Dr. Baselga's Really, Really, Bad Day

You know it is going to be a bad day when you are featured in the New York Times, well really, any national news outlet. And by that measure, Dr. Jose Baselga, the now-former chief medical officer at Sloan Kettering, had a very bad week. For those of you late to the story, he failed to disclose financial conflicts of interest in papers published in august medical journals, like the New England Journal of Medicine and Lancet. And to make matters worse, he was the president of the American Association for Cancer Research, violating their rules on financial disclosure. If you want the dirt in details, you can look here or here.

Rather than continue to wring our medical and scientific hands over another blow to the integrity of the scientific process, and since I cannot impanel another group of experts to investigate and recommend I would just like to make a small aside and two things that we can do now to slow the hemorrhage of integrity. 

Do As I Say, Not as I do

Well undoubtedly Dr. Baselga cannot claim ignorance of the rules, after all, he was an officer in an organization that promulgated them. And his resignation, that any careful observer would have foretold merely from the initial NYT and ProPublica revelations is couched in so many familiar terms. They included not wanting “to distract” from Sloan Kettering’s mission, that “It is my hope that this situation will inspire a doubling down on transparency in our field,” and of course, that he is correcting the record “and will continue to do so until the record is complete.” He also noted that the failed disclosures were both unnecessary and unintentional. I do not know Dr. Baselga’s heart and from what little I do know, he is an excellent physician and researcher. But he broke the rules. More importantly, every point in his letter of resignation has been the sum and substance of every resignation letter of the powerful. Listen for the echoes, the reasons are not quite, “I want to spend more time with my family,” or “I am not a crook,” but we have heard this from so many media and political figures of late. [1]

But the commonality of all of these people is the entitlement. Do as I say, not as I do. We see this so often in the exemptions politicians create for themselves, and the same can be said for highly profitable executives and physicians, whose organizations exempt them from scrutiny as long as the profitability is in their favor. Do you really believe CBS didn't run a cost-benefit analysis on retaining or removing Les Moonves? 

The role of platforms

I use the term platforms, rather than media or primary source to describe the New England Journal of Medicine as well as any other medical journal. In today’s world, they are not responsible for their content, that is left to “peer” review. But we already know that peer review has come under fire for vetting fact from fancy. And as to disclosures of conflicted interest, that is left to the honor system, neither the peer reviewers or the journals fact check that work. True to form, the implicated journals are reviewing the situation and will take action as necessary. 

Listen again for the echoes, do the names Facebook, Twitter or YouTube come to mind? They should, because they are platforms too and also maintain that they are merely conduits, innocent of wrongdoing, betrayed by those they trust, like the CBS board and the aforementioned Mr. Moonves. And these medical platforms are also highly profitable, making money, not from ads but university and other subscription sources; not Facebook money, but then again their audience is smaller. 

So here is my first suggestion, make the platforms accountable for their publications. Make them stand behind their reviewers, and more importantly make them vet the disclosures of conflicting interest. Hold them accountable for publishing infomercials without disclosure. And while they are being held responsible, perhaps we should consider a retraction as insufficient cost. The punishment to Dr. Baselga by his home institution was swift and harsh; I am conflicted as to whether it might be too much. But instead, the New England Journal of Medicine could refuse to consider any of his papers for the next several years. Or perhaps the authors would have to wear a literary scarlet D, for dishonest, posted in their disclosures for several years.  In the world of academics, which prizes publication in essential journals, being kept from publication and mandatory disclosure of “bad acts” might be very effective. And it gives both parties, authors and journals ‘skin in the game,’ authors will not want to be barred, and journals will not want to be impugned – an alignment of incentives.

Disclosing conflict

I have not touched upon what constitutes a conflict of interest. Financial conflicts should be readily apparent, but perhaps Dr. Baselga is correct and simply working and being compensated by a company is not a conflict of interest. But conflict of interest goes deeper; who had the conflict of interest when Galileo was censored by the papal authority, the authors or the censor? For me, and I read a lot of science articles as part of my job, caveat emptor, “let the buyer beware,” is my rule. But the journals could do one more simple thing, put the disclosures at the beginning, not the end of the article. Let the reader know before they spend the time, that it was written by someone with a vested interest; it doesn’t mean the article is true or false, useful or useless. It returns the final decision to me. 

[1] For those of you too young to remember, these are the words of our former President, Richard Nixon.