Another Footnote, This One Ironic

On September 12 I wrote about the failure by a senior MSK doctor to disclose his financial interests in connection with many of the articles that he was publishing. That story in the NY Times was quickly followed by another, about this doctor resigning from his job. That was perhaps predictable. It was less predictable that a new scandal at MSK would be unearthed just a couple of days later, though I did have the feeling the story hadn’t yet been told in full. 

In fact I still have that feeling, and wonder what investigations are now underway at MSK’s competitor institutions. It strikes me as unlikely that only MSK has been infected by the kinds of maneuvers that these articles reveal. After all, these maneuvers are presumably profitable, directly or indirectly, and health care institutions must be competing with each other to provide the best possible pay packages to their top employees. (They certainly are competing with each other to attract patients, as medical advertisements and hospital merger news attest.)

In any case, on September 20 it was revealed that senior MSK doctors or scientists and some board members, along with MSK itself, were the co-owners of an artificial intelligence start-up meant to use MSK’s immense library of accumulated tissue samples to learn better how to diagnose the presence of cancer. In the process, it appears, the people involved disregarded rules governing such "related party" dealing (which is not illegal in itself, but must be correctly structured). They annoyed other MSK physicians by using the results of those doctors’ research in analyzing the tissue samples without their consent. And  this venture turned the samples donated by patients towards the goal of research into potential sources of private profit that surely were never consciously consented to.

I don’t want to say that the issues posed by the duties of honesty, disclosure and frankness are always simple, as my earlier post on nondisclosure may have implied. Truth isn't always the commanding rule -- but it is an important rule, as the age of Trump underlines. Here, it appears that MSK could not get venture capital funding for a project it believed was very promising, and so the investors – as investors tend to do – took on some special risk in the hope of some special gain. That gain in turn would have benefited us. 

But at the same time this series of stories gives the impression that our major medical institutions have decided that the way to provide care is to find profit to support it, and that the task of finding sources of profit need not be undertaken with any over-punctilious concern for virtues like disclosure. What’s perhaps most troubling about the creation of such a culture of gain is that it undercuts the culture of cure that so many of the staff at institutions like MSK pursue with daily dedication -- including in my own case.