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The New York Times
Health
Citing Ethics, Some
Doctors
Are Rejecting
Industry Pay
By GINA KOLATA,
nytimes.com on the Web, April 15, 2008
With little fanfare, a small number
of prominent academic scientists have made a decision that was until recently
all but unheard of. They decided to stop accepting payments from food,
drug and medical device companies.
No longer will they be paid for speaking at meetings or for sitting on advisory
boards. They may still work with companies. It is important, they
say, for knowledgeable scientists to help companies draw up and interpret
studies. But the work will be pro bono.
The scientists say their decisions were private and made with mixed emotions.
In at least one case, the choice resulted in significant financial sacrifice.
While the investigators say they do not want to appear superior to their
colleagues, they also express relief. At last, they say, when they offer a
heartfelt and scientifically reasoned opinion, no one will silently put an
asterisk next to their name.
They are part of a group responding to accusations of ethical conflicts inherent
in these arrangements, and their decisions repudiate decades of industry
influence, says Dr. Jerome P. Kassirer, a professor at the Tufts School of
Medicine, who has written a book on conflicts of interest.
Five years ago, “nobody paid any attention to taking money from industry,” he
said, adding: “They just took it. In some instances, I think people
thought they were suckers if they didn’t.”
Even last year, the Food and Drug Administration decided that it could not
altogether ban researchers from its advisory boards who took industry consulting
fees.
Now, Dr. Kassirer said, he keeps finding experts who are rejecting the money.
“I don’t think there’s any question that the atmosphere has changed,” Dr.
Kassirer said.
He attributes the change to publicity about conflicts and what can be almost a
public shaming when researchers’ conflicts are published. “Finally, it’s
gotten to people,” Dr. Kassirer said.
Here are the accounts of three scientists who have lost their asterisks.
Dr. Peter Libby, chief of cardiovascular medicine at Harvard’s Brigham and
Women’s Hospital, said that when he first began receiving offers from drug
companies, in the early 1980s, they seemed like a natural reflection of his
burgeoning reputation.
“When you start emerging as an opinion leader or as a researcher who has
knowledge and expertise, the pharmaceutical industry takes an interest in either
having you consult to help them with their research or to speak,” he said.
Dr. Libby wanted to assist. Like many scientists, he feels that it is
important for researchers to consult with drug companies to help develop
therapies and set up studies. He never owned stock in companies that he
consulted for. He always disclosed the fact that he consulted and spoke
for companies. And, he added, he thought that he was protected from
accusations of favoring any particular company’s products because he consulted
for so many.
“I lived safely in that comfort zone for many years,” Dr. Libby said.
Then he was hit with a moment of truth. He had spent four years working
without pay to help create a public television series, “The Mysterious Human
Heart.” The project was, he thought, a worthy effort to educate the public
about what heart disease was and how to prevent it. He was proud and
pleased when the series was broadcast in October.
But to his dismay, bloggers immediately attacked him and the other medical
experts who appeared on the programs for having consulted for manufacturers of
pharmaceuticals and medical devices, Dr. Libby said, adding: “They said we
were biased. What I thought was four years of public service was impugned.
“That was a wake-up call for me. I was singed in the blogosphere.”
This year, he made his decision. He would continue speaking at forums
sponsored by the pharmaceutical industry and would continue consulting for
companies. But he would no longer accept payment.
Since then, Dr. Libby said, company executives and lawyers have asked whether
they offended him. Does he have some secret agenda?
His motives are straightforward, he replies. “I want to speak out about
the beliefs I am passionate about regarding prevention and medical advances that
I think can reduce disease and save lives,” he said. “It is not worth it
to be under suspicion.”
Kelly D. Brownell, director of the Rudd Center for Food Policy and Obesity at
Yale, made a similar decision. His was to protect his integrity when he
began to wonder whether his industry associations were subtly affecting his
objectivity. “The money offers started happening about 20 years ago, at
the point that I became a visible person in the field,” Dr. Brownell said.
First it was drug companies developing obesity drugs. Then it was food
companies. Eventually, Dr. Brownell said, he began to worry. Were
his associations unconsciously affecting his objectivity? He said the
money could be substantial. He was offered, for example, $50,000 to be on
an advisory board.
“It is easy to offer subtle statements that would favor a drug,” Dr. Brownell
said. “You do it for two reasons. You’ve got a money stream coming
in, and you get to like the people who work for the companies. You feel
like you’re on a team.”
About 10 years ago, he decided he had to stop accepting money, he recounted.
It was one factor, along with higher taxes and his wife’s decision to work fewer
hours, that led him to sell his house and move to a less expensive one.
And that $50,000? He turned it down. The offer arrived after he had
made his decision.
Dr. Eric P. Winer, director of the Breast Oncology Center at the Dana-Farber
Cancer Institute at Harvard, made his decision about a year ago. “Several
times when I was interviewed for stories, after my comments there would be the
obligatory phrase, ‘Dr. Winer has accepted honoraria,’ ” he said. “I was
tired of having to see that.”
He had also accepted a position as chief scientific adviser for a group that
advocates for women with breast cancer, Susan G. Komen for the Cure. Those
asterisks, he decided, could hinder his ability to help the group.
Dr. Winer, like many other investigators, points out that conflicts are not so
simple. His honoraria were typically on the order of $2,000 or $3,000 for
attending an advisory board meeting for a day and a half or two days. “It
truly is not a large amount of money we are talking about here,” he said.
There are many other sorts of conflicts that attract little comment but that can
be much more significant, Dr. Winer added. There is the researcher’s need
to run a clinical trial because that can help the researcher’s career or
obtaining financing. The reward is not money, but career advancement and
prestige.
In today’s atmosphere of intense scrutiny of scientists who accept industry
money, he said, he felt he had little choice.
“I am responding to a societal pressure,” Dr. Winer said. “I just said
enough is enough. And in truth, it has made my life simpler. I no
longer debate can I take this, can I not take this. It is simpler when I
talk to reporters. It is simpler when I give lectures.”
On the other hand, he mused, the decision had a subtle effect. Now that he
receives no compensation, he is less willing to help pharmaceutical companies
research treatments.
“My willingness to go to an advisory board meeting has gone down,” Dr. Winer
said. “Do I want to spend my Saturdays and Sundays at a meeting? As
much as I am a dedicated researcher, I have to have a life.”
“This is a complicated arena,” he added. “And on some level I resent the
fact that I had to make this decision.”
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