Playing God

The annals of academic hubris have recently been enriched by a renowned Harvard psychiatrist, who, upon being asked to identify the next rank above his full professorship, replied: “God.”

An arrogant wisecrack? Yes. But this pecking-order assertion merits notice for the explanatory light it sheds on an old and stubborn problem: the persistence of covert financial gains and other conflicts of interest in the conduct and reporting of research. When these unwholesome practices come to light, as so many have for many years, the commonly offered alibi is that there’s no connection between the money and the science. Unlike ordinary mortals, the wizards of science insist, they possess immunity to contamination by money.

That’s what the Harvard psychiatrist, Joseph Biederman, asserted in dismissing suggestions of a connection between his favorable publications concerning anti-psychotic drugs for children and money he has received from Johnson & Johnson, manufacturer of risperidone, which is prescribed for attention deficit disorder and hyperactivity. Biederman has been called as a witness in lawsuits filed by several states alleging Medicaid fraud through improper marketing of anti-psychotic drugs for children; he made his God remark in a deposition.

Until recently, Biederman was director of the J&J Center for Pediatric Psychopathology Research at the Harvard-affiliated Massachusetts General Hospital. Between 2000 and 2007, Senator Charles E. Grassley (R-Iowa) says, Biederman received at least $1.6 million from J&J and other pharmaceutical firms. Biederman contends that “any implication that J&J’s interests interfered with the center’s work is wrong,” according to a report in the New York Times.

Federal regulations require academic scientists to report outside income above $10,000 to their university. For the many schools receiving grants from the National Institutes of Health, the rules call for reporting conflicted situations and the measures taken to resolve them. But during those years, Biederman reported only $200,000 of his $1.6 million to Harvard, which found nothing to report to NIH. Awakening to the issue, Harvard recently appointed a 19-member committee to study consulting and other income-producing activities by faculty members and to recommend policy changes.

Transparency, the standard, and perhaps overrated, treatment for conflicts of interest, is catching on. The young at Harvard are ahead of their professors and deans, with several hundred of them teaming up to demand disclosure of commercial ties on campus and in affiliated hospitals. The American Medical Student Association gave Harvard an “F” for its conflict-of-interest enforcement. Stanford University’s School of Medicine has announced creation of a web site on which faculty members must report payments above $5,000 a year from any one source.

As previously reported in this column, “trust but don’t verify” could be the working motto of federal agencies that are supposed to be concerned with scientific integrity (September 2008). And the same applies to universities and to scientific and medical journals. Surveys by federal inspectors general have found that NIH devotes scant resources to monitoring conflicts of interest in grantee institutions, and, accordingly, harvests scant information. Meanwhile, many universities simply trust their professors to abide by disclosure regulations.

The leading scientific journals require authors of papers submitted for publication to disclose any financial connections related to the subject matter. But editors reasonably plead that they lack the resources to check up on authors and therefore rely on them to own up to commercial entanglements.  Always in quest of hot papers that will attract readers and advertising, few journals have a policy of banishing offenders from returning to their coveted pages. In 2006, Catherine DeAngelis, the editor of the Journal of the American Medical Association (JAMA) wrote that “sanctions against an author who fails to disclose financial interests … would only encourage that author to send his or her articles to another journal; it cleans our house by messing others.” The JAMA editor passed the buck to universities, suggesting they police their scientists.

Derek Bok, former president of Harvard, is well-acquainted with the species located just below God. “Officials of the university have very little authority over their senior faculty,” he wrote in 2003. “The latter have virtually complete license to do as they choose, thanks to the security of tenure buttressed by the safeguards of academic freedoms. Since it is difficult to monitor closely the work of highly educated professionals, faculty members can travel more than the university rules allow or remain at home tending their garden or enjoying their hobbies without much fear of detection. So long as they meet their scheduled classes and refrain from criminal acts, they can stay happily in their jobs until they retire.”