NEWS

p258 Pandemic p261 Red zone: p266 Monkey see: panic: Has the Medicine Why are primate H5N1 virus adapted turns its spotlight researchers rushing to humans? on China. to China?

Money matters roil ’s reputation

An independent audit of the famed Cleveland of its profits. Cosgrove served as one of FMP’s began questioning the arrangement. He has also Clinic on 8 February revealed that the clinic and three managing general partners. vacated his role as general partner of FMP. its scientists have not been attentive enough FMP invested in several firms whose The Wall Street Journal’s report on Cosgrove’s to financial conflicts of interest. The finding products the clinic’s doctors tested on their ties to AtriCure appeared on 12 December. is prompting the clinic to change the way its patients, although they did not disclose these The same day, the clinic’s trustees stripped its scientists report and manage conflicts. relationships to the patients. In one instance, chief, Eric Topol, of his posts as chief The clinic has in the past few months found Cincinnati-based AtriCure developed a device academic officer and medical school provost, itself the subject of intense media attention— that the clinic’s doctors used to correct irregular along with his seats on the conflict-of-interest and not the kind to which it is accustomed. heart rhythm in nearly 1,250 individuals. committee and board of governors. Investigative newspaper reports revealed in FMP owned about 4.1% of AtriCure’s stock Topol had helped wage a long and noisy December that several clinic officials have and Cosgrove sat on the company’s board of campaign against the now-withdrawn

http://www.nature.com/naturemedicine had questionable financial ties with makers of directors until March 2005. He told The Wall painkiller Vioxx and its manufacturer, Merck. He medical devices and drugs tested on the clinic’s Street Journal that he stepped down to avoid the severed his own ties to industry after a report patients. Those reports prompted the clinic to perception of a conflict, and that he had been in December 2004 revealed that he had been launch the audit. considering doing so before the committee advising a hedge fund that profited from a decline “The clinic has reached a point of imbalance in the value of Merck’s stock. Clinic officials say between innovation and transparency,” the 2001 Topol’s demotion was a streamlining move, but Cleveland Clinic invests $25 million in the venture auditors wrote in their preliminary report. fund Foundation Medical Partners (FMP) and is entitled to Topol has complained that it was payback for Managing financial conflicts is a challenge 38% of profits. his criticism of Merck. The clinic announced on

for any research institution, but even more so Surgeons at the clinic begin using device 9 February that Topol was leaving his post to join for one with as much of a business slant as the by FMP-backed company AtriCure. the faculty at Case Western Reserve University. Cleveland Clinic. Cleveland Clinic surgeon Delos ‘Toby’ The Clinic’s difficulties with conflicts of

Nature Publishing Group Group Nature Publishing Cosgrove sits on AtriCure board and 6 “The way I think of the clinic is that it’s like a serves as a paid consultant. interest, ethicists say, stems from a dynamic that zebra,” says Arthur Caplan of the University of is troubling but far from unique. More than 200 Pennsylvania’s Center for Bioethics. “Half of it is 2005 one-half of US academic medical centers lack © Cardiology chief Eric Topol and others on a business, half of it is an academic health cen- the conflict-of-interest committee question policies that mandate the disclosure of conflicts ter. These two creatures don’t always fit so nicely connections between the clinic and various of interest to clinical-trial participants, according companies. together. They make a funny-looking animal.” to a study published in February (Acad. Med. 81, With a cardiac center that is perennially February 2005 113–118; 2006). ranked as the best in the US, the nonprofit Committee asks the clinic to suspend clinical trials while “I wouldn’t be surprised if, quietly, other consent forms are reworded to clarify the clinic’s stake in Cleveland Clinic Foundation generates $3.8 bil- AtriCure and other companies. systems like the clinic aren’t asking themselves, lion in annual revenues and employs 30,000. The ‘What can we do so that we don’t get caught like March 2005 institute boasts a 15,000-square-foot ‘innovation Cosgrove steps down from AtriCure board. the clinic did?’” says John Kastor, professor of center’ to help its researchers develop and com- medicine at the University of Maryland. October 2005 mercialize products—and that mission begins at Cosgrove relinquishes Kastor, who last year wrote a book about the the top. Chief executive officer Delos Cosgrove, a position as FMP general partner. clinic, says the clinic’s organizational structure cardiac surgeon, is the owner of 20 patents. 12 December 2005 resembles that of a large corporation more than Much of the recent focus on the clinic has Newspaper reports reveal business relationships between the the lumbering bureaucracy of most universities, centered on Cosgrove. An internal committee clinic, Cosgrove and other clinic trustees and companies and its entrepreneurial ethos is integral to its whose products were used at the clinic. in early 2005 began questioning whether he mission. In any case, few expect that the events Topol is stripped of his positions as chief academic officer and had undisclosed conflicts of interest. The audit medical school provost and his seats on the conflict-of-interest will permanently tarnish the clinic’s reputation. concluded that neither Cosgrove nor any other committee and board of governors. “The Cleveland Clinic is the most

clinic officer has shown a “lack of integrity,” says December 2005 entrepreneurial, most aggressively business- clinic spokeswoman Eileen Sheil. The clinic launches audit of its conflict-of-interest policies. oriented hospital of any I know, but to be frank,

In 2001, Cosgrove had helped launch a 8 February 2006 that’s why most people travel tens and hundreds venture capital fund, dubbed Foundation Preliminary report of the audit finds “institutional and individual of thousands of miles to get there,” says Caplan. Medical Partners (FMP), which would draw on inattention to conflict disclosure and management.” “This isn’t a place where people jump up and the clinic’s expertise to identify promising new 9 February 2006 start screaming because their doctor has equity drug and device companies. The clinic invested Clinic officials announce that Topol is leaving to join interest in a company.” $25 million in FMP and is entitled to receive 38% the faculty at Case Western Reserve University. Bruce Diamond, New York

NATURE MEDICINE VOLUME 12 | NUMBER 3 | MARCH 2006 257