Monday, April 11, 2005

The Conundrums of Conflicts

A man named James Battey wants to be the permanent president of the California stem cell agency. He is quitting his current, very important job because it has new conflict of interest standards that would cost his family “a lot of money.”

By most measures, Battey appears to be qualified to head CIRM. He is head of the National Institutes of Health's stem cell program, but is retiring in September.

He is not alone. Three other high level researchers are leaving the NIH because of the new rules.

The case of James Battey, his colleagues and the NIH illuminates some of the conundrums of conflicts of interest. The situation suggests that conflict policies should start out very restrictive and be eased later, if necessary. It illustrates the very real personal burdens that can laid on top researchers and others. And it demonstrates some of the difficulties in controlling the most insidious sorts of conflicts, the ones arising from a lifetime of belonging, so to speak, to the same club.

Battey said he is leaving the NIH because “the new rules imposed an insurmountable problem for me,” according to a piece in the Washington Post by Michael S. Rosenwald and Rick Weiss.

“I manage a family trust...which supports the education of my father's seven grandchildren, and it contains assets I'm told I'd have to divest. That would cost a lot of money, and I can't do that to my family,” Battey was quoted as saying.

Quite justifiably he may think that the situation is not fair. He once operated under the rules, but then the rules changed through no fault of his own. As a result, the NIH is losing a valued executive and scientist.

An identical situation could occur in California if it has to toughen its conflict standards someplace down the road. It could lose valued employees as a result and then waste time, energy and money replacing them. Better now to be more restrictive than face embittered staff later.

The NIH situation shows how individuals can personally feel the burden of complying with conflict standards, something critics do not always seem to fully understand. It goes beyond consulting arrangements that yield hundreds of thousands of dollars in compensation.

One cancer researcher with the NIH was recently told she could not accept a $200 train ticket to present a paper at a conference for a physician's education group, according to the Post. The researcher said it was embarrassing to cancel her appearance.

The newspaper quoted a legal opinion prepared for a group of senior agency scientists that laid out the scope of the new conflict policy.
"Basically (it) means anything NIHers do outside -- whether getting paid for it or not, from singing in a jazz group to selling art or jewelry, from volunteering at charity organizations to membership in a school or community organization to developing their own small business completely unrelated to biomedical science -- requires prior NIH approval," the memo says.

"We find this very disturbing,” the scientists said. “It is intrusive and scary. It suggests the NIH owns our lives away from work."
The NIH rules additionally touch on the web of relationships that nearly all successful persons build during their careers. The Post said that many NIH employees are barred from holding executive positions with trade or professional organizations, even on a volunteer basis.

One NIH researcher said it could lead to an unpleasant backlash. “We will be cut off, disenfranchised from our academic colleagues.”

Most conflict codes, including the ones now in place at CIRM, can't deal with the ambiguous issues that can arise from the relationships that are built during a career. Sometimes they are formal as in leadership positions in professional organizations. Other times they involve informal or past connections to men and women who have assisted a person during his professional or business life, either financially or with advice or friendship. Sometimes it is training and shared experiences that create a way of thinking that imbues a person's approach to business or science.

The California stem cell agency has built into it a reliance on persons you might call “members of the club” who dominate the Oversight Committee. They bring special expertise, experience and skills to the effort, which is to be valued. They also bring a lifetime of comfortable relationships with other accomplished persons, people they have worked with, rely on and trust. It would be unrealistic not to expect them to go back to these people to seek their help and to help them.

It is also unrealistic to expect codes to catch all of the subtle conflicts and abuses that can and do come up involving such relationships. The best watch dogs, in fact, are other members of the Oversight Committee and CIRM employee peers. They may be the only ones who can stop a breach before it becomes serious enough to become a scandal.
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