A conference at the Cleveland Clinic about conflicts of interest held seemed, at first glance, like a PR event to restore the clinics once pristine reputation for integrity, which has been battered in the past year by dueling allegations of conflicts of interest between two of the systems top physician leaders.
World-renowned heart surgeon Eric Topol was forced out last year after criticizing the systems president and chief executive officer, Delos "Toby" Cosgrove, for his outside financial conflicts of interest. The two doctors had vied for the leadership role after Floyd Loop retired in 2004.
So it took some guts for the clinic, consistently ranked among the nations top hospitals, to host a meeting on Sept. 20 called A National Dialogue on Biomedical Conflicts of Interest and Innovation Management. Several hundred ethics, compliance and conflict of interest officers from academic medical centers, medical schools and hospitals attended the conference. Top industry leaders, including Boston Scientific Corp. Chief Operating Officer Paul LaViolette and former Merck & Co. Chief Executive Officer Roy Vagelos, debated how to do the right thing without stifling innovation and the creation of blockbuster drugs and devices.
Speakers railed against the growing coziness between physician-researchers, inventors and clinical study heads and giant drug and devicemakers, as well as the increasing influence of money on medical decisionmaking.
(Modern Healthcare Reporter Mark Taylor, who covered the Sept. 20 conference, was part of a media panel the next day addressing the news medias role in reporting on ethical and conflict of interest issues. He was not paid for speaking there and Modern Healthcare covered his expenses.)
Compliance choirboy Jim Sheehan, the Associate U.S. Attorney in Philadelphia, National Public Radio Legal Reporter Nina Totenberg, who moderated some of the discussions, attempted to define the intersection between greed and self interest and the development of products that improve and save lives.
At the conference, deans of medical schools and researchers said they have struggled over how to encourage entrepreneurship without surrendering independence and ethics. Everyone wants to be a millionaire, and universities offer some of the best opportunities for creating and testing new drugs, devices and other potentially lucrative products.
There was plenty of talk about angst, hand-wringing and finagling over how to best manage, eliminate and avoid conflicts of interest, which everyone seemed to agree are inevitable in a capitalist, market-driven economy. Following a growing trend, each of the speakers seemed to make some personal disclosure about possible conflicts they had struggled with.
Academic medical centers, prescription drug companies and devicemakers have attracted the attention of federal enforcement agencies over expensive gifts, sham consulting contracts and kickbacks.
The lives of some patients participating in clinical trials have been lost or ruined because of unreported errors or study flaws, sometimes blamed on conflicts of interest. But at least one speaker, Thomas Stossel, a Harvard University professor and physician, derided the growing disclosure requirements as excessive and onerous. Stossel claimed some of the new mandates violate the privacy of researchers and encourage overregulation. "Are we solving problems? I dont think so," Stossel said.
But collegiality dominated and speakers demonstrated their "good guest" manners. A reporter from a medical trade publication twice unsuccessfully asked about Cosgroves alleged outside conflicts of interest, receiving "no comments" from two speakers -- former U.S. Attorney General William Thornburgh and New England Journal of Medicine Editor in Chief Jeffrey Drazen. In one case, the "no comments" drew applause from attendees.
Though the clinics hosting of the event seemed a genuine and sincere effort to grapple with tough ethical issues, the "no comments," however appropriate, seemed to scratch at sensitive issues that have long plagued healthcare. Maybe medicine just aint ready for reform.