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Pogo at the NIH

If we, as health professionals, want health care to be more honestly and rationally managed, we must be prepared to do our best to conduct ourselves honestly and rationally. Of course, dealing honestly with others is a fundamental value for physicians, and is codified in, for example, the <a href="http://www.ama-assn.org/ama/pub/category/2512.html">AMA Principles of Medical Ethics</a>, and the <a href="http://www.mja.com.au/public/issues/177_05_020902/bre10417_fm.html">ACP-ASIM-ESIM Physician Charter</a>. <a href="http://www.washingtonpost.com/wp-dyn/articles/A58845-2005Feb2.html">Today's Washington Post has a disturbing report </a>about NIH staff reactions to the new ethics policy, (first reported on Health Care Renewal <a href="http://hcrenewal.blogspot.com/2005/02/ban-on-federal-scientists-consulting.html">here</a> and <a href="http://hcrenewal.blogspot.com/2005/02/nih-seeks-higher-standard-better-late.html">here</a>.) According to the Post, "nary a positive word had been uttered about the new policy, and there was more vented spleen around than a busy medical center like the NIH might normally see in a year." For example, <a href="http://www.bioethics.nih.gov/people/emanuel-bio.html">Chief of Clinical Bioethics Ezekiel Emanuel </a>"fumed" that his secretary would have to sell her stock, (presumably because the rules require that lower-ranking NIH employees limit individual stock holdings in drug, biotechnology, and similar companies to those valued at less than $15,000), and later asked "if we want to reassure the public, why don't we apply these [rules] to everyone who gets an NIH grant." There was indignation that the rules didn't apply to other federal departments, like Energy, Agriculture, and Defense, and that they didn't apply to grant reviewers. These comments seem to reflect a troubling lack of knowledge about how the NIH funds research outside of its walls. Hardly any individuals get NIH grants. The money goes to their institutions. Many research universities have had strict conflict of interest policies in place for quite a while. NIH grant reviewers have also had to follow strict conflict of interest rules going back to at least the 1980's. These rules, unlike those that applied to NIH full-time employees, were never, to my knowledge, relaxed. The comments also seem to exaggerate the hardships imposed by <a href="http://www.nih.gov/about/ethics/020105COIsummary.pdf">the new rules</a> for NIH full-time employees. NIH employees are not being asked to give their stock holdings away. They are being asked to sell them, and they get to keep the money. Nor are they being barred from most kinds of investment. They can own stock in any kind of company that is not directly involved with pharma, biotech, and the like, and they can own any mutual fund or other diversified holding. But it is most discouraging to hear high level NIH employees, and particularly their head of bioethics, complain that they should only be subject to the lowest common denominator of ethical rules, rather than at least acknowledge the need to set an example after their organization has been tarred by scandal. As Pogo said, <a href="http://www.igopogo.com/we_have_met.htm">"we have met the enemy and he is us."</a>

Pogo at the NIH

If we, as health professionals, want health care to be more honestly and rationally managed, we must be prepared to do our best to conduct o...

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Hungering for the here and now

Got a craving for <a href="http://local.google.com/local?q=spaghetti+bolognese&near=san+francisco">spaghetti Bolognese in San Francisco</a>? Maybe you're on the road and must have <a href="http://local.google.com/local?q=free+wifi&near=chicago">free wi-fi in Chicago</a>, or a <a href="http://local.google.com/local?q=hotels+near+the+beach&near=santa+monica">beachfront hotel in Santa Monica</a>. And Valentine's Day is approaching: time to find the perfect <a href="http://local.google.com/local?q=romantic+restaurants&near=philadelphia">romantic restaurant in Philadelphia</a>. There's been such great demand for Local search results that we've added a Local link on the <a href="http://www.google.com/">Google homepage</a> so you can find nearby businesses around the U.S. and Canada even faster than before. Try it out and tell us how it's working for you. We suggest keeping an eye on Local, too - you'll soon see even more features. Whether you're at home or traveling, you're now one click closer to whetting your appetite. Thai Tran Product Manager, Google Local

Hungering for the here and now

Got a craving for spaghetti Bolognese in San Francisco ? Maybe you're on the road and must have free wi-fi in Chicago , or a beachfront...

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NIH Seeks "Higher Standard" - Better Late Than Never

Finally, <a href="http://www.latimes.com/news/nationworld/nation/la-na-nih2feb02,1,5273080.story?coll=la-headlines-nation">the headline reads "NIH Seeks 'Higher Standard.'"</a> More than 13 months after the Los Angeles Times published its first investigative report detailing serious conflicts of interest affecting top NIH leaders, NIH Director Elias Zerhouni has decided the time has come to provide "at least one source of public health information in the country that can be completely trusted," and "we need to hold NIH and ourselves as scientists at NIH to a higher standard, because we do have national public health responsibilities." Of course, prior to the alteration of the NIH rules and disclosure requirements about possible conflicts in the 1990's, the NIH was a completely trusted source of science. But for 13 months, Zerhouni and his organization fought restrictions on outside income for full-time government employees, even as it was revealed that some NIH leaders were making hundreds of thousands as "consultants" to pharmaceutical and biotech companies. See our previous discussions <a href="http://hcrenewal.blogspot.com/2005/01/yet-more-conflicts-of-interest-at-nih.html">here</a> and <a href="http://hcrenewal.blogspot.com/2004/12/anechoic-effect-and-conflicts-of.html">here</a>. But now, at least Zerhouni admits "I've changed my mind." Better late than never....

NIH Seeks "Higher Standard" - Better Late Than Never

Finally, the headline reads "NIH Seeks 'Higher Standard.'" More than 13 months after the Los Angeles Times published its ...

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Revisiting: More Tuition, But Less Teaching

Revisiting: More Tuition, But Less Teaching

We are not the only ones talking about how tuition rises while instruction suffers. Here is an interesting blog discussion of the problem a...

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All in a year's work

All in a year's work

We made lots of improvements to Google AdWords in 2004. Find out how they can help your business as you meet some of the engineers who made...

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A New CEO for Independence Blue Cross

Independence Blue Cross (IBC) of Pennsylvania just announced the appointment of a new CEO after the untimely death of its former leader, G. Fred DiBona Jr. His <a href="http://www.philly.com/mld/philly/news/10622025.htm">Philadelphia Inquirer obituary </a>summarized his career before he started at Blue Cross: <blockquote>In 1976, at the age of 25, he was appointed to the Philadelphia Zoning Board of Adjustment, quickly rising to become its chairman. Two years later, Mr. DiBona was named head of the Philadelphia Port Corp. He led the agency for four years and was appointed president and chief executive officer of the Greater Philadelphia Chamber of Commerce in 1983. During his three years there, membership rose to 5,000 from 1,800. From the chamber, he moved in 1986 to Pennsylvania Blue Shield....</blockquote>The new CEO is Joseph Frick. His brief bio in the <a href="http://biz.yahoo.com/prnews/050126/phw041_1.html">IBC press release </a>includes: <blockquote>Frick, 52, had been Senior Vice President - Human Resources and Administration since 1997. In this capacity, he was responsible for corporate planning and business development, as well as IBC's Human Resources and Administrative services functions. He joined IBC in 1993 as Vice President, Human Resources, after spending almost six years in several HR positions at Philadelphia Newspapers Inc. (PNI). Before coming to PNI, Frick spent 13 years at Westinghouse Electric Corporation in various training and development, quality control and planning positions. </blockquote>Thus IBC, a huge health insurer and managed care organization with 3.5 million subscribers and $10 billion in revenue, will have had two successive CEOs with no demonstrable experience "on the ground" in health care. I received a comment on this issue from a correspondent with considerable relevant insurance and managed care experience:<blockquote>What you're seeing is typical of most businesses. This seems to me to be the result of some myopic views taught in B-schools; "you don't have to know 'THE' business, just how to run 'A' business." Similarly, some folks think just because they can "do anything," they can run a business. I'm trying to convince them that "it ain't necessarily so." </blockquote>It makes you wonder how much better off we all would be if such large health organizations had leaders who actually had experience in health care. We can only hope that Mr. Frick at least gets some input from people with real "on the ground" experience. <blockquote></blockquote>

A New CEO for Independence Blue Cross

Independence Blue Cross (IBC) of Pennsylvania just announced the appointment of a new CEO after the untimely death of its former leader, G. ...

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Ban on Federal Scientists' Consulting Nears

An article in the NY Times today on a forthcoming ban on consulting arrangements for NIH employees. Whether hard action occurs and is strictly enforced over the long haul remains to be seen. These type of scandals tend to burn brightly for awhile, then turn to more lukewarm efforts once out of the public spotlight. February 1, 2005 Ban on Federal Scientists' Consulting Nears By GARDINER HARRIS The National Institutes of Health and the Office of Government Ethicsare expected to announce a ban today on private consulting arrangements between scientists at the institutes and pharmaceutical and biotech companies. The ban comes in the wake of damaging revelations that some government scientists leveraged their positions at the institutes to gain lucrative consulting contracts with such companies, arrangements that sometimes overlapped with their government work. Dr. Elias Zerhouni, director of the institutes, emphasized in an interview last year that only 369 of the institutes' 6,000 scientists had consulting arrangements with such companies from 1999 to 2004. More than 80 percent of these scientists received $5,000 or less from outside consulting, Dr. Zerhouni said. "I want to dispel the notion here that every scientist at N.I.H. has consulting arrangements with 10 companies," he said in the interview. Dr. Zerhouni had hoped for months to preserve scientists' right to engage in some of these activities, saying a ban would turn the institutes into "a convent," which, he said, was not in keeping with Congress's insistence that its research lead to cures. But a series of articles in The Los Angeles Times detailing the conflicts between some N.I.H. scientists' public and private work and several hearings by the House Energy and Commerce Committee forced Dr.Zerhouni to retreat and finally propose late last year a ban on outside consulting activities. Since the ban was a change to government policies, it required approval from the Office of Government Ethics. That office is expected to announce today that it has approved such a ban. Representative Diana DeGette, a Democrat from Colorado and a member of the House Energy and Commerce Committee, released a statement yesterday saying that the institutes' new consulting guidelines would be "a major step toward restoring public confidence in our nation's premier research institution." Studies show that researchers who accept money from private companies are less likely than others to share the results of their work with their colleagues. Such researchers are also more likely to focus on commercially applicable studies, said Dr. David Blumenthal, director of the Institute for Health Policy at Massachusetts General Hospitalin Boston. Mildred Cho, associate director of the Center for Biomedical Ethics at Stanford University, said that academic researchers increasingly collaborated with drug and biotech companies, and that the growing number of consulting relationships between N.I.H. researchers and companies had simply reflected that trend. "What's different about this," Dr. Cho said, "is that it involves the government, government research and government funding of research. That represents a crossing of a line that hadn't been crossed before." The number of cases that have come to light so far are wide-ranging and include top-level administrators and working researchers alike. Dr. Bryan Brewer Jr., for instance, is chief of the National Heart,Lung and Blood Institute's molecular disease branch. In 2003, he wrote an article promoting the benefits of Crestor, a cholesterol-lowering medicine from AstraZeneca. The article was published in a medical journal "supplement" that was paid for by AstraZeneca, and Dr. Brewer's N.I.H. title was prominently displayed. The article failed to mention potentially serious safety problems with Crestor. In the interview last year, Dr. Zerhouni distanced himself from Dr.Brewer's Crestor article, saying that it was a "marketing effort" and "a product-driven endorsement" that should be banned. Dr. P. Trey Sunderland, a senior researcher at the National Institute of Mental Health, received more than $500,000 in consulting fees from Pfizer at the same time that he was collaborating with it in his government capacity of studying patients with Alzheimer's disease. Despite rules requiring that government scientists disclose their consulting arrangements to the health institutes, Dr. Sunderland failed to make such a disclosure. Dr. Zerhouni has described Dr. Sunderland's case as "a way outlier" that is being closely investigated. Private consulting arrangements between N.I.H. researchers and drug and biotech companies were relatively rare until the 1980's, when they slowly started to grow. They grew quickly after Dr. Harold Varmus, who was the institutes' director in the 1990's, decided to lift the limits on outside income, and administrators loosened disclosure rules about these activities. When the House began investigating, it asked Dr. Zerhouni to produce a list of agency researchers who were consulting for companies and the amounts they made. At first, Dr. Zerhouni said such a list would be impossible to produce. The committee asked pharmaceutical companies to disclose a list of their consultants at the agency. Finally, Dr. Zerhouni produced a list of consultants. But the lists produced by the drug companies included dozens of researchers who had not been listed by the institutes. Dr. Zerhouni said some of those names were errors. But, he said, the agency is investigating "30 or 40" people whose outside consulting arrangements were unknown to the institutes, and among them is Dr. Sunderland. Neither Dr. Sunderland nor Dr. Brewer could be reached. An institutes spokesman also declined to comment.

Ban on Federal Scientists' Consulting Nears

An article in the NY Times today on a forthcoming ban on consulting arrangements for NIH employees. Whether hard action occurs and is strict...

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