Recently, the US Department of Justice levied a 40 million dollar fine against CareFusion, makers of ChloraPrep® surgical skin antiseptic agent, because of kickback money paid to one member of the National Quality Forum’s board, Dr. Charles Denham, MD. As a result, it’s become clear that much of the physician demonizing and marketing hoopla surrounding the patient safety movement might not be just about patient safety, but rather more about a money grab. And it hasn’t stopped there.
We have now learned that Christine Cassells, MD, former President of the American Board of Internal Medicine (ABIM) and the current President and CEO of the National Quality Forum has her own conflicts of interest since she was also serving as a paid consultant to several organizations who stand to benefit from the patient safety and quality initiatives created by the National Quality Forum.
Fool me once, shame on you. Fool me twice, shame on me.
Given these ongoing revelations, it seems only logical to investigate if other conflicts might exist with these same doctors who make their living in these professional society circuits, especially when they serve as authors of papers outlining how doctors should behave professionally. After all, the seemingly well-intentioned paper entitled "Medical Professionalism in the New Millennium: A Physician Charter" was published by Ms. Cassell’s former organization that she lead at the time, the American Board of Internal Medicine (in conjunction with the American College of Physician-American Society of Internal Medicine (ACP-ASIM) and the European Federation of Internal Medicine).
Not surprisingly, the current analysis is stunning.
For instance, remember the recent announcement from CVS Caremark about no more sales of tobacco products in CVS Stores splashed far and wide in the media – even by the President of the United States and the head of the Department of Health and Human Services? Well guess who now serves as the Executive Vice President and Chief Medical Officer for CVS Caremark? Troy Brennan, MD, JD, the lead author of the medical professionalism paper published in 2002. While employment in the private sector after a lifetime in medicine does not violate current ethical standards, we have to wonder if it’s medically professional to leave the medical profession itself to a greener, more lucrative pasture sculpted by one’s papers that now are seen to serve corporate (and perhaps self-) interests more than patients, especially when they invoke the relatively new ethical requirement for social justice: that is, the needs of the collective should supersede the needs of the individual patient in the name of cost savings.
Another author of the medical professionalism paper, Walter McDonald, MD, also seems to feel it’s medically professional to serve as executive vice president and CEO of the ACP-ASIM while also serving as the senior vice president for QHc Advisory Group, LLC.
Double-standard, anyone?
Finally, let’s not forget about Lisa J Lavisso-Mourey, MD, another of the paper’s authors, who is President and CEO of the Robert Woods Johnson Foundation itself created from the riches of one of the sons of the Johnson and Johnson, Inc. fortune. According to the organization’s 2012 Form 990, Dr. Lavisso-Mourey pulls in a cool $918,519 in salary and benefits as its President and CEO. Not a bad day job. But why was she authoring an article on medical professionalism? Shouldn’t she have recused herself when not actually practicing medicine? We should note that before joining RWJF, Dr. Lavisso-Maurey was senior vice president of the Health Care Group and member of the Clinton Task Force for Health Care Reform, so a political motive might have superseded a truly medical motive. And since she was a co-author with Dr. Troy Brennan on the medical professionalism paper cited above, we should not be surprised that Dr. Lavisso-Mourey’s had nothing but a glowing endorsement of the CVS Caremark decision to abandon tobacco sales. After all, the back-slapping by these old pals goes way back.
For patients and hard-working doctors in the trenches, what does all of this really mean? Can anything our professional organizations say to us and the public be trusted any longer? Are edicts on medical professionalism, patient safety, prevention, EMR order sets with their "meaningful use" requirements, more about a power and money grab than real ideals for patient care?
We have to wonder.
When any organization tolerates board members receiving kickbacks and ignoring cushy consultant positions that have clear conflicts of interest, a good, thorough, house-cleaning is needed. And that house-cleaning should start at the top. Anything else is window-dressing.
Without such a dramatic move, our professional organizations’ credibility with those they pretend to serve will never recover.
-Wes
