Cardiologist Peter Libby: Negative Perception Prompted Refusal of Pharma Money

Peter Libby, MD, now refuses pharma fees for his consulting services not because of impropriety, but because of the growing perception of impropriety. The chief cardiologist at Brigham and Women's Hospital in Boston told NPR's Madeline Brand last week that his decision was motivated by negative comments in the blogosphere after he appeared in a public-service documentary on PBS.

The documentary, "The Hidden Epidemic: Heart Disease in America," was a 4-year, unpaid labor for the doctor, according to a recent mini-profile in the NYT. However, shortly after the show's airing in October, Roy Poses, MD, at the Health Care Renewal blog raised conflict-of-interest (COI) issues, given that the show was funded by pacemaker-producer Medtronic and statin-maker AstraZeneca and that Libby, in particular, had an undisclosed relationship with AstraZeneca (although that relationship was not specified by Poses, other than in the form of grant support, consulting services, or participation on a speakers' bureau—which are important to distinguish [see below]).

Poses also discovered that another program participant, Douglas Zipes, MD, of Indiana University, had an undisclosed relationship with Medtronic. However, Poses did not identify particular instances in the documentary in which undue influence appeared to be exerted by the funding companies or by the participating experts themselves—other than to cite the unbranded claim that some cardiac arrhythmias are treated with implantable pacemakers (ho hum).

Yet despite the lack of specific examples suggesting commercial influence on the documentary's content, Pharmalot's Ed Silverman posted the story, arguably fomenting the unfounded perception that the program or its physician participants were biased, solely on the basis of their undefined relationships with the 2 supporting companies. Silverman (and Poses) also neglected to call out other documentary participants, including outspoken pharma critic Steven Nissen, MD, of the Cleveland Clinic.

In a moment of needed clarity, one Pharmalot commenter ("Reality") wrote:

Oh dear, another case of the COI vapors! Overall, I'd say this ranks around an 8 out of 10 on the conflict-of-interest overreaction scale...[F]rom what I've read, this was a simple, layman's educational series. No specific products were mentioned and what they reported in terms of treatments was straigh[t]forward and followed expert guidelines...

Should the advisors' ties to AZ and Medtronics...been noted? Probably. But I think the level of criticism here goes far beyond the seriousness of the infraction, or lack thereof. Look, there are some very real and very troubling COI issues out there, but to me, this is not one of them. This is a case of someone looking for a problem.

When Libby was asked by NPR last week if he could have been unconsciously* biased given his relationships with pharma, he denied influence. Because he has worked with "virtually every company that has produced, manufactured, sold, or even thought about producing, manufacturing, or selling" any cardiovascular product, he could claim no particular commercial allegiance.

Libby believes that academic investigators should be involved with pharma to ensure the integrity of clinical trials and, ultimately, the public good. Unfortunately Libby's decision to now refuse pharma money may confirm to a suspect crowd that his previous choice to do so was, somehow, improper.

N.B. In the 5-minute segment featuring Libby, NPR made a disingenuous, if not inaccurate, segue from the discussion of Robert Jarvik^† appearing in Lipitor's DTC ads to physicians consulting for or receiving grant support from commercial interests. In doing so, NPR failed to make important distinctions among 1) the appearance of physicians in advertisements, 2) their participation in speakers' bureaus, 3) their participation in advisory boards, and 4) the receipt of grant support.

*Of course, consciously assessing unconscious influence is really difficult, given that the influence, by definition, hasn't bubbled up to consciousness. So it's a very difficult question to answer, other than to ensure that there are conditions (such as consulting for everybody) that make unconscious bias toward one company unlikely.

†NPR also falsely stated that Jarvik is not a medical doctor. Jarvik evidently earned his MD from the University of Utah; however, to my knowledge, he does not hold an active license to practice medicine.