Nick Naylor, the anti-hero and suave spin-doctor at the “Academy of Tobacco Studies” in Christopher Buckley’s satirical novel, Thank You for Smoking, would be very unhappy with Gardiner Harris.
Yesterday, Harris, one of The New York Times’ veteran medical reporters, published a front-page story exposing cigarette manufacturer Liggett’s financial support for recent scientific research, which concluded that 80 percent of lung cancer deaths could be prevented by early and frequent CT scans. The study, published in The New England Journal of Medicine in October 2006, caused quite a stir in the cancer world and elicited a fair bit of news coverage. Reporters did a good job picking up the controversial nature of the study (some experts argue that it was flawed and would lead some patients to seek costly tumor screening they don’t need), but completely absent from that wave of articles was any mention of the relevant funding-and certainly no hint of a conflict of interest. According to Harris’s article:
Small print at the end of the study … noted that it had been financed in part by a little-known charity called the Foundation for Lung Cancer: Early Detection, Prevention & Treatment. A review of tax records by The New York Times shows that the foundation was underwritten almost entirely by $3.6 million in grants from the parent company the Liggett Group, maker of Liggett Select, Eve, Grand Prix, Quest and Pyramid cigarette brands.
Financial conflicts of interest are, perhaps, as old as medical science itself, but awareness of these issues has increased over the last decade as research institutions, peer-reviewed journals, and the U.S. Department of Health and Human Services have tightened disclosure guidelines. Transparency is still a major problem, however, because these passive guidelines have not led to active policing. I asked Harris what red flags intrepid reporters can look for when ferreting out conflicts and whether or not journalists are the last line of defense against misconduct when it slips by universities, institutional review boards, and journals.
“There is no line of defense on this stuff,” he told me. “As you look into it, you will discover that nobody does it particularly well.” He did make one exception: The Cancer Letter, a weekly publication founded in 1973 that reports on oncology “extremely well.” It was an article in the Letter published just two weeks earlier that had led Harris to investigate the lung cancer foundation, which is located at Cornell’s Weill Medical College in New York. The article had revealed that the foundation’s president and secretary-treasurer, Drs. Claudia Henschke and David Yankelevitz, had failed to disclose, in articles and lectures, a patent and ten pending patents related to the CT scans upon which their research is based. While following up on that story, a source tipped off Harris to the donations from Liggett’s parent company.
“I think that these things are completely ad hoc,” he told me later. “It is very difficult to chase these things down unless someone is helping you because a lot of medical reporters are like me-you cover a thousand different stories in medicine, you’re not a specialist, so you don’t follow any particular technology or any particular disease very closely. So I think it’s all but impossible for any medical reporter to know things well enough that you can sniff it out on your own. You need a tip.”
Organizations like the National Institutes for Health, universities, and journals will provide reams of conflict-of-interest guidelines, Harris said; as he reported in the Times, they’ve almost universally shunned funding from the tobacco industry, for instance. “Everybody will tell you that they take these issues extremely seriously, but if you pick that apart and look at any individual circumstance you will find almost inevitably that there is an enormous gap between the written policy and the day-to-day reality. And universities do a miserable job policing conflicts of interest; they rely entirely on voluntary disclosures from their faculty.”
In Thank You for Smoking, a female journalist sleeps with Nick Naylor to get dirt on his tobacco industry cohorts. The reality is not that difficult, but almost. Harris describes issues of scientific misconduct as “very ripe” for more reporting, but he cautions repeatedly about the obstacles that face reporters. In addition to the challenge of finding good sources who can spot financial transgressions, explaining how those transgressions affect the underlying research is difficult.
“I wish I did have a good way of doing this,” he said. “Getting past editors is difficult. Even with my story today, I think there’s a fair number of people that will say, ‘So what? Did this money really change the study?’ It’s very difficult to get a bottom-line impact to the piece, where you can say, somebody took this money and it changed what we thought we knew about a disease, and that is outrageous.” Indeed, Weill Medical College’s connections to the tobacco funding are unlikely to sink the notion that early screening for cancer is sometimes a good idea. A major epidemiological study by the National Cancer Institute, the results of which are due in 2010, is expected to provide useful new data.
While reporting his article, Harris received an email from Drs. Henschke and Yankelevitz saying that their foundation no longer accepts money from the tobacco industry. He also noted in the piece that the Journal of the American Medical Association had published corrections related to patent interests revealed by The Cancer Letter. When I pointed out that the New England Journal of Medicine, which published the original paper on CT scanning in 2006, hadn’t done the same, Harris said that the public-and reporters-should not expect journals to shoulder universities’ and research institutions’ neglected responsibility to police misconduct:
The journals are in this business for science-they analyze the science. They don’t have rooms full of accountants to check whether disclosures are appropriate or complete … I guess if I had any advice for reporters, I would say, ask your local university if they’ve set up any associated [non-profit organizations]; many universities have an associated charity or foundation through which they solicit donations from corporate sponsors to support medical research. Find out about who those corporate sponsors are. Unfortunately, many universities set up these associated charities and foundations in such a way that they don’t have to disclose much publicly-ask about that, you know, try to push.