June 27, 2006

Cleveland Clinic: The Natural Place to Hold a Conference on Conflict of Interest in Innovation. Not.

I love Cleveland Clinic. I've made no secret about it. I'd be working there now had I been able to persuade my wife that Cleveland is the center of the universe. So it was no fun to tear into them over the preposterous problems the institution has created for itself with the appointment and continuation of a board of directors riddled with conflict of interest, with its summary execution of Eric Topol, or with the odd way in which the institution has handled Toby Cosgrove's conflicts of interest with his devices and their trials at the Clinic.

But I'm all done feeling bad. The CCF has crossed all sorts of lines with its Karl Rove-worthy, no-ethics-left-behind conference on "conflicts of interest in innovation," featuring for example a section on "Guidelines and Performance: Creating a Culture of Ethics." The conference itself is just lovely, featuring a litany of the extraordinarily powerful including a whole bunch of pharma top brass, and one ethicist, Jeff Kahn, who will really have to shine in the three panels on which he serves in order to help this institution hold this conference with a straight face: there isn't a single mention - not one - of the issues the Clinic has created for all of medicine and for itself with its abominable and unethical treatment of Topol in the Vioxx matter, with its mishandling of the Cosgrove devices, and with its board of directors, more than half of whom (according to Wall Street Journal) do business with the Clinic.

The chutzpah. Imagine Penn holding a conference a year after the death of Jesse Gelsinger on how to do gene therapy well - without mentioning Gelsinger in the program. Or Johns Hopkins holding a conference on how to set up clinical trials with children and lead paint without highlighting the Kennedy Krieger lead paint study. No, really, this is worse than that. This is like Anderson Consulting holding a conference on how to handle the disposal of paperwork for oil companies.

The irony is that, as we discuss in our article, Eric Topol of the Clinic did perhaps the best job of learning from a problem in conflict of interest in the history of medicine. He too went very public, conducting study of the phenomenon of physician involvement in hedge funds and similar activity. He was very candid about his own encounter with a little hedge fund, surveyed to find that lots and lots and lots of physicians offer similar advice or other information in inappropriate ways, and then Topol offered some suggestions about how to prevent the problem in the future. He discussed the problem self-referentially, rather than trying to confuse people into thinking he'd never had an issue in the area by holding a big conference in which he didn't mention his own misadventures.

But he's gone now, down the street to Case Western Reserve, after he was fired from two of his positions and removed by extension from the ... yes ... conflict of interest committee, after testifying against ... yes ... Merck (that's right, the same Merck whose former CEO will be on the program) on the Vioxx matter.

It's big entertainment, I'll give them that. But seriously - this is a mockery of bioethics. And that they charge $300 for this ... why not just ask one of the board members' companies to subsidize the $300 ... then again, wouldn't want to create a confli...

You get the point.

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