Feature

Memorial Sloan Kettering’s season of turmoil


 

This story republished by permission of ProPublica.

Hundreds of doctors packed an auditorium at Memorial Sloan Kettering Cancer Center on Oct. 1, deeply angered by revelations that the hospital’s top medical officer and other leaders had cultivated lucrative relationships with for-profit companies.

One by one, they stood up to challenge the stewardship of their beloved institution, often to emotional applause. Some speakers accused their leaders of letting the quest to make more money undermine the hospital’s mission. Others bemoaned a rigid, hierarchical management that had left them feeling they had no real voice in the hospital’s direction.

“Slowly, I’ve seen more and more of the higher-up meetings happening with people who are dressed up in suits as opposed to white coats,” said Viviane Tabar, MD, chairwoman of the neurosurgery department.

“The corporatization of this institution is clear to many of us who have been here a long time,” said Carol L. Brown, MD, a gynecologic cancer surgeon, according to an audio recording of the meeting.

The meeting ended after several doctors advocated an immediate no-confidence vote in the hospital’s senior leadership. The turmoil followed reports by The New York Times and ProPublica that the hospital’s chief medical officer, José Baselga, MD, had been paid millions by drug and health care companies and failed to disclose those ties more than 100 times in medical journals, and that hospital insiders had made lucrative side deals that stood to earn them handsome profits, sometimes for work they had done on the job.

The day after the meeting, the hospital’s chief executive, Craig B. Thompson, MD, promised greater openness with rank-and-file doctors about decisionmaking. He also committed to doing the “root-cause analysis” requested by the doctors of how “egregious conflicts of interest,” as one physician put it, had been allowed to happen.

Other hospitals around the country are confronting similar dilemmas. But at Memorial Sloan Kettering, one of the nation’s leading cancer research and treatment centers, they are especially acute. Internal emails, audio recordings of meetings and interviews with doctors show how this major New York institution has struggled to contain a crisis of confidence in its leadership.

Closer ties between nonprofit research centers like Memorial Sloan Kettering and corporations are being fueled by a rush of potentially breakthrough cancer treatments. Venture capital firms and drug companies have looked to cash in on the scientific discoveries, said Brad Loncar, the founder of an investment fund that focuses on cancer. “Money follows success,” he said, and Memorial Sloan Kettering has been a focus “because they conduct terrific science there.”

In recent years, the hospital, like its competitors, has struck increasingly sophisticated deals to commercialize its discoveries, in some cases receiving equity stakes in startups rather than simply collecting royalties.

The predicament of Memorial Sloan Kettering also reflects a shift in its own culture. Its prior chief executive, Harold E. Varmus, MD, a Nobel Prize-winning scientist, personally kept companies at arm’s length, while Dr. Thompson, also a respected cancer researcher, has more fully embraced such relationships. The new approach has been applauded by some for expanding access to the cancer center’s discoveries, even as others have worried that the hospital may be losing sight of its mission.

Its leaders and top researchers also hold influential positions in the corporate world. When news of Dr. Baselga’s disclosure lapses broke in September, 12 doctors and researchers at the hospital served on the boards of publicly traded companies, more than at any other major cancer center, according to a review by the Times and ProPublica. Dr. Baselga has since resigned from the hospital and the two boards he served on. And a day after the physicians’ meeting on Oct. 1, Dr. Thompson resigned from the boards of the pharmaceutical giant Merck and Charles River Laboratories, a health care company, that together had paid him $585,050 in compensation in 2017.

The concern of ethicists and health experts is that a bias in favor of industry can unduly influence scientific research and medical treatments and remove a valuable check on soaring drug prices.

“We do have to sort of decide which side of this we’re on, or at least notice that we are feeding at the very trough that is causing worse access here than in any other Western country,” Peter B. Bach, MD, director of the hospital’s Center for Health Policy and Outcomes, said at the Oct. 1 meeting.

The problems at Memorial Sloan Kettering have shaken other cancer centers. At Dana-Farber Cancer Institute, officials have said they are considering whether Laurie H. Glimcher, MD, their chief executive, and others should continue to serve on the boards of publicly traded companies, including the drugmaker GlaxoSmithKline, on whose board Dr. Glimcher sits.

At the Fred Hutchinson Cancer Research Center in Seattle, a task force is reviewing the conflict-of-interest policies that govern employees’ financial relationships with drug companies. And medical centers around the country have instructed researchers to review their financial disclosures to medical journals, leading to a series of corrections to scientific articles.

Even as Memorial Sloan Kettering leaders have promised greater transparency, they have engaged a public affairs firm, SKDKnickerbocker, to manage their message and have aggressively pushed back against the idea that the hospital’s leaders are too close to industry.

“I can see how someone might think that business relationships are problematic,” said Lisa DeAngelis, MD, who has stepped into Dr. Baselga’s former position at Memorial Sloan Kettering on an acting basis. “But I’m telling you, as someone who works with patients, and I’ve worked with patients throughout my entire career here, that working with industry has helped me save lives.”

The Times and ProPublica asked to speak to Dr. Tabar and Dr. Brown about the critical remarks they made about the hospital’s direction at the Oct. 1 meeting. Mike Morey, managing director of the communications firm engaged by the hospital, arranged for them to speak to reporters on the phone while he listened. The doctors said they were not specifically referring to Memorial Sloan Kettering during the meeting that was recorded by one of those in attendance, but to broader changes in the medical world.

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