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Health reporter Martha Rosenberg discusses her article, “Conflicts of interest are eroding trust in U.S. health agencies.” Martha outlines how faith in government health bodies like the FDA and CDC has plummeted due to escalating conflicts of interest, tracing some concerns back to the 1992 Prescription Drug User Fee Act (PDUFA), which allowed drugmakers to fund aspects of the drug approval process. She points to a pattern of FDA commissioners, such as Dr. Scott Gottlieb, Dr. Robert Califf, and Dr. Margaret Hamburg, having significant financial ties to the pharmaceutical industry, and notes the concerning practice of drug trials being funded by the manufacturers of the drugs under investigation. Martha also examines the CDC Foundation, which accepts private donations, and cites several CDC directors, including Dr. Brenda Fitzgerald, Dr. Tom Frieden, Dr. Julie Gerberding, and Dr. Robert Redfield, who faced scrutiny over alleged conflicts or ethical issues. The conversation delves into the pervasive influence of pharmaceutical lobbying on Congress and the increasing tendency of medical journals to publish industry-funded research, highlighting the danger these interwoven interests pose to public trust and patient well-being.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Martha Rosenberg. She’s a health reporter. Today’s KevinMD article is “Conflicts of interest are eroding trust in U.S. health agencies.” Martha, welcome back to the show.

Martha Rosenberg: Thank you, Dr. Pho. I always appreciate the different points of view that your podcast shows because there are so many different opinions.

Kevin Pho: Well, thank you again for coming on and sharing your latest article. What led you to write it in the first place, and then talk about the article itself?

Martha Rosenberg: Well, what led me to write this is I’m very aware of conflicts of interest in all of the government agencies: NIH, CDC, and FDA. I believe it’s underreported, and so I feel that I have a mission to report it.

Kevin Pho: So tell us about some of these conflicts of interest that you are seeing.

Martha Rosenberg: Well, recently with the new administration, Robert Califf left as FDA commissioner. He had fifty-one financial links to drug makers. In my humble opinion as a reporter, you cannot regulate big pharma when you’re funded by big pharma. It infuriates me, and he’s not the only one; I don’t want to single him out. Under Trump, the first time we had him, we had Scott Gottlieb, who’s a Pfizer doctor, and then we had Califf, who I just mentioned. But they’re really, Dr. Pho, it’s almost as if there are fewer officials who aren’t funded by or linked to big pharma.

And so I wrote in this latest article about the CDC Foundation. Most people aren’t really aware of it. There’s a CDC Foundation and also an NIH Foundation. Both of them are chartered to make private-public partnerships with big pharma, and to me, that’s just wrong. So that’s why I wrote the article.

Kevin Pho: So it sounds like a lot of these leaders in our governmental health agencies, you said, were previously linked to big pharma, and of course, that leads to several conflict-of-interest questions. So give us a specific example or a case where that conflict of interest really hindered their ability to lead our agency.

Martha Rosenberg: I’ll talk about Julie Gerberding. I hope I’m pronouncing it correctly. She was head of the CDC in 2009. And see, this is very wrapped up, Dr. Pho, in the revolving door. She left CDC and went to work for Merck in 2009 and had a Merck department. She came back to NIH in 2022, and she now has the Foundation of the NIH.

We’re dealing with the revolving door, which, one of its problems is when you leave there, if you are now with industry, many people go back and lean on their colleagues: “Hey, we had lunch together.” Now, you see this a lot. And so, I consider her a poster child for conflicts of interest. Dr. Julie Gerberding, because her departure for industry and return to government is maybe the most glaring.

Kevin Pho: So are these conflicts of interest identified during the vetting process? Are they transparent, these conflicts of interest? What kind of reporting is normally done, or what type of disclosures are typically made?

Martha Rosenberg: That’s a good question. Some of the officials will say they’ve recused themselves for that exact reason. The connections are somewhat looked at by lawmakers, and some of the officials with pharma links will say they’ve recused themselves. Dr. Califf, who just left as FDA commissioner, said that he gave all the funds to charity. And I would say that’s not the point. But there is some awareness, but not as much as I would like to see.

I think that one thing I’ve often talked to you about on your site is advertising. My background is advertising, which is why I am so oriented toward drug ads. What we see a lot is, advertisements have almost engulfed and almost captured the news media. The news media now is not going to bite the hand that feeds them, and consequently, you don’t really hear some of these things we’re talking about. I recently wrote, not for your site yet, but I have another piece coming up about this eye drug that they’re really marketing on the radio here in Chicago. When you look at it, they’re spending so much money that it’s almost obnoxious; every five minutes you hear this ad. And when you research it, the research on the drug was all funded by NIH, funded by us, the taxpayers, and now the advertising is coming from the private industry. And so, what we’re seeing is a lot of the conflicts of interest exist in advertising as well, and because so many media are now captured.

Kevin Pho: And these conflicts of interest are prevalent throughout both Democratic and Republican administrations, is that correct?

Martha Rosenberg: I think so. I think that there are inherent risks to the whole system. And I might add too, Dr. Pho, that if these agencies, such as the FDA, were funded properly, they wouldn’t need to take some of this industry funding, or wouldn’t need to as much. One thing we talked about years ago is PDUFA, in which the drug makers would pay the FDA to approve their drugs. Think about that.

Kevin Pho: So tell me more about that. You mentioned PDUFA, which is the 1992 Prescription Drug User Fee Act. You said that this is a pivotal moment in the story, so tell us more about that act, about why it was such a pivotal moment for those who aren’t familiar with it.

Martha Rosenberg: The concern back then was that drug makers would buy approvals, and I can’t say that it hasn’t happened. A lot of people, even in our industries, Dr. Pho, don’t realize that CROs exist. And those are contract research organizations that take charge of all the approvals for drug makers. And so they now will get the drug approved through FDA. But the concern is that you would buy an approval.

And I have to say, since I’ve been covering this for quite a while, that many drugs that come out and make a lot of money for Wall Street are then withdrawn because they weren’t really safe anyway, like a bad movie. Until people review it and say it’s a dog, everybody goes there. And I think with drugs, we see a lot of approvals that shouldn’t have gone through. And I hate to say this, but because of how much a patented drug makes, the legal fallout is covered by what they’ve made for it. So, buying approvals obviously is connected with dangerous drugs being approved that maybe we all regret. So, there is a lot of concern with the FDA connections. It is supposed to regulate drug makers and keep the public safe.

Kevin Pho: Now in the past, have any of these leaders of health organizations been called out for their conflict of interest? Has anyone gotten into trouble or been dismissed or resigned because of overwhelming conflict of interest?

Martha Rosenberg: No, I have to say that most of the revelations about COIs, or conflicts of interest, are ex post facto, after the fact. I’ll say, and I don’t mean to attack doctors, but I do think that taking industry money is a conflict in terms of public health. One example that came out was Dr. Margaret Hamburg used to head FDA, and she, in 2011, was lamenting the fact that so many doctors were funded by big pharma—either through their stocks or through their research or through their position at a university—that she could not find non-affiliated doctors for advisory committees for FDA, which was pretty bad. And then when she left there, they showed conflicts of interest that she had too. So it’s almost like nobody’s unscathed. I’ve attended FDA advisory committees, and it’s shocking how much better funded industry is than our government. That’s basically the nexus of it.

Kevin Pho: Now, what do you say to the argument that sometimes without industry money, research wouldn’t be funded at all? So if some doctors aren’t sponsored or funded by the pharmaceutical industry, they may not be able to have their research proceed.

Martha Rosenberg: That’s a good question. I would submit, first of all, we need better funding for actual, valuable health research that helps people from the government. Secondly, I would say let’s look at what we’re investigating here. Some of the research—like one example I’ll give you—some of our top universities in the world are now literally partnered with Novo Nordisk, who makes a GLP-1 agonist. OK. So the research funded by that pharma, the drug maker, is of course going to say it’s a great drug, right? So I would say, let’s look at what the research is addressing. Do we really need it? Is obesity really such a world U.S. problem, or is it maybe fast food advertising?

But in answer to your question, we do need money for research. But I would say let’s look at what we are researching here and who is profiting from it. And who is going to have it? Here where I live, Northwestern University will hand its research over to industry, and they’ll make—well, the best example is our eye drug; the research was funded by NIH, and then the profiteering is by drug makers. So I would say, let’s look at what we’re studying, who’s profiteering from it, what’s the ten-year plan, not just the six-month plan. And you’re right, we do need more money for research, but I would love to see some kind of committee that evaluates the validity of the research. Is this really even necessary? We need that.

Kevin Pho: In your article, you wrote that there are three pharma lobbyists for every member of Congress. Is that true? And tell us about that scope of pharma-powered lobbying.

Martha Rosenberg: Well, it’s a true fact that we’ve seen revealed that there are three lobbyists for every member of Congress. For every doctor, one statistic I saw recently that just shocked me, because I’m very against drug advertising, is that 70 percent of U.S. adults are on a pharmaceutical drug. Now, that was not the case before direct-to-consumer advertising. So that’s another issue that we have to look at. But I think it’s just very significant that the lobbying… well, obviously, we all need money. There were some really great breakthroughs in lobbying about more than ten years ago where some of the drug makers would fly a whole medical office to the Caribbean. Some of that has definitely been highlighted and regulated, and that’s good. That’s very good.

And when I used to go to medical conferences, all the beautiful people became pharma reps because people wanted to meet the cute guys and the cute girls. A lot of that has been stopped. They used to give a lot—maybe they still do—but a lot of free samples of a new drug to an office. And some of these things have been improved. I will say that they’ve been improved.

Kevin Pho: So tell me the path forward. What would you like to see in terms of clearing up the conflicts of interest among our health regulation leaders?

Martha Rosenberg: First, I would really like listeners and viewers of public media, news media, to be aware of the fact that all these so-called epidemics and dangerous diseases are funded by drug makers to sell drugs. Right now, we’re seeing a push against atrial fibrillation (AFib) and chronic obstructive pulmonary disease (COPD). “Oh, you may be suffering that.” No, actually, that’s funded. That’s unbranded advertising from pharma. But I would like to see that parlay into a greater awareness of the footprint of drug makers in our government and in media, because it’s appalling.

Kevin Pho: We’re talking to Martha Rosenberg. She’s a health reporter. Today’s KevinMD article is “Conflicts of interest are eroding trust in the U.S. health agencies.” Martha, as always, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Martha Rosenberg: Well, thank you. I would like people to be aware of drug advertising and be aware of the drug footprint in our government agencies: CDC, NIH, and FDA, and to become outraged when we’re not getting good medicine.

Kevin Pho: Martha, thank you again for sharing your perspective and insight. Thanks for coming back on the show.

Martha Rosenberg: Thank you. Thank you for your good work.