When money meets medicine and research
September did not go well for Memorial Sloan Kettering Cancer Center.
At the beginning of the month, The New York Times and ProPublica revealed that the center’s chief medical officer, a notable cancer researcher and physician, had failed to disclose millions of dollars of payments he’d received from pharmaceutical and biotech companies.
In recent years, he’d published dozens of articles in leading medical journals that made no mention of his extensive ties to industry.
For instance, he published an article in The New England Journal of Medicine about a clinical trial of an experimental cancer medication produced by the drugmaker Roche. When asked by the journal to disclose any financial interests he held that could bear on the research, he responded that he had “nothing to disclose” — even though Roche had paid him more than $3 million for consulting work and for his stake in a startup company it had acquired.
Two years later, he participated in a clinical study of another Roche experimental cancer drug, administering the therapy to his patients. When the results of the trial were later revealed, he wrote in a blog post that those results were “incredibly exciting.” That same day, Roche announced it was scrapping plans to develop the drug. I could go on, but I think you get the point. And so, too, did Sloan Kettering’s chief medical officer. Less than a week later, under heavy pressure, he resigned.
Later in the month, the Times and ProPublica published another story about conflicts and
Sloan Kettering. This one involved a spinoff company the center had started. Several board members were investors, and two of the center’s prominent scientists held stock in the company.
Sloan Kettering had given the new company the exclusive right to use its archive of 25 million patient tissue samples. The story questioned whether this arrangement was proper and whether the nonprofit center had received fair value in this deal, which provided a virtual treasure trove of medical data to a company dominated by insiders.
Understandably, these episodes have shaken Sloan Kettering to its core. They’ve damaged the public’s trust in the center and imperiled its reputation as a global leader for cancer research and treatment. (I’d guess they’ve also led the center to cancel its subscriptions to the Times.)
Predictably, one reaction to Sloan Kettering’s troubles has been a call — led by the Times — to prohibit doctors from receiving any payments from industry. While this might seem like a sensible solution, in reality, it would be devastating to the development of much-needed new drugs.
The insights that physicians and researchers provide to industry are vital at every step of the process of creating and testing new therapies.
To ask these experts to work on these projects without remuneration is not only inequitable, but nonsensical. Without some ability to be compensated for their thought, expertise and effort, most will turn their time and attention to other projects.
And removing medicine’s leading experts from the drug development process would be like trying to send a rocket into space without physicists.
Don’t get me wrong: I’m not saying that what happened at Sloan Kettering is OK. It’s just that we need measured solutions to a complex problem.
Clearly, no doctor should be working on a clinical trial — or publishing papers about one — when he’s simultaneously being paid by the drug company sponsoring that trial. Nor should board members or senior scientists at a nonprofit like Sloan Kettering be negotiating a deal with a company in which they have a stake. And $3 million sounds like an awful lot of money for physician-researcher to receive for a side gig from a drug company.
That said, there are only so many lines that can be drawn. Those lines will, of necessity, be somewhat arbitrary. They will not anticipate every potential conflict. Like all rules, they will also beget unintended consequences and problems. And, of course, unethical people will still find ways to evade them.
Instead, I’d suggest the best solution is disclosure. We should focus our energy on ensuring these potential conflicts are out in the open for all to see. With transparency, patients can make informed choices.
Likewise, it allows institutions and regulators to monitor and, when needed, control or eliminate those conflicts. The many players in this game must also work more closely to share information.
Institutions need to know when their scientists are working with industry. So do the journals publishing scientists’ work and the government agencies funding their research.
There is no realistic way to prevent all improper behavior. But our best hope lies in using sunshine to prevent most of it — and, ultimately, to catch any bad actors who were accustomed to hiding in darkness.
A physician and medical researcher, Prescott is president of the Oklahoma Medical Research Foundation and can be reached at firstname.lastname@example.org.