Medical Establishment: More Dubious Goings On In Mainstream Medicine

They did it again. Just when I get to the point where I think I've seen it all, they raise the bar to a new height of absurdity.

'They' in this case is the mainstream medical establishment in general, and the drug industry specifically. If you think drug company influence has a long reach, wait till you hear this one.

Can of worms deluxe

When you see the terms 'secret consultancy fees' and 'drug companies' mentioned in the same article, you know it's time to fasten your seat belts. But this time it goes way beyond fees paid to individual doctors. This time the fee recipients are highly placed officials with the US National Institutes of Health (NIH).

Hats off to David Willman, a two-time Pulitzer Prize winning reporter for the Los Angeles Times in the US, who recently concluded a five-year investigation of the inner workings of the NIH. Mr. Willman's article reveals that hundreds of thousands of dollars of drug company consulting fees have been paid to top NIH officials who oversee the clinical trials of drugs. Now, this may apply to the US but you can bet that the situation isn't much better here in the UK either.

Wait. It gets worse

Willman cites a 1998 legal opinion that provides a loophole by which more than 90 percent of NIH officials are allowed to keep their consulting income confidential. In addition, many of them sign confidentiality agreements with the companies from whom they receive fees and corporate stock options.

If there were ever a situation tailor-made for conflict of interest, this would be it.

An LA Times survey of more than 30 other federal agencies revealed that the NIH had the lowest percentage of employees filing reports of 'consulting' income. In many of those agencies ALL of the most well paid officials submitted public reports. Mr. Willman concludes that in the area of financial disclosures, the NIH is 'one of the most secretive agencies in the federal government.'

But wait. It gets even worse.

Consulting we will go

To understand the trust that has been violated by the NIH's easy-does-it attitude toward consulting fees, Mr. Willman highlights one case in particular.

In an NIH study of a drug to treat kidney inflammation related to lupus, one of the subjects receiving the drug died of a complication that was believed to be related to the drug. But the senior NIH official connected to the study didn't stop the study, nor did he attempt to warn the medical community of the potential danger of the drug.

That official was a paid consultant for the company that produced the drug. And in the past 10 years, he received well over half a million dollars in consulting fees from various drug companies and biomedical firms.

And he wasn't alone. According to the LA Times article, among his many colleagues who provided consulting services, one of them has accepted almost $1.5 million in fees.

He must be a REALLY good consultant.

Once upon a time...

During the Reagan era, Margaret Heckler (the secretary of Health and Human Services, which is the agency that oversees NIH in the US) called NIH 'an island of objective and pristine research, untainted by the influences of commercialisation.'

Ah, those were the days!

In 2003 the NIH comprised 27 individual institutes, more than 18,000 employees, an annual budget of almost $28 billion and a very protective bureaucracy.

When Dr. Ruth L. Kirschstein (the NIH deputy director who approved many of the consulting arrangements) was asked about the results of the Willman investigation, she told the LA Times that NIH staff members are 'highly ethical' and have 'enormous integrity.' She admitted that systems can be 'tightened up,' and said that, 'perhaps, based on this, we will do so.'

Wow. Sounds like Dr. Kirschstein is going to go all out!

And last month, NIH Director Elias A. Zerhouni announced that he would study the situation by forming a committee.

Well, well, well... a committee! Now that IS impressive! What next? A memo?