DRKOOP.CON? America's Family

Doctor and His Conflicts of Interest

The Doctor in Need of Doctoring

Sidney Wolfe M.D. is director of Public Citizen's Health Research Group, and the co-author of Worst Pills, Best Pills (www.worstpills.org)

Dr. C. Everett Koop long ago surpassed TV doctor Marcus Welby as the best-known and most-trusted physician in the nation. His Quaker-style beard, air of integrity, and baritone voice make him memorable, as did his record as United States Surgeon General under presidents Ronald Reagan and George Bush.

Dr. Koop earned our trust by bucking the narrow ideology of the Reagan Administration. Reagan right-wingers thought they were appointing a reliable conservative to the post that has been called "America's family doctor." But soon after he was confirmed in the position, Dr. Koop showed his maverick's stripes by repeatedly and forcefully denouncing the health effects of smoking -- though the tobacco industry was then (and remains) among the GOP's most reliable patrons -- and by bringing to national attention the burgeoning AIDS crisis.

Despite his exemplary work as Surgeon General, it seems that Dr. Koop has since become a family doctor with corporate conflicts of interests. He has given his name and the reputation that goes with it to a for-profit web site, DrKoop.com, that is now one of the most-visited such sites on the Internet. He presides over a namesake charitable foundation, consults with private companies, and occasionally offers congressional testimony.

A growing number of critics have challenged Dr. Koop recently, criticizing him for trading on his reputation as an independent-minded, squeaky clean ombudsman even while shilling for several healthcare corporations with less than public-spirited goals.

What has happened to the Dr. Koop who once acted as our national conscience on important health care issues?

Dr. Koop and his aides consistently claim that there is no evidence that the "scientific" positions he takes on behalf of various companies or the alliances he makes with questionable organizations are influenced by the money his foundation or his for-profit web site get from these enterprises.

But leaving aside the exemplary work he has done and continues to do on tobacco, most, if not all of these stands cannot be scientifically supported. Moreover, they usually coincide with the position of industry. Is this coincidence or are Dr. Koop's positions influenced by money? He says they are not. I believe he suffers from a pathological dose of naivete, since he has repeatedly told reporters, when faced with questions of apparent conflict of interest, that "it never occurred to me that it could be a conflict of interest."

One example of Dr. Koop's advocacy for corporate interests against the interests of patients involves the widely-promoted allergy drug, Claritin, manufactured by Schering-Plough. In 1999, Dr. Koop sent a letter to members of the U.S. House of Representatives urging passage of legislation that would extend Schering-Plough's patent on Claritin for an additional three years. If passed, this law would yield well over $1 billion in additional profits to Schering-Plough by depriving Americans, for an additional three years, of the chance to purchase a generic version of the drug at a much lower price. Curiously, Dr. Koop did not mention in his letter to Congress that the Koop Foundation had been given a $1 million grant from Schering-Plough.

Lest this seem like an extraordinary failure to disclose a conflict of interest, we might be reassured by a statement from Schering-Plough that: "We did not pay him to do that." The same spokesman went on to say, according to the Washington Post, that Dr. Koop had long taken positions favorable to the drug company [Schering-Plough] and that the two simply were backing "policies of mutual interest."

Dr. Koop's spokeswoman was similarly reassuring. She said, "Dr. Koop does not work on behalf of any pharmaceutical company."

Another example of a strange concurrence between Dr. Koop's opinion and an industry's need for 'independent' corroboration involves the controversy over powdered latex gloves, used by health workers everywhere. Dr. Koop entered the controversy with scientifically insupportable positions, including congressional testimony, trivializing the serious occupational health dangers posed by the gloves. His conclusions were barely distinguishable from those of a major glove manufacturer, Allegiance. Dr. Koop had, coincidentally, received more than $600,000 in consulting fees from WRP Corporation, another major glove maker.

Another example involves the giant pharmaceutical company Warner-Lambert, which has been in serious trouble because of its diabetes drug, Rezulin, which was finally taken off the market on March 21 by the Food and Drug Administration, two years after it was removed from the market in the United Kingdom. As of now, with many cases not reported, there have been ninety cases of liver failure, including sixty-three deaths, associated with Rezulin use.

Well before the drug was removed from market last week, Warner-Lambert needed some help to restore its Rezulin-tarnished image, and it found a way to partner with an American icon -- through DrKoop.com. Several months ago, according to the Wall Street Journal, Warner-Lambert became the sponsor, for an undisclosed amount of money, of the portion of the web site called the "Diabetes Center." It was hardly surprising that the day after the FDA announced its recommendation against Rezulin, DrKoop.com posted an article from the New York Post that makes it seem like a mistake to remove this dangerous drug from the market. More disturbing, no other articles on the site lay out in detail the case against Rezulin.

"The great defender of petrochemical companies" on DrKoop.com Dr. Koop's web site also has a special partnership with the American Council on Science and Health (ACSH), which is heavily funded by the chemical, auto, oil and food industries. Like Dr. Koop, ACSH and its president, Dr. Elizabeth Whelan, have advocated strongly against tobacco. But on most other issues pitting questions of public health against the interests of industry, ACSH sides with its patrons.(Click here to read more about ACSH.) It is fair to say that much of the organization's work is nothing less than propaganda, offering chemical manufacturers an 'independent' source for reassuring the public that most chemicals are benign, or for attacking anyone who would suggest otherwise.

ACSH is one of the least credible voices on environmental health issues, yet DrKoop.com relies heavily on the organization for its material on such topics. The web site and its archives contain some 100 articles and releases by ACSH staffers or consultants. Common themes include the trivializing of animal-test evidence of cancer and other dangers posed by toxic chemicals. ACSH is consistent in its wrongheaded certitute that pesticides and other petrochemical-derived chemicals such as PCB's, formaldehyde, phthalates (a key ingredient in plastics), and dioxins are much more innocuous than indicated by many thorough and independent scientific reviews of their toxicology.

In a 1992 memo obtained by Consumer Reports in which she bemoaned the loss of funding from the Shell Oil Company Foundation, Dr. Whelan indicated why the public is rightfully suspicious of the industry front group that claims to be a consumer advocate. She wrote, "When one of the largest international petrochemical companies will not support ACHS, the great defender of petrochemical companies, one wonders who will." (Emphasis added.) So much for independence and the credibility that goes with it.

The reason Dr. Koop would affiliate his web site with such a notorious band of opinions-for-hire is hard to guess. But the fact is that his reputation is sullied as much by the association with ACSH as it is by the apparent financial advantages that have come with supporting the positions of powerful corporations.

As John Fletcher, Emeritus professor of ethics at the University of Virginia, told the Washington Post after reviewing the facts concerning the controversy, Dr. Koop has been "morally reckless with the trust that had been invested in him." This is the most generous interpretation.

Dr. Koop is riding on the reputation he built as Surgeon General, but today it looks more like he's cashing in through crass commercialism. Unless he stages a radical turnaround, Dr. Koop'S place in history will be that of another self-serving huckster instead of the valuable public advocate and educator he was as Surgeon General.

A spokesperson with drkoop.com declined to comment on the allegations made by TomPaine.com against Dr. Koop and the website. "This is not news," she told us. In the interest of fairness the following are Dr. Koop's responses to other journalists:

Re: Latex Surgical Gloves: Dr. Koop confirmed to the New York Times that his foundation had received a $1 million grant from Schering-Plough, "but he said the company's money did not influence his public positions. 'I never disclosed the grant because I did not think it was an issue. I'm not a lobbyist, de facto or otherwise. I did not receive any payment for my work. Most foundations accept grants from private sources. There was no quid pro quo.'" Moreover, Dr. Koop pointed out to the Washington Post that he based his case on behalf of the gloves on a study he believed came from the Centers for Disease Control and Prevention. He found out later that it came from a glove manufacturer.

Re: Claritin: Dr. Koop told the Washington Post: "You might think I'm naïve, but it never occurred to me that it could be a conflict of interest," since the company's contribution went to the foundation and does not benefit him directly.