Jeff Wang Under Attack

Jeffrey Wang, M.D.Last week, the University of California—Los Angeles announced that it had removed Jeffrey Wang, M.D., as co-executive director of the UCLA Comprehensive Spine Center. The University is investigating whether Dr. Wang’s research was affected by payments he received from spine device companies. Wang will remain on the school’s faculty while the investigation is being conducted.

From our perspective, it appears as though UCLA has thrown one of its own research and surgery stars under the bus.

The genesis of last week’s surprising announcements could arguably be traced back to May 2009, when Senator Charles Grassley sent a letter to the Chancellor of UCLA stating that Dr. Wang “consistently checked no” on university forms when asked whether he had received income of $500 or more from companies funding his clinical research. California requires that state university researchers disclose all financial ties to nongovernmental entities funding their work.

UCLA has alleged that Dr. Wang did not disclose financial interests in connection with the following research projects:

• DePuy Spine, which paid Dr. Wang $125, 900 in royalty and consulting payments from 2002 through 2008;
• Facet Solutions Inc., a company in which Dr. Wang acquired options for 18, 000 shares in 2004;
• Paradigm Spine, an entity related to another company in which Dr. Wang received options for 20, 000 shares;
• FzioMed, which paid Dr. Wang $144, 000 from 2002 through 2008; and
• Medtronic Inc., which paid Dr. Wang $275, 000 in royalty and consulting payments from 2003 through 2008.

According to the school, Dr. Wang did report some, but not all, payments from Medtronic.

Employment Contract Enforcement

Dr. Wang is a NASS (North American Spine Society) board member and chair of the Society’s CME Committee. NASS has the profession’s strictest disclosure policy, and we have personally heard Dr. Wang present from the NASS podium and disclose his financial relationships with companies.

We note that Dr. Wang had made disclosures to NASS and as part of his published papers and in those venues he had disclosed his financial relationships with the firms listed above.

Orthopedics This Week asked a representative of UCLA, Ms. Roxanne Yamaguchi Moster (Director of UCLA Health Sciences Media Relations), about Dr. Wang’s other disclosures as well as the sense that UCLA is losing talented surgeons due to confusing and obfuscatory employment policies. She did not answer our inquiries directly but, instead, offered the following statement:

“The University regrets that a pattern of non-disclosure could have persisted without our knowledge, ” in the case of Dr. Wang. She went on to say that UCLA was committed to examining the institution’s processes to determine “how, as an institution, we will prevent similar problems in the future. Our internal investigation will be thorough and is proceeding with deliberate speed.”

Star Chamber

Moster’s statement said that an independent committee has been appointed and is charged with reviewing “whether any of the potential conflicts-of-interests identified have in any way affected the research performed and if there are any mitigating actions needed to ensure the integrity of the research results.”

OTW has requested the names of the committee members but was informed that the committee is an internal advisory group and UCLA does not release names of such committee members.

As an aside, we did find it curious that the institution declined to name its committee members  as the institution’s stated policy is: “UCLA understands that conflict-of-interest policies that provide the highest level of transparency and accountability are critically important to UCLA and all other academic medical centers.” We believe that investigations of conflicts-of-interest also require the highest level of transparency and accountability.

Moster stated that UCLA has seen no indication of research misconduct as defined by federal regulation, only a failure by Dr. Wang to make timely reports of financial interests. She said they were evaluating an appropriate action against him in connection with those omissions.

The University of California has sent a complete copy of UCLA’s response to Senator Grassley to the California Fair Political Practices Commission, the body which oversees conflicts-of-interest matters in California.

In addition to these actions, UCLA’s David Geffen School of Medicine has developed and implemented a new faculty disclosure process that supplements the annual disclosure of outside activities. This procedure is now part of the School of Medicine’s salary negotiations process. Moster’s statement also said the school is reviewing policies and procedures to “identify appropriate enhancements that will better support management of conflicts-of interest.”

If Senator Grassley had not requested documents from UCLA about its surgeon salary agreements, it’s doubtful that we’d be seeing this played out in public.

Show Me the Money

Money and medicine are a volatile mix. In New Jersey, the efforts to separate orthopedic manufacturers from their surgeon inventors and advisors resulted in a $311 million fine levied against the major orthopedic implant manufacturers. Since then, we’ve learned that more than $50 million of those dollars went to affiliated friends and colleagues of the lead prosecutor. We’ve also calculated that roughly $200 million of the settlement amount came directly out of surgeon’s pockets.

Given the recent history of attacks on the relationships between surgeons and manufacturers, we are skeptical about UCLA’s positioning in this case—particularly with the backdrop of California’s financial meltdown. For example, did UCLA attempt to receive any of these research and other funds for itself? What are the rules for UCLA scientists and researchers with regard to studies and intellectual property? What are the UCLA policies with regard to surgeon research and consulting fees?   

Policies regarding surgeon consulting practices are available online from NASS, SAS (Spine Arthroplasty Society), AANS (American Academy of Neurologic Surgeons), and AdvaMed. We could not find any such policies for UCLA online, nor were they provided to OTW by the University. 

Furthermore, if a researcher discloses his or her financial ties through the surgeon societies and if that information is public (as in available online), then has the researcher adequately disclosed?

Robin Young, publisher of Orthopedics This Week and a frequent podium speaker at spine surgeon meetings, had a strong reaction to the UCLA action and statement. 

Said Young;

“UCLA bears culpability in this matter. We know from our own research that Dr. Wang had disclosed his financial ties in other venues, most notably at the North American Spine Society. Furthermore, UCLA itself suffers from a lack of transparency, which undermines the legitimacy of their actions. Finally, we believe strongly that many of the problems attributed to Dr. Wang are quite likely the result of institutional mismanagement and confiscatory rules that affect not only research dollars coming into UCLA but also legitimate consulting contracts coming to its best and brightest researchers.”