One top oncologist failed to disclose payments from big pharma. That hurts all cancer patients

The resident tells me our next cancer patient is septic. We walk in together to find a thin woman in a half-open gown struggling to walk to the bathroom. Her short hair is pasted to her sweaty forehead, cotton wool stick to puncture marks on her arm, and her eyes are a pale hue.

“Remember me?” she sighs.

My heart skips a beat.

She once owned a bakery I loved, where the staples were her genuine smile and still-warm bread. Every morning she’d say how much she respected my work and I’d respond that hers spread more happiness. At 50 she sold the shop to enjoy life, and I couldn’t bear to go back.

Shortly afterwards she developed cancer and now, some years later, she is unwell.

“They give me chemo, then they pour in blood. I’m sick of it.”

She looks at me fondly. “How bad is it, love?”

Her disease has progressed through every therapy; transfusion-dependant and now in the grip of an infection, she is dying.

“You are pretty ill,” I say gently to explore her understanding.

“But when I get out I am going to pay for this new treatment,” she huffs. “They say it’s great.”

Her hope is pinned to an unapproved, exorbitantly-priced drug with no evidence for her type of cancer and significant side effects. Where it works, it helps one in five patients. My dismay is complete when she continues, “We aren’t made of money, but I’d mortgage the house to save my life.”

This alarms me. I know how hard she worked, enduring inhospitable hours and encroaching competition, and I can’t bear the thought that she would squander her savings through innocence.

“Don’t do that! We don’t even know it works!”

“But the experts like it and my doctor said to fund it myself if I was desperate.”

“It’s still under study,” I explain, feeling bad about combating palpable human hope with bland clinical evidence.

“Oh.” Her expression says it all – now I have told her that it isn’t money standing between her and a cure.

I have been thinking about my deceased patient since Propublica, a non-profit investigative organisation, reported that one of the world’s best-known oncologists and physician-in-chief of the respected Memorial Sloan Kettering Cancer Center, Dr Jose Baselga, had failed to disclose millions of dollars in payments from pharmaceutical and healthcare companies in dozens of published articles and prominent presentations.

Baselga failed to disclose board membership of a major pharmaceutical company, directorship of another company and cash and stock options from start-up firms that did not even have an approved drug on the market. The lapses occurred over several years, including a time when he was an editor-in-chief of a distinguished journal and president of a respected cancer association. From a global podium, he presented the results of a pharma-sponsored trial and cast a positive spin on the use of a very expensive drug that puzzled many oncologists because the actual results were disappointing. Their ire grew when it emerged that the same pharma company had paid him more than US$3m in consulting fees.

Baselga is a familiar name among oncologists and patients who have undoubtedly benefited from his commitment to cancer medicine. He has acknowledged his oversight, plans to correct the omissions that he considers relevant, has defended his publications as “high quality manuscripts” and argued that his conduct does not compromise his work as a physician.

But his own institution has distanced itself from him, and the many distinguished journals and professional bodies tainted by the association are deeply unhappy. Lacking the resources to constantly fact-check, they rely on the integrity of authors to disclose any conflict of interest. Investigations have begun but very few will pay attention till the end. Meanwhile, I can’t help thinking that the harm done to the doctor-patient relationship will be felt by very many.

Prominent doctors at a handful of prestigious cancer institutions occupy a vaunted place in the profession. Important journals and major conferences vie for their attention, making their very name a powerful brand. Since it’s impossible to keep up with all the developments, professionals end up relying on a highly select group of oncologists to illuminate the way. Papers they write, research they direct, and talks they deliver have an outsized influence on determining how patients are treated. Consequently, every pharmaceutical company with a stake in cancer treatments wants to woo them.

There was a time when their influence was circumscribed, but now that the internet has turned the world into a village, the view of these so-called key opinion leaders travels from New York to Nigeria in a flash. Most oncologists will never set foot inside a glittering cancer institute that boasts a multibillion endowment, but a lot will be influenced by what happens there.

Annually, over 14 million patients are diagnosed with cancer and almost 10 million patients die. Most will get no further than their local hospital, rural clinic or a threadbare setting.

Before committing these vulnerable patients to emptying their life savings, it is imperative that oncologists provide the best possible advice. This is why full disclosure of bias, compromise and every single payment matters, so that the least empowered patient can receive the most effective treatment rather than the most hyped one. Without full disclosure, the oncologist and the patient are both in the dark and society pays the price.

“I know, I know,” a patient snapped at me this week. “Of course, you want me to have chemo, they pay you to sell it.” This 35-year old, self-described cynic has a curable cancer, but prefers vitamin infusions because he is convinced that providers like me are in the pocket of big pharma. This is upsetting to the vast majority of oncologists who receive no money from, and wield no influence with, big pharma. But when cancer patients who can’t afford the parking and who suspend the kids’ swimming lessons because money is tight, read the front-page news about one oncologist being paid millions of dollars by big pharma, understandably they begin to question the integrity of every doctor. This mars the trust at the core of a therapeutic doctor-patient relationship.

The oncology community is reeling from an extraordinary lapse of ethics and good governance in its midst. But what this sorry event has again underscored is that when it comes to the practice of medicine, what is indispensable is personal integrity. My favourite definition of integrity is what you do when no one is watching. When integrity slips, the casualty will be doctors and our patients, and the damage can be irreparable.

• Ranjana Srivastava is is an oncologist and Guardian Australia columnist