America's Family Doctor
We are dismayed at recent revelations in last Friday's New York Times and Saturday's Boston Globe about the questionable practices of a member of our Dartmouth community, C. Everett Koop, MD. The New York Times story was the third on how money from corporations and hospitals influences the advice of the man who calls himself "Americas family doctor." The Boston Globe carried a follow-up news story and an Op-Ed by Dr. Jerome P. Kassirer, editor-in-chief emeritus of the New England Journal of Medicine, discussing financial influence on medical information web sites, including Dr. Koop's.
The former U.S. Surgeon General became an internet millionaire this year when his web site went public. According to the prospectus filed with the Securities and Exchange Commission, the goal of DrKoop.com was to "establish the DrKoop.com brand so that consumers associate the trustworthiness and credibility of Dr. C. Everett Koop with our company." But Koop's recent web site and political activities, as reported by the Times' Holcomb Noble, raise questions about the former Surgeon General's current levels of trustworthiness and credibility.
Koop's web site, DrKoop.com promoted a list of hospitals and health centers as "the most innovative and advanced health care institutions across the country." In fact, each of the medical institutions on the list had paid a fee of about $40,000 to be included on the site.
The web site recruited volunteers for clinical trials for new pharmaceuticals. However, DrKoop.com did not disclose, until the Times made it public, that the web site had a contract with Quintiles Transnational Corp., a North Carolina firm that manages clinical trials for drug companies. The financial agreement between Quintiles and DrKoop.com entitles the web site to receive a payment from Quintiles for each person enrolled in a trial through the site. Under the rules of the American Medical Association, "payment by or to a physician solely for the referral of a patient is fee splitting and is unethical."
In March, Dr. Koop testified before a Congressional subcommittee on the safety of latex gloves. Koop told the panel that the hazards being linked to the gloves by scientists and other health authorities were exaggerated and "borderline hysteria." He did not, however, disclose his four-year, $1 million contract with a leading manufacturer of latex gloves. In April 1999, the former surgeon general urged Congress to pass legislation that would allow New Jersey's Schering-Plough Corporation to extend its patent on the allergy drug Claritin by five years, an extension that could generate approximately $6 billion in sales.
Dr. Koop also met with House members in support of Schering-Plough's position on legislation involving another drug, used to treat hepatitis C. In neither meeting did Koop disclose that earlier in the year his foundation received a $1 million grant from Schering-Plough. In May, Dr.Koop.com formed a partnership with the American Council on Science and Health, a New York based organization that promotes pro-industry positions on pesticides and chemicals.
In June, as the chair of an ACSH panel, Koop put his name on a scientific review that defends the safety of plasticizer chemicals in toys and medical products made from polyvinyl chloride (PVC) plastic. This review was in response to a report by a group called "Health Care Without Harm," which we have read and whose conclusions we support. Our colleagues have criticized the ACSH review for omitting scientific evidence that did not support its conclusions. From the recommended hospitals on his web site to his Congressional testimony on the safety of latex gloves, Dr. Koop has undermined his image as an independent and esteemed former U.S. Surgeon General.
He is quoted by Dr. Kassirer as saying, "I cannot be bought. It is true that there are people in my situation who could not receive a million-dollar grant and stay objective, but I do." At a minimum, Dr. Kassirer suggests that such potential conflicts of interest be disclosed. We expect more from the man whose stand against the tobacco industry helped to earn him the title of Elizabeth DeCamp McInerny Professor of Medical Ethics at Dartmouth Medical School.
These are serious charges and should be of concern to Dartmouth and its reputation. As Dartmouth alumni, we urge the college and the medical school to address the issues raised inThe New York Times stories and The Boston Globe Op-Ed. The coverage of Dr. Koop presents Dartmouth with an opportunity to consider the emerging ethical issues surrounding internet medical advice. The Times' stories also suggest that Dartmouth has a responsibility to consider how to draw the ethical line between money and medicine -- between paid product endorsement and independent medical judgment.