Some rare good news! Citing Ethics, Some Doctors Are Rejecting Industry Pay: NY Times April 15, 2008

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From a Silent Sister: . . . by Kolata, no less! . . . For those who don't know her, she blasted doctors who took a stand against breast implants in 1994. One of the doctors was an excellent neurologist who, as a response, refused to treat breast implant women. ----------------------------------------------------------

NY Times April 15, 2008 Citing

Ethics, Some Doctors Are Rejecting Industry Pay By GINA KOLATA 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. 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.” 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. 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, 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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