Crooked academics and the Universities that shield them - more on Brown and Keller

It's all very well blaming pharmaceutical companies for the decrepit state of integrity in medicine.

The chief villians remain our academic institutions and medical leadership. They have colluded with and have acted as apologists for commercial scientific fraud. They have tolerated the telling of lies by senior academics. They have encouraged the prostitution of medicine. They have allowed abuse of the most fundamental safeguards of science. Most importantly, they have set terrible examples for our students.

Last week I posted a copy of my letter to the new Dean of Medicine at Brown University, Professor Ed Wing. The letter was about scientific integrity at Brown, the problem of Professor Martin Keller, and the silence over Brown's treatment of Professor David Kern.

I have not had a response.

A source now informs me that Brown has conducted a formal "investigation" into the activities of Professor Martin Keller. The prior probability that such an investigation would be anything other than a sham is pretty low (P<0.001), but the report is nevertheless "confidential". The trail of oddities involving Keller extends into the distant past. Now the US Senate Finance Committee is probing Keller's financial kickbacks.

It is hard to say this nicely. Based on the publicly available evidence, Professor Martin Keller is guilty of gross and obvious scientific deception and abuse of the scientific process. He has betrayed the trust of our patients. More about Keller here, here, here, here, here, here, here and here

Brown University have continued to provide Keller with a shield of University respectibility. Since he remains in post, we can only guess the level of scientific deception that Brown administration deem to be acceptable.

Should you remain silent Professor Wing?

This is the guidance Brown University provides to it's students:

Principles of the Brown University Community

We, as members of the Brown University community – faculty, undergraduates, graduate and medical students, and staff – are dedicated to supporting and maintaining a scholarly community in which all share together in the common enterprise of learning. As a central aim, Brown University promotes intellectual inquiry through vigorous discourse, both oral and written. The fundamental principles that must necessarily undergird this aim include respect for the integrity of the academic process; individual integrity and self-respect; respect for the freedoms and privileges of others; and respect for University resources. In becoming a part of Brown University, we accept the rights and responsibilities of membership in the University’s academic and social community, and assume the responsibility to uphold the University’s principles.

Respect for the Integrity of the Academic Process

The rights and responsibilities that accompany academic freedom are at the heart of the intellectual purposes of the University. Our conduct as community members should protect and promote the University’s pursuit of its academic mission. We are all, therefore, expected to conduct ourselves with integrity in our learning, teaching, and research, and in the ways in which we support those endeavors.

Individual Integrity

In order to ensure that the University can dedicate itself fully to its academic and educational vision, it is expected that an individual’s personal integrity will be reflected not only in honest and responsible actions but also in a willingness to offer direction to others whose actions may be harmful to themselves or the community. The University expects that members of the Brown community will be truthful and forthright. The University also expects that community members will not engage in behavior that endangers their own sustained effectiveness or that has serious ramifications for their own or others’ safety, welfare, academic well-being, or professional obligations.

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Dean Edward J Wing and integrity at Brown Medical School

One thing will be obvious to anyone who has spent time looking at scientific misconduct and academic bullying. Publicly known instances tend to aggregate within particular institutions.

It may be a denominator effect. "Bad apples" might arise in productive institutions with a large number of apples. Ineffective (or corrupt) leadership might also permit fraud and bullying. Unprincipled leadership is also associated with sham investigation and attempted cover-up, which in turn precipitates public discussion.

True "bad apple" aberrations never leave an institutional stain. The fraud of Jan Hendrik Schön did not alter the reputation of Bell Laboratories. Other so called "bad apple" cases are nothing of the sort. The fraud of John Darsee at Harvard, or Vijay Soman at Yale involved collusion of leadership, ignoring of principles, bullying and cover-up.

Several institutions spring to mind, not only for the frequency of serious problems but also dismal cover-up, ignoring of principles, and bullying of those who have discussed integrity.

• The University of Toronto (cases of Nancy Olivieri, David Healy, Godeon Koren, Brenda Gallie and others)
• Berkeley (Ignacio Chapela, Tyrone Hayes)
• Brown University Medical School (David Kern, Martin Keller)
• Harvard (too many cases to mention)
• Kingston University in the UK

Another characteristic of leadership failure is the refusal of institutions to apologize when they must know that they have done wrong. There is failure to discuss the principles honestly and publicly. There is failure to demonstrate proper academic behavior to students. When apology does take place it is often end-stage "damage limitation" of the sort illustrated here by John Cleese.



Why discuss Brown University now? Brown has a new Dean of Medicine as of 5 days ago. Professor of Edward J. Wing, M.D. took up his position on July 1 2008. There was considerable controversy about the manner of his appointment. In particular there were concerns that the process was designed to limit the field to particular insiders (see here, and here). Perhaps choosing an insider was not the best idea for an institution with a growing integrity stain.

Wing was certainly present at Brown during the terminal phase of the bullying of David Kern. It is not known that he did anything to help Kern. He must also have had interactions with Professor Martin Keller.

It is however possible that Wing will do the right thing. I wrote to Wing to find out. My communication was also sent to Associate Provost Pamela O'Neil, Provost David Kertzer and President Ruth Simmons. Given the absence of any acknowledgement, I thought I would make my communication public.

Professor Ed Wing
Chairman of Medicine
Brown Medical School

29 June 2008

Dear Professor Wing

I note that you will take up your Deanship at Brown two days from now. I congratulate you on your appointment.

I am sure you are aware of increasing concern about the integrity and honesty of leadership in medicine. Further, I am sure that you realize that the outsider's view of Brown is tainted by two unfortunate scandals. One a decade ago, has never been resolved in any principled manner. The other is ongoing.

I am referring to the cases of Dr David Kern, Professor of Occupational Medicine, and the many problems involving Professor Martin Keller.

David Kern was bullied and effectively fired at around the time you joined the faculty at Brown. Brown has never to my knowledge undertaken any soul searching with regard to this dismal affair.

I am sure that you are aware of the obvious obscenity of tainted research and research misrepresentation involving Professor Martin Keller. This research has done a grave disservice to the image of our profession. Brown has so far taken no apparent action.

I am therefore writing to ask whether you have made (or intend to make) any comment about these two incidents.

Have you anything to say of the future integrity of research at Brown, Professor Wing?

Kind Regards

Dr Aubrey Blumsohn
Sheffield, England

There is a Chinese saying, "a fish begins to smell from the head down...". You may not be a culpable head as yet Professor Wing. You are however in a position to make some statement about the institutional infection that has characterized Brown.

As Peter Drucker said, "Management is doing things right; leadership is doing the right things". Some statement about manipulated drug studies, an honorary degree for David Kern and an honest statement of regret might be a good idea.

Perhaps consider doing the right thing Professor Wing.

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More on the David Kern affair at Brown University

I have written previously about the depressingly familiar treatment of Professor David Kern at Brown University. The reputation of Brown was brought into disrepute through those events and through other parallel scandals such as that involving Professor Martin Keller. As Kern states "while our medical school and university administrators continue to proclaim a dedication to truth, to the search for knowledge, and to the advancement of civilization, it is all pretense as wordsmithing triumphs over truth and as knowledge is buried."

The best description of the Kern affair is hidden within the (non electronic) archives of the International Journal of Occupational and Environmental Health. It is the now the 10th anniversary of those events. Brown University have yet to make any public apology, conduct any public exploration of their actions, or explain their actions. The main point of this posting is to make available the full text of the 1998 Kern manuscript detailing those events of 1997. I do so with the kind permission of the IJOEH editors. It is mandatory reading for anyone who cares about research integrity and the functioning of universities.

The manuscript is here (IJOEH 1998, 4(1) 19-40):
Manuscript (1.1 Mb)
Appendices (0.2 Mb)

An important quote in the paper comes from The American Thoracic Society who stated:

"Barriers to the open communication of scientific information must be resisted. In particular, the threat of litigation and/or elimination of financial support to prevent the open communication of scientific information is abhorrent."

Kern emphasizes the points actually at issue: the need to protect the freedom of scientists to communicate findings important to the health of the public, and the physician's overarching professional responsibility to his or her patients.

Some extracts from the paper follow:

We are left confronting arrogance, dishonesty, and a callous disregard for the health of workers. While our medical school and university administrators continue to proclaim a dedication to truth, to the search for knowledge, and to the advancement of civilization, it is all pretense as wordsmithing triumphs over truth and as knowledge is buried. What makes such pretense infuriating goes beyond hypocrisy to the failure of these administrators to realize that people's lives hang in the balance. They either fail to appreciate or are unwilling to acknowledge that their words and actions have jeopardized the health of individual workers, have contributed to the potentially irrevocable loss of an opportunity to advance both scientific understanding and the public health, and have undermined the collective sense of trust and mission in this academic community.

At the close of the meeting, I provided the company with a draft of a scientific abstract, describing the clinical dimensions of the ILD outbreak, which I was planning to submit to the American Thoracic Society for presentation at its annual international conference in May 1997. Two days later, Mr. Fulks called to say that I could not submit the abstract and, that if I did, the company would take legal action against both the hospital and me.

THE MEDICAL SCHOOL ADMINISTRATION'S FIRST STRIKE

During the following week, I contacted the University Grants Office and was referred to Peter Shank, Associate Dean of Medicine and Biological Sciences. Dr. Shank wrote to me, stating: "I see no way in which you can publish results of your studies at the company with-out their written approval . . . you should immediately withdraw your abstract to the national meeting." He copied his letter to both Rick Dietz and H. Denman Scott, MD, Physician-in-Chief at Memorial Hospital. [Professor Shank's letter is here]

THE HOSPITAL'S SHIFTING SANDS

The following day, Dietz told me that he would arrange for me to speak with the hospital's legal counsel. He then went on to say that given the absence of any public health concern it seemed to him that I should withdraw the abstract. When I asked him why the disease outbreak did not pose a public health concern, his response was that no other company in the world makes what this company manufactures and that NIOSH personnel were already conducting an investigation at the company. I explained that this is not the only company in the world manufacturing these products, to which he replied, "Yes it is." I noted the existence of two other companies in Rhode Island, a considerable number of business competitors throughout New England, and an international trade organization having at least 50 member companies. With that, he became somewhat agitated, stating that I was going to destroy the company.

CONFLICTS OF INTEREST

Perhaps worthy of note is that Microfibres is one of eight benefactors responsible for construction of the hospital's histology laboratory. Three members of the company owner's family serve as members of the Memorial Hospital Corporation. More troubling, however, is that the company was asked to contribute to the hospital's Primary Care Center Capital Campaign at approximately the same time as Frank Dietz and Dr. Scott were attempting to allay the company owner's anger about our having submitted a scientific abstract on the disease outbreak. Moreover, the solicitation was made jointly by Rick Dietz and the Chairman of the Capital Campaign. The Chairman of the Capital Campaign also serves both as Vice Chairman of the hospital's Board of Trustees and as hospital attorney. In the latter role, he has provided guidance to Frank Dietz on how to deal with the confidentiality agreement, the submitted scientific abstract, and me.

THE MEDICAL SCHOOL ADMINISTRATION'S SECOND STRIKE

On December 20, I asked Dr. Scott for clarification of two points. When I asked what would happen if I re-fused to withdraw the abstract, I was informed that if the company sued the hospital, the hospital would in turn countersue me. When I explained that what I had really been asking was what would happen to my job, he answered that he did not know. When I asked what Frank Dietz had meant in stating that our occupational health program no longer existed, Dr. Scott answered that I could not have any contracts with industry.

THE MEDICAL SCHOOL ADMINISTRATION'S THIRD STRIKE

Over the following month, the actions and statements of both Dean Marsh and the Committee of Inquiry made it clear that a search for truth was not in progress.

A Committee of Inquiry released its report. While the committee concluded that my academic freedom had been violated, it reached this conclusion on the basis of tortured legalistic reasoning and all but ignored the truly compelling facts and issues. It is difficult to imagine how anyone can take the report seriously given such conclusions as: "The company's attempt to have the abstract withdrawn is not considered by the Committee to be an attempt to compromise the health of its employees but rather an effort to avoid bad publicity and to protect its economic position."

COMMENT

Representatives of the company, the hospital, and the university have gone to great lengths to distort the truth. Yet, even were their claims true, their points of contention are irrelevant to the critical issues in this matter. That is [not], whether ... the confidentiality agreement in question has any legal standing [but]

• attempts to suppress the dissemination of scientific findings critically important to the public health
• interference with my professional responsibilities to care for patients, and
• immediate termination of our occupational health program.

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The path of least resistance and the case of Professor Martin Keller

Matthew Holford has been discussing the rather interesting case of Professor Martin Keller at Brown University. See
Part I
Part II
Part III.

Keller was involved in some highly questionable science at Brown involving GSK's drug Seroxat/Paxil [Link] [Link] [Link].

I'm interested in the University culture within which this saga developed. I am particularly interested because the Keller affair is connected with two other cases I am investigating:

a) The Gillberg affair (to follow)
b) The case of David Kern, effectively fired from Brown 10 years ago for attempting to publish scientific information about a new lung disease in local factory employees.

I have been doing a little of my own digging into the Keller affair. In the process I came across two newspaper articles hidden in the depths of the archives of the Boston Globe.

For the moment I will simply summarize the two newsarticles without comment. I am not even sure whether comment is required.

Article 1: Bass A. Brown researcher faced billing questions in past.
Boston Globe, January 21, 1996. P.21.

The article notes: In 1994, Keller was investigated by the Rhode Island Attorney General and the Police for "padding his travel expenses." The financial crimes unit of the Police said that the case was dropped after the University requested that it be handled internally. The University spokesman (Mark Nickel) denied that "the university interceded to halt the investigation. Keller first denied the allegations, saying there was "absolutely no truth" to them. Later he acknowledged the audit, but said it found that Brown owed him money. In fact the audit found overbilling that "amounted to several thousand dollars." Keller eventually repaid the University $918.

But then a few months later the following appeared

Article 2: Bass A. Ex-employees allege harassment by Brown.
Boston Globe, June 24, 1996. P. 17.

The article notes: Multiple Brown employees who expressed concern about Keller's travel finances and other problems in the Psychiatry Department said they had been abused by Keller and other Brown administrators as a result. Diane Hanks, a former technical writer at Brown alerted Brown officials to problems in Keller's travel budget. Hanks wrote to Brown University President Vartan Gregorian, "It has been evident to me since March 1993 that I would never be allowed to advance my career within the university. How odd that the university chose to punish me, and so many others, rather than to deal with Dr. Keller." Former executive secretary, Patty Kostka, said that staff members who were funded by federal research grants "were actually doing research for drug companies, such as Upjohn." and "It really shocked me to see federal grant money used for drug companies. But when I questioned it, they took away my duties and assigned them to someone else." Donna Howard, a former assistant administrator said "the deans were all aware of what was going on in Keller's department, and they were certainly aware of problems with the Corrigan contract. But they chose not to do anything about it. I guess they considered myself, Diane, and other employees more expendable than Marty Keller."

One year later Professor David Kern's research was destroyed by Brown University when he attempted to tell the truth about a disease.

"Following the path of least resistance is what makes rivers and men crooked."
--Unknown

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Dr David Kern's "dilemma" - learning from history

In November 1996 Dr David Kern, Professor of Occupational Health Medicine at Brown University in Rhode Island received a letter.



The integrity of medical research is under threat. Many cases have arisen which have demonstrated the inclination of our profession to act in a way that damages both science and the interests of the patients we serve. In many instances, organizations charged with maintaining integrity have colluded, almost routinely, to pervert science, to bully those raising concerns, and to obscure problems. These organizations include our medical Journals, professional regulatory bodies, drug regulators and even formal bodies devoted to maintaining "integrity".

The story of Dr David Kern and the "dilemma" of flock workers' lung is one of many such stories. The letter mentioned Kern's "dilemma". The problem was that Kern had no dilemma. Kern knew that the integrity of a doctor is paramount. The dilemma was one for Brown University.

What happened to David Kern is a stain on the reputation of Brown University. In 1994 Kern reviewed a patient with unusual lung disease. He wondered whether the disease might be due to occupational exposure. Kern visited the patient's place of work - Microfibres Inc. Before visiting he signed a standard confidentiality agreement forbidding the disclosure of any "trade secrets" he might discover during his visit. Over the next two years at least 6 more cases arose, and Kern believed he had sufficient evidence to prove the existence of a new lung disease. He informed the company of his decision to publish his findings, initially in the form of an abstract at the annual meeting of the American Thoracic Society in May 1997.

In response to this, Microfibres Inc., threatened to sue citing the confidentiality agreement prohibiting disclosure of any "trade secrets". However occupational lung disease is not such a "trade secret". The associate Dean of Medicine, Paul Shank attempted to force Kern to withdraw his abstract, and to prevent publication of the findings. Kern refused. He next received correspondence from Francis Diez, president of Memorial Hospital instructing him to withdraw. The hospital, the letter added, was shutting down his entire program "effective immediately". Shamefully, six months after the actions of Shank and Diez, Brown University pretended in a duplicitous statement that they had supported Kern's academic freedom and integrity all along. Less than a week after that, Kern received a letter informing his that his teaching and research positions had been eliminated. Brown University appeared to see nothing to gain from honest research or medicine. Microfibres’ owner and two relatives sat on the hospital’s board, and the company had helped to fund the hospital’s facilities.

University obfuscation in the Kern case was damaging both to our profession and to our patients: In the words of Dr Kern:
Extracts from speech delivered at MIT March 29, 1999

"A small group of Brown University faculty members rallied and called for university administrators to take a principled stand. Instead, the Dean of Medicine hand-picked a Committee of Inquiry comprised of two associate deans whose subsequent report side-stepped nearly every critical issue."

"Moreover, far more important issues such as the suppression of scientific findings critically important to public health and interference with a physician's responsibilities to care for his patients were not addressed at all."

The ATS [American Thoracic Society] admonished: "Barriers to the open communication of scientific information must be resisted. In particular, the threat of litigation and/or elimination of financial support to prevent the open communication of scientific information is abhorrent."

Democracy can coexist with the belief that all humans are sinners but not with the belief that all sins are equal. Democracy has within each of its camps, not excluding the civilitarian camp, thugs in number. And when you're in an argument with a thug, there are things much more important than civility."

I do not like incivility. Yet, I like thugs even less. What I am asking, rather, what I demand of us all is honesty and truth. For without honesty and truth, there is nothing.

In my case, representatives of the company, the hospital, and Brown University have gone to great lengths to distort the truth. Yet, even were their claims true, their points of contention are irrelevant to the critical issues that remain (a) their attempts to suppress the dissemination of scientific findings critically important to the public health, (b) their interference with my professional responsibilities to care for patients, and (c) their immediate termination of the state's only occupational health program.

And so, we are left confronting arrogance, dishonesty, and a callous disregard for the health of workers. While our medical school and university administrators continue to proclaim their dedication to truth, to the search for knowledge, and to the advancement of civilization, it is all pretense as wordsmithing triumphs over truth and as knowledge is buried. What makes such pretense infuriating goes beyond hypocrisy to the failure of these administrators to realize that people's lives hang in the balance. They either fail to appreciate or are unwilling to acknowledge that their words and actions have jeopardized the health of individual workers, have contributed to the potentially irrevocable loss of an opportunity to advance both scientific understanding and the public health, and have undermined the collective sense of trust and mission in our academic community.

For more information about David Kern see:

1. New Disease, Old Story. Annals of Internal Medicine 15 August 1998 129(4) Pages 327-328 (by Frank Davidoff, Editor)
2. Transcript of a speech by Dr Kern, Delivered at MIT, Cambridge, MA, March 29, 1999
3. Objectivity Lost: University Industry Science Collaborations
4. David G. Kern, Robert S. Crausman, Kate T.H. Durand, Ali Nayer, Charles Kuhn III. Flock Worker's Lung: Chronic Interstitial Lung Disease in the Nylon Flocking Industry. Annals of Internal Medicine 15 August 1998 Volume 129(4) 261-272 [Full Text]

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