[TS] Drugs, Devices and Doctors
By PAUL KRUGMAN

Merck, the pharmaceutical giant, is under siege. And one side effect of that siege is a public relations crisis for the Cleveland Clinic, a celebrated hospital and health care organization.

But the real story is bigger than either the company or the clinic. It's the story of how growing conflicts of interest may be distorting both medical research and health care in general.

...Dr. Eric Topol, a famed cardiologist at the Cleveland Clinic, has been warning about the dangers of Vioxx since 2001. In videotaped testimony at a recent federal Vioxx trial (which ended in a mistrial), he accused Merck of scientific misconduct, and also testified that Merck's former chairman had called the chairman of the Cleveland Clinic to complain about his work - an action Dr. Topol called "repulsive."

Two days after that testimony, according to Dr. Topol, he was told early in the morning not to attend an 8 a.m. meeting of the clinic's board of governors, because the position of chief academic officer, which gave him a seat on the board, had been abolished. A clinic spokeswoman denied that the abrupt elimination of this post had any link to his Vioxx testimony.

A few days later, The Wall Street Journal reported on a web of financial connections between the Cleveland Clinic, its chief executive and AtriCure, a company selling a medical device used in a surgical procedure promoted by the clinic. Dr. Topol - whose demotion also cost him his seat on the conflict-of-interest committee - was "among those who questioned the ties," the newspaper said.

O.K., it's sounding complicated. But the essence is simple: crucial scientific research and crucial medical decisions have to be considered suspect because of financial ties among medical companies, medical researchers and health care providers.