A policy review follows months of turmoil at the cancer center, which pledged an overhaul, including new rules on public disclosure and limits on outside profits.
This article was first co-published on Thursday, April 4, 2019 in ProPublica and The New York Times.
Top officials at Memorial Sloan Kettering Cancer Center repeatedly violated policies on financial conflicts of interest, fostering a culture in which profits appeared to take precedence over research and patient care, according to details released on Thursday from an outside review.
The findings followed months of turmoil over executives' ties to drug and health care companies at one of the nation's leading cancer centers. The review, conducted by the law firm Debevoise & Plimpton, was outlined at a staff meeting on Thursday morning.
It concluded that officials frequently violated or skirted their own policies; that hospital leaders' ties to companies were likely considered on an ad hoc basis rather than through rigorous vetting; and that researchers were often unaware that some senior executives had financial stakes in the outcomes of their studies.
In acknowledging flaws in its oversight of conflicts of interest, the cancer center announced on Thursday an extensive overhaul of policies governing employees' relationships with outside companies and financial arrangements — including public disclosure of doctors' ties to corporations and limits on outside work.
The review was one of several steps the nonprofit cancer center has taken in the wake of reports last year by The New York Times and ProPublica that several top executives and board members had profited from relationships with drug companies, outside research ventures or corporate board memberships.
Those revelations prompted Memorial Sloan Kettering, based in New York, to hire outside firms to conduct inquiries into those relationships as well as into internal allegations of ethical lapses.
The scrutiny of researchers' stakes in startups has intensified at a time when venture capitalists are betting millions of dollars on the next potential cure for cancer and when expensive treatments like immunotherapy have fueled public concern over rising drug prices.
The spotlight on the deals at Memorial Sloan Kettering also swayed other leading cancer centers, like Dana-Farber Cancer Institute in Boston and Fred Hutchinson Cancer Research Center in Seattle, to reconsider their policies.
Dr. Walid Gellad, director of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh, said the changes appeared to be more comprehensive than those in place at many other health care institutions.
"Memorial Sloan Kettering really does seem to be taking this seriously and this document, I think, shows it," he said, referring to the hospital's revised policies. "Kudos to them."
At the staff meeting, Mark P. Goodman, co-chairman of the law firm's commercial litigation group, told doctors that the review found "a number of instances of serious noncompliance with MSK's conflict-of-interest policies," according to a recording. A spokesman for the hospital, Mike Morey, declined to provide a copy of Debevoise's findings.
The conflicts and some profit-making deals — which were not specified at the meeting — did not occur through intentional misconduct, Goodman said. Rather, the review exposed inadequate oversight and a lack of established protocols for examining whether employees' and executives' affiliations with corporations could result in biased results that favored a company's products.
Goodman also said the review, involving interviews with 36 current and former employees and board members and an examination of 25,000 documents, did not find that the ethical shortcomings had hurt patients or compromised research. In an email, Goodman disputed the characterization of the findings as violations of rules and said the report did not conclude that top officials acted in a concerted way.
In his presentation, he referred instead to "noncompliance" with hospital policies and to instances where executives appeared not to have followed existing policies.
Scott Stuart, chairman of the cancer center's Boards of Overseers and Managers, said in an emailed statement: "We took a deep and honest look at what went wrong at our own institution, examined what was occurring in the wider cancer research community, and are putting in place best practices that will not only allow us to learn from our mistakes, but will contribute to best practices for the wider research community."
The cancer center has been reeling from the series of reports by the Times and ProPublica, including that its chief medical officer, Dr. José Baselga, had failed to disclose millions of dollars in payments from drug and health care companies in dozens of articles in medical journals.
Baselga resigned in September, and he also stepped down from the boards of the drugmaker Bristol-Myers Squibb and Varian Medical Systems, a radiation equipment manufacturer. The British-Swedish drugmaker AstraZeneca hired Baselga to run its new oncology unit this year.
Additional reports detailed how other top officials at Memorial Sloan Kettering had cultivated lucrative relationships with for-profit companies, including an artificial intelligence startup, Paige.AI, that was founded by a member of the cancer center's executive board, the chairman of its pathology department and the head of one of its research laboratories. The hospital struck an exclusive deal with the company to license images of 25 million patient tissue slides that had been collected over decades.
Another article detailed how a hospital vice president was given a nearly $1.4 million stake in a newly public company as compensation for representing Memorial Sloan Kettering on its board.
In October, Memorial Sloan Kettering's chief executive, Dr. Craig B. Thompson, resigned from the boards of Charles River Laboratories, an early-stage research company, and the drugmaker Merck.
Then, in January, Memorial Sloan Kettering went a step further, barring its top executives from serving on the corporate boards of drug and health care companies. Hospital officials also instituted policy changes to limit the ways in which its top executives and leading researchers could profit from work developed at Memorial Sloan Kettering, which admits about 23,500 cancer patients each year.
Goodman said at the staff meeting that the law firm had not found evidence of intentional wrongdoing — defined as "a conscious decision to engage in misconduct" — by the hospital's leaders or board members.
"Although we did not identify evidence of breaches of fiduciary duty, we did find that processes and controls for the review and management of senior executive and board-level conflicts were deficient and resulted in instances of noncompliance with MSK policies," Goodman said.
Specifically, he noted, plans to manage executive conflicts of interest, a requirement at the hospital, "were not implemented because it was felt to be unnecessary or because there was a failure to realize that a management plan was needed."
Goodman also said that hospital leaders' corporate ties were handled differently from other employees. Beginning in 2014, senior executives were no longer required to vet financial relationships with a conflict-of-interest advisory committee because the hospital felt the committee should not be asked to make decisions about executives to whom it reported. While Goodman said that rationale made sense, the general counsel's office — tasked with overseeing the leaders' conflicts — did not put in place formal procedures to examine potential problems.
"As a result," Goodman said, "conflicts were allowed to persist without formal firewalls in place."
Hospital leaders also did not always disclose to faculty and staff when they had relationships to companies whose research was being conducted at Memorial Sloan Kettering, Goodman said.
The policy changes that Memorial Sloan Kettering announced on Thursday include the creation of a board committee to focus on overseeing conflicts, an existing hospital policy that the law firm learned had not been carried out.
The hospital also said it would disclose financial interests of faculty members and researchers on its website and create a more centralized review of conflicts between employees' work at the hospital and their outside duties.
Other changes included new limits on how income is distributed from research discoveries that originate at Memorial Sloan Kettering, and regular audits to ensure the hospital is complying with its own rules. The cancer center reinforced its earlier statements that many profits from outside work should flow back to MSK research.
Heather H. Pierce, the senior director for science policy and regulatory counsel at the Association of American Medical Colleges, said the hospital decided to undergo a review that "was far broader than the initial concerns that were raised." As an outside member of the task force recommending changes, Pierce noted that "there was nothing that wasn't up for discussion."
Gellad, of the University of Pittsburgh, said the issues raised at a prominent institution like Memorial Sloan Kettering have placed others on notice. "We've seen what happens when these conflicts, even if they're only perceived, they lead to problems in terms of how an institution is judged," Gellad said. "Every institution, if they're not, should look to see how that impacted Memorial Sloan Kettering."
Katie Thomas covers the pharmaceutical industry for The New York Times.
“Conflicts were allowed to persist without formal firewalls in place.”
Report author Mark P. Goodman, Debevoise & Plimpton, law firm.
ProPublica is an independent, non-profit newsroom that produces investigative journalism in the public interest.
An independent audit concluded that Slon Kettering officials frequently violated or skirted their own policies.
Hospital leaders' ties to companies were likely considered on an ad hoc basis rather than through vetting.
Researchers were often unaware that some senior executives had financial stakes in the outcomes of their studies.