From The Guardian Before committing vulnerable patients to emptying their life savings, oncologists must provide the best possible advice
I have been thinking about my deceased patient since Propublica, a non-profit investigative organisation, reported that one of the world’s best-known oncologists and physician-in-chief of the respected Memorial Sloan Kettering Cancer Center, Dr Jose Baselga, had failed to disclose millions of dollars in payments from pharmaceutical and healthcare companies in dozens of published articles and prominent presentations.
Baselga failed to disclose board membership of a major pharmaceutical company, directorship of another company and cash and stock options from start-up firms that did not even have an approved drug on the market. The lapses occurred over several years, including a time when he was an editor-in-chief of a distinguished journal and president of a respected cancer association. From a global podium, he presented the results of a pharma-sponsored trial and cast a positive spin on the use of a very expensive drug that puzzled many oncologists because the actual results were disappointing. Their ire grew when it emerged that the same pharma company had paid him more than US$3m in consulting fees.
Baselga is a familiar name among oncologists and patients who have undoubtedly benefited from his commitment to cancer medicine. He has acknowledged his oversight, plans to correct the omissions that he considers relevant, has defended his publications as “high quality manuscripts” and argued that his conduct does not compromise his work as a physician.
But his own institution has distanced itself from him, and the many distinguished journals and professional bodies tainted by the association are deeply unhappy. Lacking the resources to constantly fact-check, they rely on the integrity of authors to disclose any conflict of interest. Investigations have begun but very few will pay attention till the end. Meanwhile, I can’t help thinking that the harm done to the doctor-patient relationship will be felt by very many.
Prominent doctors at a handful of prestigious cancer institutions occupy a vaunted place in the profession. Important journals and major conferences vie for their attention, making their very name a powerful brand. Since it’s impossible to keep up with all the developments, professionals end up relying on a highly select group of oncologists to illuminate the way. Papers they write, research they direct, and talks they deliver have an outsized influence on determining how patients are treated. Consequently, every pharmaceutical company with a stake in cancer treatments wants to woo them.
There was a time when their influence was circumscribed, but now that the internet has turned the world into a village, the view of these so-called key opinion leaders travels from New York to Nigeria in a flash. Most oncologists will never set foot inside a glittering cancer institute that boasts a multibillion endowment, but a lot will be influenced by what happens there.
Annually, over 14 million patients are diagnosed with cancer and almost 10 million patients die. Most will get no further than their local hospital, rural clinic or a threadbare setting.
Before committing these vulnerable patients to emptying their life savings, it is imperative that oncologists provide the best possible advice. This is why full disclosure of bias, compromise and every single payment matters, so that the least empowered patient can receive the most effective treatment rather than the most hyped one. Without full disclosure, the oncologist and the patient are both in the dark and society pays the price