Monday, July 10, 2006

Stanford University: Medical Research, Money and Conflicts of Interest

In a news story that has major implications for the California stem cell agency, the San Jose Mercury News has detailed a web of relationships that have enriched Stanford University and "fattened the personal bank accounts of many of its prestigious faculty members."

The article by reporter Paul Jacobs is a rare look inside the normally private Stanford documents designed to monitor the ties between faculty and medical companies.

The story said:
"Dozens of professors moonlight for medical firms or have founded companies based on their government-funded research.

"In the 2004-05 academic year alone, $38 million in royalties poured into the university from medical school discoveries -- roughly $10 million of which went directly to faculty researchers whose discoveries were patented.

"Critics worry that these complex financial and ethical relationships between companies and the nation's premier research universities are corrupting science and producing overly enthusiastic portraits of new treatments."
Friends and foes of the California stem cell agency have longed expressed reservations concerning the built-in and legal conflicts of interest that riddle CIRM. A measure –opposed by CIRM -- is now before the legislature to tighten oversight and force more disclosure of potential conflicts of interest.

Jacobs' thorough and even-handed story, based on six months of work, said:
"Financial conflicts can turn campus laboratories funded by taxpayer money into outposts of corporate research. They can divert researchers from work that might have a bigger impact on health toward research with bigger financial rewards. And in the worst cases, they can blind scientists to the dangers of treatments they are studying, resulting in injury or even death among volunteers."
The story noted that links between medical research and the corporate world exist at virtually every major unversity in the country.

Stanford voluntarily disclosed to the San Jose newspaper overall figures for a single year concerning its faculty's relationships. The article did not explain the university's reasoning behind the disclosure, but it was a bold decision – one that reflects well on the school but one probably opposed by significant segments within the university. The action was fundamentally good public relations. The choice is to release more information, as the school did, or suffer mightily as bits and pieces dribble out, each one making Stanford look worse and worse.

Philip Pizzo, dean of the medical school and a member of the Oversight Committee for the California stem cell agency, told Jacobs that conflicts are unavoidable but manageable. He said Stanford's "standards for dealing with conflicts are 'the most rigorous' in the country."

But, Jacobs reported, Pizzo "also says ties to industry are necessary if the university is to translate its research into practical treatments for patients."

Not everyone agrees with Pizzo on the "manageability" of conflicts. Jacobs wrote:
"'There is a focus on procedural solutions and this magical belief that disclosure is the answer as opposed to dealing with the fact that many of these things should not be allowed,' said Barbara A. Koenig, a bioethics researcher at the Mayo Clinic and former executive director of Stanford's Center for Biomedical Ethics.

"Tufts University Professor Sheldon Krimsky, author of 'Science in the Private Interest,' argues that fields such as law have stricter conflict policies than universities. A judge, for instance, isn't allowed to have any financial relationship with a party that might benefit from a ruling."
Jacobs' article also included the following segment on one of the brighter stars in stem cell research.
"...(N)o one is more up-front about his financial conflicts than Dr. Irving L. Weissman, one of the founding fathers of stem-cell biology. His lab at Stanford was the first to isolate blood-forming stem cells from animal bone marrow. Today, in addition to his own lab, he directs Stanford's Institute for Cancer/Stem Cell Biology and Medicine.

"Weissman's research has made him a multimillionaire entrepreneur.

"When he gives speeches, when he publishes papers, when he testifies before Congress, he lets everybody know what his outside financial interests are.
"After serving on the scientific advisory boards of Amgen and DNAX, he helped launch three companies, all based on his stem-cell expertise and, in varying degrees, on the research done in his medical school laboratory.

"Weissman recently recalled what led him to form the first of his companies, SyStemix.

"He describes a frustrating year trying to get the facilities he would need on campus to advance his work. He finally concluded in late 1988 that he would have to start a company. He went to (Donald) Kennedy, Stanford's president at the time.

"A biologist who is now editor in chief of Science magazine, Kennedy had reservations. 'I didn't want faculty wandering from their homes on campus into labs thinking about money in their next offshore venture,' he recalled.

"But Weissman convinced him that he could separate his work at the company from his work in the lab. A faculty committee would look at his NIH grants every year to see, Weissman said, 'if I was starting to slant my grants in favor of topics relevant to the company.' He and Kennedy agreed Stanford would not take shares in the company, avoiding a financial conflict for the university -- a policy later abandoned.

"Today, Weissman sits on the boards of directors and scientific advisory boards of two other companies he co-founded -- StemCells Inc. and Cellerant Therapeutics. His method of handling his conflicts, primarily through disclosure, has become the standard at Stanford and other medical schools.

"'The way I usually do it is, I say, `I have stock and I'm a director of this or that, so you might think I'm biased. I don't think I'm biased, but there could be unconscious bias, so you judge,' he said.

"'You ought to be able to do whatever experiment along this line with transparency so everybody knows at every step of the way what your involvements are, what your bias might be, so you can move it forward,' he said, referring to scientific progress. 'But I think it's morally reprehensible not to move it forward.'"

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