publication date: Sep. 28, 2018

In Baselga’s wake: Debate focuses on COIs of academics on boards of for-profit firms

By Paul Goldberg

As the fallout from the ethics scandal at Memorial Sloan Kettering Cancer Center continues, cancer center officials are investigating allegations contained in an anonymous letter from a group that identifies themselves as “Concerned Employees of MSKCC.”

Also, an ethics task force formed by MSK in the aftermath of the conflict of interest imbroglio will focus on the question of whether cancer center employees should be allowed to serve on the boards of directors of for-profit companies.

José Baselga, MSK’s ousted chief medical officer and physician-in-chief, whose failure to disclose competing interests had triggered the crisis at the cancer center, served on the boards of Bristol-Myers Squibb Co. and Varian Medical Systems Inc. (The Cancer Letter, Sept. 14). He was forced off those boards after he submitted a resignation from his MSK positions (The Cancer Letter, Sept. 21).

Craig Thompson, MSK president and CEO, serves on the board of directors of Merck.

Here, the MSK recommendations of the MSK task force could have broad ramifications, as academics from many institutions serve on the boards of pharma and biotech companies.

Consider Merck’s board. Besides MSK’s Thompson, it includes the following academics:

  • Thomas Cech, an investigator, Howard Hughes Medical Institute, Distinguished Professor at the University of Colorado, and director of the University of Colorado BioFrontiers Institute.

  • John Noseworthy, president and chief executive officer at Mayo Clinic and professor of neurology, Mayo Clinic College of Medicine & Science.

  • Paul Rothman, dean of medical faculty and vice president for medicine, The Johns Hopkins University, and CEO, Johns Hopkins Medicine.

Members of the boards of directors represent the interests of the companies’ shareholders. In some cases, these interests can clash with the interests of academic institutions where the board members in question hold their day jobs. Sometimes these conflicting interests can be easily managed; sometimes not.

The fallout from The New York Times and ProPublica Sept. 8 story about Baselga’s years-long failure to disclose conflicts of interest continued, as the Times editorial board on Sept. 16 published an editorial about conflicts of interest at the cancer center.

Another Times-ProPublica story published on Sept. 20 questioned MSK’s role in establishing Paige.AI, an artificial intelligence start-up that aims to use the hospital’s pathology archive—consisting of tissue slides from 25 million patients—to develop deep learning algorithms and create a decision support system for pathologists.

Late last week, a group of MSK employees submitted an anonymous letter to the hospital’s administration. The letter demands a public airing of conflicts that involve Baselga and other MSK officials.

The Cancer Letter doesn’t publish anonymous material, particularly if the source and author’s identity is unknown to us.

In this case, the letter is summarized and partially quoted, because MSK’s officials acknowledged the letter and hired outside counsel to investigate the allegations it contains.

“In addition to an independent investigation into the aforementioned conflicts, we call on all officers and board members of MSK to immediately divest themselves of any equity stake in companies doing business with MSKCC,” the letter states. “We further call on them to resign from any boards of companies that have contractual relationships with MSK.

“Going forward, no officer or board member should be allowed to serve on the board of or have an equity stake in any company financially involved with our center. Nothing short of the above will restore the public’s trust in our institution.”

The anonymous letter focuses on five areas of Baselga’s potential conflicts of interest:

  • Was Baselga’s recused from business related to GRAIL, a liquid biopsy company where he serves on the scientific advisory board?

  • Did Baselga play any role in managing an MSK phase I study of a product of Infinity, a company where he was a director?

  • What role did Baselga play in development of an MSK proton beam center in conjunction with Varian, a company that named him to the board in 2017?

  • Did Baselga play a role in Varian’s decision to make an investment in GRAIL?

  • How did MSK manage Baselga’s role in running the APHINITY trial for Roche/Genentech at the time of that company’s acquisition of Seragon Pharmaceuticals? Baselga was paid $3 million by Roche for his equity stake in the start-up.

On Monday, Sept. 24, Thompson and Baselga’s interim replacement Lisa DeAngelis sent out the following memo to the medical staff:

 

Dear MSK Colleague,

We and our board are very aware of the disappointment and distress that many of you are experiencing after recent events at our Center. We share these concerns and are deeply sorry that you feel let down. As your leaders, we recognize that nothing is more important than maintaining the integrity and reputation of MSK and its staff.

We believe that it is imperative that faculty and staff are able to voice their views around these issues and other pressing institutional issues of concern. We want to let you know that in addition to the Task Force that was announced to review our conflict of interest (COI) policies and procedures, the elected leadership of the Medical Staff is creating a forum for faculty and staff to voice their concerns and ideas which we will communicate directly to the institutional Task Force.

There will be several ways for you to voice your views. Submit your feedback by email (osquestions@mskcc.org) or via SurveyMonkey (here).

The Medical Staff leaders are also planning a town hall this Friday, September 28, at 8:00 am in the Zuckerman Auditorium. This follows the Wednesday meeting of the MSK Boards of Overseers and Managers. In parallel, the board will review MSK’s processes and policies concerning COI.

One of the specific issues that we requested the COI Task Force to examine is whether any senior leader of MSK should be permitted to serve on the board or as a consultant of a for-profit corporation.

We also recognize that communications and transparency need improvement. That’s a commitment we are making.

We have complete confidence in the outstanding care delivered every day to our patients and their families, and we know you do this with compassion and integrity. This is one of MSK’s core missions. However, there is internal and external concern that this mission has been compromised. Nothing could be further from the truth because each of you guarantees that this mission is accomplished daily with every clinical encounter. Senior leadership is committed to working with you to ensure ethical and transparent principles and policies to achieve our goals of superb care, education and developing the therapies of tomorrow.

  • Medical Staff Leadership include:

  • President – Nadeem Abu Rustum

  • President-Elect – Diane Reidy

  • Past President – Jedd Wolchok

  • Alternate – Anne Covey

  • Alternate – Richard Wong

  • Chair, Junior Faculty Council – Lisa Ruppert

We look forward to hearing from you.

Regards,

Lisa and Craig

 

The following day, Thompson and DeAngelis sent out a memo that acknowledged the existence of the anonymous letter. The concerns in the letter are “without merit,” they wrote

The text of the email follows:

Dear MSK Colleagues,

In light of recent events, we have received emails expressing some concerns. We take all statements of concern seriously, whether by staff, by patients, or by external stakeholders. An internal review of the issues raised has already begun and we believe those concerns to be without merit. In addition, MSK’s Chief Compliance Officer is engaging outside counsel to conduct a focused review.

As always, we encourage staff to refer concerns to the confidential compliance hotline at 866-546-5421. For more information about MSK’s compliance program, the Code of Conduct is a helpful resource.

Regards,

Lisa and Craig

Copyright (c) 2018 The Cancer Letter Inc.