When is the critic-at-large the ultimate example of the "conflicted" interest?

An interesting, and well-written article in the NY Times today discusses the most recent career ambition of Dr. Steven Nissen, the cardiologist at the Cleveland Clinic whose outspoken views on the risks of COX-2 inhibitors and Avandia have drawn dramatic headlines and FDA attention.  The NEJM jumped on this latest post-Vioxx bandwagon early, fitting, as it did, so well in Dr. Jeff Drazen’s lightly veiled and vociferous anti-industry campaign.  Of course, Dr. Drazen’s long-time lucrative association with Merck, and the Singulair program, as well as a large number of pharmaceutical companies for which he was a key opinion-leader for many years and from which he profited handsomely, is now just a distant memory, rarely spoken of since he’s taken his post at the NEJM.  Dr. Nissan seems cut from the same hypocritical cloth.  Though Dr. Nissen likes to think of himself as “both an insider and an outsider”, one is left wondering if in fact he’s neither.  Instead his position seems driven more by self-promotion, and using the “bully pulpit” of academia to over-promote marginally statistically significant results as a intentional slaughter of the innocents by big pharma.  The results of his Avandia meta-analysis are not significant in the strictest sense and would not be accepted by the NEJM if they came from anyone other than an academic with a reputation for indicting Big Pharma.  And yet, the NY Times article nicely outlines how things are never quite as clear or idealistic as they seem when individuals’ careers are carefully analyzed.   

 

http://www.nytimes.com/2007/07/22/business/22nissen.html?_r=1&th&emc=th&oref=slogin

 

 

The Academic Emperor

The economics of academic medicine are THE "third rail" topic. It leads to a lot of hidden costs to and hiding of costs by academic physicians and their families. To publicly ask about it during, for example, contract negotiations, leads quickly to the pregnant pause that implicitly asks the question "are you sure you're really in this for the right reason?" Obviously a nice "out" for the department chair. And yet, fundamentally, bills need to be paid. Hidden "moonlighting" is common among junior (and senior) faculty members, who do it under a sort of "don't ask, don't tell" policy. The moonlighting morphs as faculty move up to become extensive medico-legal, pharmaceutical, or investment "consulting" - all done in addition to the ever-spiraling and time-consuming "pro-bono" work (study sections, manuscript reviews, society work, etc) that further erases an academician's time for free-thinking, creative scientific inquiry. This is a MAJOR issue which, though not to be spoken of "in polite company," leads to an erosive hypocrisy which flies in the face of nominal academic honesty and integrity. This issue should be taken seriously by academic leaders, but will only be so when honesty prevails over wishful thinking and averted eyes.

See www.jci.org/cgi/content/full/117/6/1727 for a very interesting discussion on some of these issues. It is the 2007 American Society for Clinical Investigation Presidential address, by Barbara Weber, a prominent oncology clinical trialist who recently moved from U Penn to GSK where she is VP of Oncology Discovery and Translational Medicine. One is left wondering if the "sultan," like the emperor, may be a bit less well-dressed than he (or she) would like to think.