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Uncovering conflicts of interest in medicine, research Date: 03/18/10

By John Fauber

Covering conflicts of interest in medicine can be a full-time beat.

For nearly two years, I have been working on stories about the pervasive influence of drug company money on the University of Wisconsin School of Medicine and Public Health and its doctors.

It has dominated my reporting unlike any other story in my 13 years as a medical writer.

It began a few years ago when the higher education reporter and a business reporter at the Milwaukee Journal Sentinel wrote a story about a UW orthopedic surgeon who was getting $400,000 a year for eight days of work as a consultant to the medical device company Medtronic.

As medical reporter at the paper I was shocked that the medical industry was throwing that much money at an academic physician. Little did I know that eventually I would be reporting that the amount the doctor was getting actually was 10 times that amount.

Of course I never expected to be sitting at the bar in a steakhouse trying to eavesdrop on doctors having dinner at a nearby table. Or lurking outside on the sidewalk, trying to peer into their dinner affair so I could count guests and bottles of wine that I suspected were being paid for by the drug company hosting the event.

In 2007 and 2008 I started making public records requests for what are known at UW as “outside activity reports.” These are documents that are filed annually by doctors at the university. The reports list income the doctors and other university officials receive from entities such as drug and medical device companies.

My understanding is that most public universities have similar documents. Private institutions also have such documents, although they can tell you to take a hike if you ask for the records.

Poring over the UW records, creating spreadsheets and doing interviews would take several months.

However, in January 2009, we ran a two-part series called "Side Effects," detailing the large sums of money that dozens of UW doctors were getting from drug companies.

The stories led to an inquiry by U.S. Sen. Charles Grassley (R-Iowa) and eventually resulted in tougher new rules at the medical school, including a ban on so-called dinner talks such as the one I watched at the steakhouse months earlier.

I had no big plans for a follow-up project after the stories ran. And then I got a tip.

It had to do with the UW medical school itself and a much bigger conflict of interest: millions of dollars it was getting every year from drug companies that wanted to sponsor continuing medical education courses for doctors.

I began making open records requests for contracts between the medical school, drug companies and several shadowy organizations known as medical education communication companies.

MECCs usually are private, for-profit firms that work as middle men between drug companies and medical schools. For a cut of the action, they can set up continuing medical education courses, including ghostwriting medical journal articles and then finding prominent doctors who agree to put their names on the pieces.

As you might expect, the articles often are little more than marketing, downplaying the risks of drugs and promoting the benefits.

Our first such story, which I did with our former science reporter, Susanne Rust, was an eye-opener.

It was about an entity known as the Council on Hormone Education, which for several years UW operated to "educate" doctors about hormones.

Wyeth, the company that makes the two top-selling hormone therapy products, had poured $12 million into the council ... with good reason. The council began in 2002, the same year that a large clinical trial that was part of the Women's Health Initiative was stopped early because women in the study who were taking combined estrogen and progestin were found to be at increased risk for breast cancer, heart disease, stroke and blood clots.

The finding was devastating for Wyeth. It is now suspected the council was an attempt to boost sagging hormone sales.

A follow-up story I did with Meg Kissinger, one of our watchdog team reporters, was about UW's involvement in ghostwritten medical articles on hormones. That story was based on unsealed court records that were given to me by an attorney involved in suing Wyeth on behalf of women who were diagnosed with breast cancer after being on the drugs.

To do these doctor education course stories, you need records of the financial transactions between the drug companies and the universities.

But the trick is looking at the science and going to medical experts without conflicts of interest who can assess the courses for bias.

I did two more stories on drug company-funded doctor education courses at UW.

One was on Pfizer and the $3.5 million it gave UW for a smoking cessation course that helped its controversial drug Chantix dominate the market.

Then I started looking at the $1 million Solvay Pharmaceuticals paid for a UW-sponsored course that involved its testosterone product, Androgel.

That story found that testosterone sales were surging though the phenomenon was based largely on iffy science, promotion and manipulation.

After that I focused on medical journals and UW doctors. I used the records the doctors filed with the university to see if they were disclosing their conflicts of interest in the medical journal articles they wrote. Several of them were not, including a few fairly blatant omissions.

The last story of the year was a piece on the UW orthopedic surgeon who was getting about $4 million a year in royalties from Medtronic for spinal implants he invented.

Toward the end of the year, I learned that he also was the editor of a medical journal that featured studies about spinal disorders and treatments.

That story was about the conflict of interest arising from being editor of such a journal while also being in a lucrative business partnership with Medtronic.

After looking at hundreds of studies published during his seven-year tenure as editor, I found that articles involving Medtronic products regularly were published in his journal, on average of more than once per issue. Usually, the articles had good things to say about the Medtronic products.

The Side Effects series now is up to about 15 stories.

In 2010 I would like to take it beyond UW and look at other examples of how drug and device company money and influence is affecting patient care.

John Fauber is a medical reporter at the Milwaukee Journal Sentinel.