Monday, June 25, 2012

How COI Poisons Academic Medicine: UC-Davis

Thanks once again to our friend Dr. Roy Poses over at Health Care Renewal--
--for filling in the backstory on a recent event at UC-Davis med school. I had not initially blogged about this incident because it had little to do directly with the pharmaeutical industry, and because the two principals, Drs. Michael Wilkes and Jerry Hoffman, are personal friends (Jerry being half of the Rick Bukata-Jerry Hoffman team that does Primary Care Medical Abstracts, whose reviews of the medical literature I often rely on here). But Dr. Poses helps highlight why the incident is of more general concern regarding conflicts of interest at the interface between industry and academic medicine.

What happened: Drs Wilkes and Hoffman had the effrontery to write an op-ed for the San Francisco Chronicle in thich they did two things. First, they pointed out the evidence that prostate screening by means of the PSA blood test is not a very useful thing--no news here as the US Preventive Services Task Force has recently said the same thing even more strongly. Second, they noted that UC-Davis, where Dr. Wilkes is on the faculty, has a program that aggressively promotes PSA testing, and wondered if that was linked to the money the university receives for the increased number of procedures and cancer treatments (mostly unnecessary) that PSA screening reliably generates. The program, Dr. Roses adds, was supported by the urologists' foundation, which in turn receives big bucks from the various device makers who profit from prostate surgery. (The urologists as a group continue to throw evidence to the winds and to attack the USPSTF viciously for advising men to consider carefully whether to have a PSA test.)

Dr. Wilkes was then contacted by UC-Davis lawyers, and was informed that he was being terminated as the head of several academic programs that he was responsible for, including programs on professional practice and global health. These were accompanied by threats that he'd be sued for defamation for what he said about Davis in the op-ed.

Dr. Wilkes filed an internal complaint. The current Hwealth Care Renewal post is occasioned by the results of that investigation (see post for link), in which Dr. Wilkes was found to have been unfairly treated and subjected to unjust reprisals for exercising his academic freedom to speak out on medical issues of public concern. Dr. Poses adds that given the past record of UC-Davis in suppressing dissent among students, it's not surprising they'd treat a faculty member this way. (By the way, if the Davis leadership has apologized or in any way made it up to Dr. Wilkes for their outrageous treatment of him, it has yet to be reported.)

Dr. Poses has hit the nail on the head by addresing the past track record of UC-Davis and its leaders. When the people who run academic medical centers start to think of what they do as a business, and when they see industries that make profits off questionable patient care as lucrative sources of funding, they naturally start to think of their physician and scientist faculty members as their sales force that is supposed to roll up their sleeves and sell the Davis "product." When a faculty member adheres to his academic responsibilities and puts the truth over the UCF-Davis "brand," the leadership becomes outraged at this treasonous behavior.  Which is why conflicts of interest in academic medicine, especially at the institutional level, need to be vigorously rooted out--and why we need leadership in health care and academic medicine that understands the difference between a business and a profession.

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