Top Cancer Doctor Resigns After Failing to Disclose Industry Ties | Hacker News Reader

Top Cancer Doctor Resigns After Failing to Disclose Industry Ties

nytimes.com

104 pointskylebarron38 comments

I briefly dated someone with a PHD in cancer biology who worked on the marketing side for pharmaceuticals through a "consulting" company.

On multiple occasions I watched her manipulate datasets to produce visualizations favoring whatever drug was being pushed at that time.

The rationalization process was something like the treatments were basically all equally ineffective against the specific type/stage of cancer, but still the best choices at the time for people who were going to live for a brief period no matter what. So they tweak the graphs to slightly favor whoever is paying for the research, something on the order of a couple more months of life expectancy vs. the alternatives. Just enough to funnel the patients.

sigh

How is that possible though? You cant really tweak clinical results because it is auditable by authorities, and at most what is done to favor one drug over another is cherry picking during recruitment of patients (carrying the risk of narrowing your indications in the end) or excluding patients from the study (again that has to be fixed in the study design, you cant tweak it after the fact). The kind of hacking you describe would be just plainly not allowed and easy to discover upon any investigation.

Beats me, our relationship ended that week, not something I dug further into.

They were informational pamphlets, it looked like something a doctor might hand you when recommending treatment options.

She would just remove cherry-picked samples from the set to produce the desired distribution.

From a scientific practice standpoint, that would be a good description of fraud.

There is quite a bit of leeway when you have real world data. You have to clean it. You can always find some justification. This is not neatly black/white at all. Similar in all other fields from accounting to law. I think it's a serious issue that we managed to make so many people believe way too strongly in absolutes ("science" as a magic word to end all discussions, because hey, "science" and "data" - now we have an objective reality!), when in reality the world is way more messy.

The original parent comment is describing someone hand-picking samples to obtain a predetermined conclusion. I know touching data to clean it before analysis can be a grey area, but the original parent comment -- if it is accurate -- is describing clear-cut fraud.

I refer back to what I wrote. You miss the point. There is no black/white in what is necessary and unnecessary or even nefarious "data cleaning". You just use the same fuzzy undefinable words again, but you did not make it any more a "hard fact" than any of it was before.

I'd like to raise the possibility that this is a milquetoast to reaction to something that sounds potentially criminal and cruel. I have a friend with a daughter coming out of 9 months of chemo. The thought that any of the many drugs she consumed, some of which could damaged her body in various ways, were unnecessary and given only because of fraud seems positively monstrous to me.

> this is a milquetoast to reaction to something that sounds potentially criminal

General statement: if you see someone manipulating clinical data for personal gain, write an anonymous letter to your state attorney general and top doctor. That is fraud. Brushing it off could be construed as aiding and abetting. At the very least, it is a moral failure.

Did you just call me a pansy?

I appreciate you sharing the story. There's a difference between characterizing a specific reaction as weak and calling a person weak.

There's also a natural human tendency to overlook horrors when they are abstract and "data" which is why "5000 dead" is a statistic, but that kid around the corner who died is a tragedy.

The word "milquetoast" specifically criticizes a man as weak, timid, unasertive, or childish. If that's not your intention, you're misusing the word.

It's not equivalent to saying "this is a weak reaction".

You may have preferred I reacted more severely to what I observed, but I, like everyone, must pick my battles and this particular one was and is not a priority for me. And if it were a priority, I wouldn't go about combating it at such an individual level - this is just a symptom of the profit-driven system. Just look at Purdue and the opiod crisis they've created by lying to doctors and consumers, and how rich and powerful they've become in the process. The behavior is rewarded systemically.

Which medication(s) in particular was this being done for?

Interesting. When the original report was submitted to HN last week, the top comment was from someone working in the field basically saying it was a nothingburger. [1] This latest development doesn't necessarily contradict that, but it does show that executives at least saw the issue as rather serious.

[1] https://news.ycombinator.com/item?id=17944235

Or they don’t think it’s serious and merely are forced to provide satisfying optics to keep people from reacting to press coverage. They might see pressure to force the resignation as a stupid, inefficient thing in this case, but nonetheless required or they’ll get slated and donors will react to the bad press.

I work in this field and find it quite serious. As physicians we must hold ourselves to a higher standard and remain above reproach. Nearly everything we do depends on patient's trusting us and without that it becomes much harder to effectively help people.

As far as whether drug trials are influenced by industry sponsorship, I think the answer is a resounding yes[0], though others might disagree. But if we are talking about hidden industry sponsorship, we erode trust and generate questionable results.

[0] https://jamanetwork.com/journals/jama/fullarticle/196846

https://cancerletter.com/articles/20180914_2/

List of publications by Baselga: https://www.documentcloud.org/documents/4840569-Baselga-Arti...

It's surprising how many authors all of these papers have. It makes it difficult to allocate credit.

Not saying this is the case here, but I'm sure that if someone was very strategic about it, they could get their names in a lot of high quality papers without having to do much work.

In fact, I think that people who focus more on the political aspect of their careers tend to be more successful than people who actually do the innovative work.

"In fact, I think that people who focus more on the political aspect of their careers tend to be more successful than people who actually do the useful research work."

That's unfortunately the case also outside research. You can have a very good career if you only focus on politics and nothing else.

How much of the successful 'politics' would you say is actually sycophancy?

Flattering is not enough. You need to also actively undermine your competitors to be successful at politics.

If you want to get promoted it really helps to figure out a way to make your boss look good.

Isn't that the first law in the book '48 Laws of Power'?

That's the case in all organizations - academic, government, business, military, charity, etc.

You can get your foot in the door by being competent. If you want to rise within any organization, you either have to know someone or you have to be great at office politics.

People naively think the hardest or best workers move up the ladder. No, you want the hardest and best workers working. You want them in the trenches. You want people with contacts or people you like promoted.

Whether we like it or not, success in life has a lot more to do with relationships than competence or merit. Who you know, who your family knows and who your friends knows matters far more than what you know.

The number of authors doesn't seem unusual there, and a high number of authors doesn't have to indicate anything problematic.

There are many valid reasons why author lists can get rather large on scientific papers. Anything that is even a bit interdisciplinary will usually multiply the authors because you need collaborators with the right expertise and can't do everything yourself.

I occasionally get listed as a co-author on papers where I feel my contribution has been very minimal. At first I objected, but apparently it is a thing in Academia to list absolutely everybody who had any involvement at all with the research.

Maybe this isn't what you meant, but it's not a thing in all fields in academia. Pure math for example is generally pretty careful about authorship, and so is cs theory, for the same reasons. Not coincidentally both fields use alphabetical author order instead of contributional.

For biomedical research this is really not a large number of authors. Some very large clinical trials often have scores of authors, which isn't particularly surprising given that they cost $100s millions and take place across dozens of sites/hospitals/countries.

Generally most of the authors don’t get much credit at all, at least in the biomedical space. The first author or co-first authors and the last author. Everyone else is more of a hanger on.

The more you learn about these stories, the more you realize that our world is just a giant clusterfuck. We haven't witnessed many revolutionary medical breakthroughs in recent years or even decades. With little resources back then scientists were still able to invent breakthroughs such as vaccines, anesthesia, antibiotics, etc. Consider all the money being dumped into medical research field today, it's disheartening that we haven't been able to achieve anything near the same level. The returns are quickly diminishing.

The medical field seems to progress at much slower pace compared to other fields like computer science. Are we facing talents distribution problem? The world certainly didn't have companies like Apple, Amazon, Google, or Facebook back then. Are these tech companies sucking up most talents? It's sad to imagine our brightest people are being utilized to create more online ads rather than help curing the world.

"It was a good description to say that it was a game, a very interesting game one could play. Whenever one solved one of the little problems, one could write a paper about it. It was very easy in those days for any second-rate physicist to do first-rate work. There has not been such a glorious time since then. It is very difficult now for a first-rate physicist to do second-rate work." P.A.M. Dirac.

The quote is about physics, but it certainly also applies to medicine. All the low hanging fruits have been picked. The problem now is not the lack of talent, funding, interest or dedication: it's the lack of fruits.

To continue the analogy: The amount of reachable fruit depends a lot on the availability of tools. That’s why we didn’t have computer science in the copper age. There have a lot of new tools been developed recently, eg deep learning, and new areas of expertise have been unlocked with it. One just has to figure out what kinds of fruit are reachable now.

Ecmo is fairly recent (less than 2 decades) and still developing.

hiv has gone from being a death sentence to a chronic illness.

Hepatitis c has better treatment options.

Mri has had diffusion weighted imaging added within last 2 decades.

Lasik is also recent

There are some breakthroughs but they are taken for granted. Differences with low hanging fruit aside. It isn't simply 'hey this slide I forgot to clean before vacation is growing something that is killing bacteria' level. Not to disparage the past groundbreaking work at all but what they had more accessible discoveries. While Salk is rightfully lauded for his role in producing the polio vaccine its manufacture was relatively simple in that it involved monkey kidney tissue grown three strains of viruses inactivated with formaldehyde. Not easy but straightforward in approach. Now the therapies are far more complex and involve things like gene sequencing and molecular biology.

We have a hepatitis C cure for one and there are other more subtle advances. We have a HPV vaccine although its rollout was sadly more limited than it should have been out of prudishness. Another more subtle example involves pediatric surgery. Before congenital heart problems were always inoperable because infants were too small to operate on. Now it is possible to do surgeries in the womb.

Medical research is so unbelievably corrupt.

no buddy you can't argue with science. Eggs will kill you, unless you take statin.

Poe’s law strikes again.

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