The "banality of evil" is a phrase coined by Hannah Arendt in 1963. She was referring to the theory that throughout history evils have been committed not by fanatics and outliers, but by ordinary people taking cues from their culture. While accepting money from drug companies for marketing is hardly “evil” in Arendt’s sense, modern academic medicine has also normalized behaviors which are morally unacceptable. Let’s call it the banality of greed.
Given this background, I was fairly nonplussed by the news in the Boston Globe that Dr. Lawrence Dubuske resigned from Harvard’s Brigham and Women’s hospital so that he could stay on the drug company gravy train. The hospital's new policy forbids faculty members from giving promotional talks.
Dr. DuBuske made just shy of $100,000 in 3 months of speaking for GlaxoSmithKline (according to the company's physician registry), which implies a windfall of $400,000 a year if he kept up that pace. He also speaks for six other companies, and consults for another six, so the chances are good that Dr. DuBuske clears $2 million a year as a hired gun. Is anybody really surprised that he would choose to stop seeing patients for one day a week in order to maintain his life style?
Out of curiosity, I looked into his background. On a superficial level, Dubuske’s career trajectory is a duplicate of that of many academic physicians over the last couple of decades. He got onto the fast track through a combination of his obvious intelligence and drug company partnerships. If you plug his name into Pubmed, you’ll find an impressive 46 articles on various topics related to allergies and asthma.
Most of the articles are funded in one way or another by drug companies. For example, he did a clinical trial of Zyflo for Abbott in 1997, he studied Salmeterol for GlaxoSmithKline in 1999, and over more recent years he did several studies for Schering Plough on the antihistamines Claritin and Clarinex. One of his papers, apparently ghost-written by Schering Plough, argued that not all antihistamines can cause cardiac arrhythmia, especially not Claritin and Clarinex.
So far, pretty standard stuff--just Dr. DuBuske playing his small part in the larger permeation of medicine by the pharmaceutical industry. But then we learn that Dr. DuBuske is the director of "IRINE" (Immunology Research Institute of New England) a non-profit organization that collaborates with doctors in Eastern Europe for research and education. At first glance, it sounds like an altruistic organization. A Harvard professor brings world class medical education to underfunded medical systems that have recently thrown off the yoke of Communism.
But digging into the web site, you start to get the unsettling impression that IRINE is no more than a global marketing vehicle for drug companies. For example, there is this long list of cities around the world where IRINE has presented “symposia.” We're not talking just Warsaw and Lodz—over the last several years, Dubuske and his IRINE colleagues have presented symposia in Bangkok, Buenos Aires, Vancouver, Sydney, Munich, Paris, Amsterdam, Bucharest, and the list really does go on. At least some of these symposia, and probably all of them, were funded by drug companies—for example, Dubuske and his colleagues at IRINE were funded to speak in Barcelona by Allergy Therapeutics in 2008, and in Goteberg Sweden by ALTANA Pharma in 2007.
So what is IRINE, anyway? Who founded it? Who really runs it? Where does it get all the money to run its dozens of international symposia?
Since IRINE is a non-profit, its tax returns are public. I looked them up on the web site Guidestar.org (it is free, but requires a one time registration to login). The most recent tax return, which you can view here without logging in, is from 2007, and it lists Lawrence M. DuBuske as the "President and Director." There is "0" income and "0" expenses.
How do you travel to dozens of cities to give lectures without money being exchanged somewhere? Good question; I called IRINE to ask it. The contact page on the web site lists Ilona DuBuske (Dr. DuBuske's wife--there is a photo of the two of them on the IRINE site) as the "research administrative coordinator" and provides a phone number.
I called it and a woman answered "Hello?"
"Hi," I said, "I'm Dr. Carlat from the Carlat Psychiatry Blog and I have some questions about your organization."
" I’m sorry I cannot answer any question, please don’t call this number.” And she hung up.
I then sent my questions to IRINE's email address but I have yet to receive a response.
I wondered if IRINE's global headquarters were at Dr. DuBuske's house, but IRINE's address is in Gardner Mass, while his home is listed in nearby Harvard Mass.
Best case scenario: IRINE is a mom and pop operation that operates out of a small office and does a lot of good work around the world, but keeps poor records and needs to improve its customer service. Worst case scenario: Only Dr. DuBuske knows for sure.