I have written previously about the need for transparency in medicine. Specifically, I have grave concerns about the conflicting factors which influence medical decision making. Further up the food chain from ordinary physicians who may be influenced by drug reps sit the researchers and thought leaders whose articles, studies and seminars influence other physicians and often dictate which medicines or devices become widely used.
A recent story by the always excellent Charles Ornstein for ProPublica details the resignation of Dr. José Baselga, the chief medical officer of Memorial Sloan Kettering Cancer Center. Dr. Baselga came under intense scrutiny after reports by ProPublica and the New York Times revealed that he had failed to disclose millions of dollars in payments from health care companies in a majority of his research articles since 2013.
It seems that Dr. Baselga, a salaried staff member making $1.5 million in 2016, omitted significant financial ties in numerous articles. The companies who paid Dr. Baselga these unreported, but substantial amounts, purportedly stood to gain from acceptance of the author’s conclusions. A well-known breast cancer specialist, Dr. Baselga also failed to disclose such affiliations in articles he published in the journal Cancer Discovery. This is particularly troubling in that he serves as one of two editors in chief.
Why should we even care about such industry ties?
Why should we even care about such industry ties? The transparency rules requiring disclosure of such conflicts are designed to ensure that proper weight or scrutiny can be made of any findings or opinions. Consider a study which concludes daily consumption of orange juice is healthy. This sounds entirely reasonable, as we know oranges have a healthy supply of vitamin C. But what if the study itself was conducted by the Citrus Industry, or the Citrus Industry paid the lead researcher a significant sum. Wouldn’t we be skeptical of such a finding?
Peeling back the study further we may find that the study focused on children, not adults, or that the amount of juice was 3 ounces, not 8, or that it resulted in dangerous increased blood sugar levels in diabetic patients, or any other number of critical distinctions that a legitimate objective researcher would highlight or consider before promoting the conclusion that “orange juice is healthy.”
There is no question that the pharmaceutical and medical device industry should be able to fund, invest in, or otherwise reward researchers, thought leaders, or health care providers. However, any such payments must be disclosed. In fact, there is a law which requires public disclosure of payments made by such companies to physicians and teaching hospitals. See Physician Payments Sunshine Act—Section 6002 of the Patient Protection and Affordable Care Act (PPACA).
When a distinguished physician like Dr. Baselga conceals these payments from his published research or articles, it creates more than the appearance of impropriety, it calls into question what he is hiding. The origin of such laws and rules stems from fairly recent scandals involving undisclosed conflicts. Yet here we are again. While the good doctor has resigned his position and now says that he intends to correct his conflict-of-interest disclosures in 17 journal articles, including in The New England Journal and The Lancet, is it too late?
The corrections are mere whispers or footnotes compared to the shouting of his prior body of work.