagrant disregard for the rules. To him it was trivial to disclose these conflicts, because in fact it is trivial
Listing conflicts of interest at the end of a paper does not prevent the corruption that huge money has brought to medicine and biomedical research. It may make the public feel better, but the bias is still there.
The defense of these industry connections is that "we need" these highly trained scientists/doctors to be involved in the biotech industry. But what does being involved have to do with making these amounts of money (outside their already substantial salaries)? The only way to avoid the conflict is to stop taking the money.
Biotech has not cured cancer. In fact a good case could be made that it has so corrupted cancer research that we are worse off than if these industry connections had never been allowed.
44
What’s wrong with research doctors on salary, just like university biochemistry faculty who also do cancer research? Shouldn’t their primary motivation be the love of science, not the love of money?
10
@Ockham9 their primary motivation should be to earn a living wage, take care of their families and plan for retirement just like everyone else with a career. They have already chosen a career that will pay them less then their similarly educated peers because of their love of science. Should they also take a vow of poverty while everyone else gets rich? Are you aware that research scientists do not get paid for journal publications, for being a grant reviewer for the NIH, for lectures at academic conferences? That they have to travel coach and get a minimal stipends for lecturing at other academic centers. Not enough to compensate for a trip away from home. That is the life of a research scientist. Of course this man was unethical because he did not completed disclose possible conflicts of interest but the US is already struggling to maintain talented students in a life as a research scientist so we should be careful before we curtail other income opportunities.
1
I recommend a South Korean TV show, "Life". (it may be available on Netflix) medical commercialism is well depicted. and hospitals' own problems too.
4
@Jung Myung-hyun
Thanks for the tip - for everyone reading, it is available on Netflix here in the states and looks really good.
The influence of the pharmaceutical industry on medical practice and medical research is often more subtle than having doctors on a payroll...
The best current example is the field of Rheumatology which has been transformed by the emergence, 20 years ago, of so called "biotherapies" which improve greatly the treatment of arthritis.
In these 20 years, academic Rheumatology has been infiltrated by big pharmaceutical companies using sophisticated strategies:
-Creating "Key Opinion Leaders" by helping friendly rheumatologists publish articles and give lectures at major Meetings
-Giving money to support "Research", actually clinical trials whose results are controlled by the initiating company.
20 years later, the whole specialty of Rheumatology, despite the new weapons against arthritis developed in the 2000s, is very weak because it has lost real scientific leaders and arthritis oriented basic research programs.
28
Headline says disclosure rules may seem 'arcane', but money corrupts.
Arcane means " knowable only to a few people. "
So disclosure seems like what is known only to a few? What?
Disclosure is needed. And clarification.
8
I’m a nurse working in government and I make recommendations that can impact coverage, testing, etc.
I choose to not take meals, “swag,” not even pens, from companies that may, in theory, have a product/drug/service that could be impacted by my decisions. State limit is $50. My limit is zero.
But at a recent professional conference, the WiFi was sponsored by a company whose product was being reviewed in a session. In a conference center without cell reception, you have to use the WiFi. There was no way to avoid this blatant conflict of interest.
We have to stop thinking we are “better than” influence. If sticky note pads and coffee didn’t work, the companies would stop offering them. Of course it impacts behavior. Nothing is truly free and we all need to stop acting like it is when people’s lives are at stake.
115
When insulin was discovered by the Canadian doctor Banting in 1921 , he sold the patent to the University of Toronto for $1 .
In 1923 , together with Scottish dr. Macleod, dr Banting received the Nobel prize for physiology.
Now , because of the vultures of Wall Street , the price of certain types of insulin have skyrocketed and became unaffordable.
This is just an example that describes the intrinsic ethics that should be part of any research.
Research can be time consuming and costly, the Federal Government has been subsidizing most of it .
But...once the results of research become available for use , there is always a speculator ( Wall Street) trying to make an incremental , often immoral , profit , damaging the patients the research was meant to help .
It’s immoral that any physician or medical researcher should be involved in any kind of “ bribery “ from financial institutions.
Research should be clean , autonomous, with the only goal to improve humanity.
94
It's worth noting that virtually every pharmaceutical company and medical device manufacturer have important executives of healthcare organizations, mostly involving medical schools, on their board of directors.
These people usually get several hundred of thousands of dollars per year for attending few meetings on top of their high salaries at their regular jobs which are supposed to be full time.
I sure would like all those medical school ethic boards which have banned physicians from getting a piece of pizza or a pen out of fear they will be corrupted by these look into how taking vasts amounts of money somehow isn't corrupting.
Oh well, as Bob Dylan sang "The masters make the rules."
73
Do any hospitals have rules
against this practice or is it
considered prestigious for
the institution to have their
doctors on boards? Are there
limits on the number of
of boards, pharmaceutical
or tech companies a doctor
is allowed to consult with?
In most (maybe all)
hospitals there will be
a team in place
to analyze and determine
the course of treatment.
I would think that would
increase the likelihood
of the use of the
best possible treatment for
the patient. It would not
be one (possibly “tainted”)
doctor advocating the drugs
he/she is researching,
rather several options determined
in a group analysis.
Is that naive? We hold our
physicians in high regard
thus these ethical issues are
troubling.
1
Money corrupts medical research and medical practice. The extent of this corruption is unknown. This case of the Memorial Sloan Kettering Center is extremely sad because of patients' suffering and their tragic situation. I have been deeply affected by it. I know the center and I had the highest regard for it.
Money also corrupts other types of research from climate change to software. In addition, universities put great pressure on faculty to get research money. There have cases in which entire departments in the hard science (Math, Statistics) have been axed because of their research money is lacking. The motto "publish or perish," has become secondary to "money or perish."
32
Unfortunately, there is not yet a Drug available for GREED.
Just saying.
129
@Phyliss Dalmatian And why no consequences for the drug companies. Their greed will continue until they also have to pay for seducing doctors and medical organizations. Maybe we should give them pens "greed kills."
My thoughts exactly! What is wrong with people?
This is only one of many ways that physicians benefit from special relationships. What about the physicians who refer to labs or X-ray places in which they have a financial stake? There is big money in medicine and physicians are as vulnerable as anyone else to maximizing their incomes.
51
"In statements to industry analysts and the American Association for Cancer Research, Dr. Baselga praised two drug trials that many of his peers considered failures, without mentioning that the trials’ sponsor, Roche, had paid him millions of dollars. He also withheld his financial conflicts from dozens of publications, including at least one journal that he edited."
The solution to this is in fact in the editorial. Create a uniform reporting system. Congratulations NYT board - you got this one right. And it is easy to do. Via the Medicare reporting system. One disclosure document, updated annually as a condition of continued enrollment in the Medicare provider system will do the trick. The penalty phase at the end is self-evident to any doctor or institution; banning of participation in Medicare and any and all federal health dollar programs.
End of problem.
64
As a long retired physician I must admit that this failure to put the patients' welfare first because of payments from outside sources when choosing a treatment or speaking or writing as an authoity to other physicians is a cancer on the medical profession.
I grant that what we earn after many years of training and the responsibilities we shoulder may not seem fair compared to for example what investment bankers or professional athletes earn but this is the life we have chosen.
This behavior has gone on far too long and even though one may claim that his or her judgement is not influenced by outside money the appearance of wrong doing is still there.
Like Caeser's wife we must strive to be beyond reproach.
75
@Edward Blau"One may claim his or her judgement is not influenced" simply shows the naivete of these physicians. The drug and device companies certainly know better. Another issue I've personally seen is where companies pay physicians to "do research" and then write papers with the physicians name in vanity journals.
1
But wasn’t his salary more than a million a year? Doctors aren’t the only ones with a lot of education and training.
1
Money changes everything.
There's so much money at stake for every successful treatment that can be marketed, spending whatever it takes to override ethical judgment is a small price.
It's a simple calculus that drives the for-profit medical-industrial complex: your money or your life. That's the trade-off for life-saving treatments. The resemblance to extortion is not entirely coincidental.
It's also a reflection that there is less and less money available to fund basic research coming from the government. The struggle to compete for grants, the expense of medical research and trials... If a doctor is bringing in big bucks to an institution constantly needing infusions of cash to stay alive, there is a real incentive to not press too hard as long as everything looks good on the surface.
18
It's quite clear that Dr. Baselga could have avoided this whole imbroglio by simply setting up a foundation, and having big pharma write checks made out to the foundation. Even if the foundation employed Dr. Baselga's family members, there would have been no ethical boundary crossed.
7
@Middleman MD
The problem is that the unsavory territory begins just a hair on this side of the ethical boundary...
1
This is excellent and timely editorial. The relationship between the the pharmaceutical and medical devise industry and medical profession particularly the leading researchers is wide spread and are not transparent. Even with most stringent requirements for reporting conflict of interest do not deter and have not changed the behaviour of many of the people who are engaged in these practices. The main reason for this failure is absence of clear consequences of violations of code of conduct of industry and physicians who have financial relationship with industry. I hoping that medical profession and its leadership will look at the steps in this editorial and make effort to adopt them.
3
Drug companies must hate palliative care...we use simple, effective, powerful and cheap medications; now I wonder how many studies of the ‘benefits’ of oncology drugs are truly valid. We all know oncologists try not to ‘give up’ on their patients ( bravo for that) but this makes me wonder if (our suspicion that) many chemotherapies do not extend life at all, rather, they continue to shred the quality of the last months of a dying patient’s life - and may even shorten it.
137
@Johnbbf
Well said sir. My sentiments exactly...
9