Money and medicine make strange bedfellows. That is the one fact on which both sides of recent arguments over Medicare coverage and pharmaceutical drugs can agree.
In today's competitive health research field, the National Institutes of Health competes with private firms for the nation's top experts. So scientists must decide whether to follow the lure of higher pay at a private biotech firm or to work for the NIH, which has built a reputation as a haven for pure medical research that is not driven by the quest for profits.
When "Subject No. 4" died in June of 1999 during an NIH study from complications related to a German company's kidney drug treatment, the institute did not stop the study or warn other doctors of the drug's dangers. Many wonder if this had something to do with the fact that Dr. Stephen Katz, in charge of the institute conducting the study, was a paid consultant of the German company. He denied that the ties influenced his decisions in the case, but how can the public ever be sure?
Earlier this year, an NIH study panel investigated the increasing concerns over of conflict-of-interest cases. The panel passed to Congress recommendations that would tighten restrictions on the work NIH scientists do for universities and outside companies and the ways they are paid for it. Stricter rules are necessary to curb the increasingly common tendency to let the appearance of impropriety taint scientific research.
For example, Pfizer Inc. revealed to a congressional subcommittee considering the NIH panel's suggestions that it paid $512,000 to Trey Sunderland, a researcher at the National Institute of Mental Health, for consulting work, honorariums and expense reimbursements. That arrangement was unusual only in the size of the payments.
But Katz and Sunderland had done nothing wrong according to the letter of the law. Though it is ethically questionable for NIH officials to accept payments from universities and private companies - especially if the payments are in stocks and other equities - there is no regulation that prohibits it.
The study panel commissioned at the beginning of the year called for an end to accepting equity payments, along with an end to consulting work by NIH officials who manage decisions on funding, contracts and grants. The panel's report also suggested limiting all NIH scientists' consulting work to 400 hours per year - roughly eight hours per week.
Critics argue these regulations would undermine the NIH's ability to keep top researchers from defecting to private companies. But the NIH's reputation and priorities are at stake here. The congressional subcommittee has the chance to reaffirm that NIH scientists' focus should be on the groundbreaking work they do on the institute's Bethesda, Md., campus, not the moneymaking they can squeeze in as a side job.