Editorials of The Times: Medicine’s Financial Contamination

The fall from grace last week of Dr. José Baselga, the former chief scientific officer of Memorial Sloan Kettering Cancer Center, illuminated a long-standing problem of modern medicine: Potentially corrupting payments by drug and medical device makers to influential people at research hospitals are far more common than either side publicly acknowledges.

Baselga, a giant in cancer research whose work led to the discovery of the lifesaving drug Herceptin, resigned Thursday after The New York Times and ProPublica reported that he had repeatedly failed to properly disclose millions in industry payments.

Decades of research and real world examples have shown that such entanglements can distort the practice of medicine in ways big and small. Even little gifts have been found to influence doctors’ prescribing habits and their perceptions of a given company’s products. Larger payments have been shown to affect the design of clinical trials and the reporting of trial results, among other things. And such financial entanglements have proved devastating to individual patients — and to society at large. The opioid epidemic, to take one recent example, was partly spread by doctors who were persuaded to ignore warning bells and prescribe these drugs liberally by companies that showered them with gifts and consulting fees.

Baselga’s lapses may not have touched off a drug epidemic, but they have damaged the reputation of a leading cancer hospital in which tens of thousands of patients place their trust every year. Medical institutions should prize that trust at least as much as they prize profits. They should work aggressively to keep themselves beyond such reproach. And they should hold leaders of Baselga’s rank to an especially high standard, because leaders more than rule books set the example that others will follow.

The latest scandal marks an especially sad failure to meet those ideals. In statements to industry analysts and the American Association for Cancer Research, Baselga praised two drug trials that many of his peers considered failures, without mentioning that the trials’ sponsor, Roche, had paid him millions of dollars. He also withheld his financial conflicts from dozens of publications, including at least one journal that he edited.

Those conflicts touched his own institution directly, in that several of the companies he advises have business with Memorial Sloan Kettering. Both Varian Medical Systems, which sells the hospital radiation equipment, and Bristol-Myers Squibb, which sells it medications, pay him several hundred thousand dollars a year for his role on their boards of directors. Likewise, Juno Therapeutics and Paige.AI, both tapped Baselga to serve as a chief adviser after securing exclusive rights to data and technology developed by the hospital. Neither Juno nor Paige are required to disclose exactly what they’ve paid Baselga, because neither has brought a product to market yet. But if those payments are on par with what he’s receiving from other companies, it would come out to hundreds of thousands of dollars for each. And if his compensation from these companies includes stock, he stands to profit personally, and handsomely, from intellectual property that belongs to the hospital.

Sloan Kettering’s other leaders were well aware of these relationships. The hospital has said that it takes pains to wall off any employee involved with a given outside company from the hospital’s dealings with that company. But it’s difficult to believe that conflicts of this magnitude could have truly been worked around, given how many of them there were, and how high up on the organizational chart Baselga sat. It also strains credulity to suggest that he was the hospital’s only leader with such conflicts or with such apparent difficulty disclosing them. After the initial report, but before Baselga’s resignation, the hospital sent a letter to its entire 17,000-person staff acknowledging that the institution as a whole needed to do better. It remains to be seen what additional actions will be taken — and by whom — to repair the situation.

Financial conflicts are hardly confined to Sloan Kettering. A 2015 study in The BMJ found that a “substantial number” of academic leaders hold directorships that pay as much as or more than their clinical salaries. According to other surveys, nearly 70 percent of oncologists who speak at national meetings, nearly 70 percent of psychiatrists on the task force that ultimately decides what treatments should be recommended for what mental illnesses, and a significant number of doctors on Food and Drug Administration advisory committees have financial ties to the drug and medical device industries. As bioethicists have warned and as journal publishers have long acknowledged, not all of them report those ties when and where they are supposed to.

Medical journals and professional organizations have also told The Times that they are looking for ways to streamline the disclosure process for doctors and to better track those disclosures themselves. Those are good first steps, but if institutions charged with curing the sick are serious about finally stopping the corruption of medicine by money, they’ll need to do much more than that.