As I have written this week, I am not disturbed that Dr. Topol lost one of his administrative positions. Administrative positions in academic health centers come with no protection and no guarantees. However, this situation will likely hurt the reputation of the Cleveland Clinic more than it hurts Dr. Topol. Sometimes you do not want investigative journalists investigating your situation.
Ties to Industry Cloud a Clinic’s Mission
Dr. Eric J. Topol, a cardiologist, has been perhaps the most public face of the prestigious Cleveland Clinic Foundation, a prominent medical center regarded as one of the nation’s best.
Not shy in the media spotlight, Dr. Topol has cultivated the persona of a Naderesque crusader against drugs he deems dangerous, as well as their makers. Some of his most impassioned criticism has been aimed at Merck and its drug Vioxx, the painkiller the company withdrew from the market over questions about its safety. But he has also been outspoken recently about other drugs.
Now, Dr. Topol’s bluntness – refreshing to his admirers, startlingly unscientific to his targets and his critics – has drawn a bright spotlight to his own conduct and that of the Cleveland Clinic. In the last month, he has been demoted and the clinic’s image has been tarnished in what has become an unusually public dispute pitting him against the clinic’s chief executive, Dr. Delos Cosgrove.
Dr. Topol, who retains the position of chairman of cardiovascular medicine at the clinic, suggested in a Webcast on Thursday (www.theheart.org) that his unabashed willingness to take on Merck was a principal reason for his removal this month as head of the clinic’s medical college. In what Merck lawyers have suggested is a vendetta, he described the company’s behavior as “appalling” in recent testimony in a Vioxx lawsuit.
But his demotion has drawn attention to the mounting tensions between the clinic’s research mission and its deep ties to the businesses that finance that research. Both Dr. Topol and Dr. Cosgrove refused to comment for this article, but associates say Dr. Topol may decide to leave the clinic.
Dr. Topol will land on his feet. Many institutions would gladly hire him to bring repute to their cardiovascular activities.
The Cleveland Clinic may take a major blow here. Reports like the one I cite above will likely damage the Clinics reputation. Reputation does matter for this institution.
I believe the important issue here is not Dr. Topol’s ongoing criticism of Merck. Rather, I would bet that we are witnessing a personality clash between two men. Dr. Topol, despite a previous probable conflict of interest, is currently occupying the moral high ground.
The real tragedy here is not Dr. Topol’s removal. The real tragedy comes when academic physicians and their institutions compromise their ethics for money.
The dispute at the Cleveland Clinic goes far beyond a simple power struggle between strong-willed men who competed for the clinic’s top job. Dr. Topol severed his ties to industry after being embarrassed last December by an article in Fortune magazine. But the continued controversy has focused attention on the many longstanding corporate ties at the clinic. Those business links involve not only staff doctors and researchers, but also Dr. Cosgrove and the clinic’s board.
The Cleveland Clinic is emblematic of the way the drug and medical device industries and the investment community work closely with medical researchers and doctors to develop and promote new medicines and technologies. Almost inevitably, such relationships raise concerns about possible conflicts of interest that could lead doctors to favor some treatments over others or to bias the results of medical research.
“It’s not just the Cleveland Clinic,” said Les Funtleyder, a health care strategist at the investment company Miller Tabak & Company in New York. He says other high-profile academic medical centers also have numerous financial ties that raise the potential for conflicts of interest.
Dr. Jerome P. Kassirer, a former editor in chief for The New England Journal of Medicine, describes the potential conflicts at the clinic “as extremely serious ones” but notes that the Cleveland Clinic is “not unique at all.”
Now I do not believe that money is the root of all evil. Some evil occurs without financial motivation. However, we must always understand that there are no free lunches. We must always remain cognizant of the implications of any financial deal. We must guard against compromising our scientific integrity.
Unfortunately, too many in our society are willing to make compromises in the interest of money. One can deal with industry and maintain ethical standards – but it takes work. Too many get seduced by the money and disregard developing necessary ethical protections.
I hope this story leads all institutions to examine all of their relationships to industry. Journals require disclosure of financial interests. I do not think all academic institutions require such disclosure. We in academic medicine have a moral responsibility to maintain the public trust in this regard. Unfortunately, too many have placed their own success above that moral responsibility. Unfortunately, some institutions are also guilty.
Thus, I find this story more troubling beneath the surface than on the surface. I would not classify the Topol situation as a whistleblower problem. I doubt this story is really about Vioxx. Rather we have a clash of 2 egos complicated by the questionable financial interests of one. I suspect that Dr. Topol’s loss of one of his positions was in the works for a long time. I have seen such conflicts in academic medicine personally. In the long run, the institution will suffer.
The Cleveland Clinc is guilty of faulty leadership. They have had short term financial gains, but will probably lose in the long run. And that is the real story that grabs my attention.
