By Roy Poses, MD, Clinical Associate Professor of Medicine at Brown University, and the President of FIRM – the Foundation for Integrity and Responsibility in Medicine. Originally published at Health Care Renewal

At least the US president-elect seems to be making the problems of conflict of interests and health care corruption less anechoic.

Dr Price’s Stock Portfolio

The latest relevant big story was first picked up by Sheila Kaplan writing in Stat. It seems that Dr Tom Price, once a practicing orthopedic surgeon, then a Congressman, and now Mr Trump’s pick for Secretary of DHHS, owned and owns lots of health care related stocks:

his stock portfolio includes investments in pharmaceutical, medical device, and health insurance companies, the heart of the industries he would be overseeing as secretary.

In particular,

Among Price’s holdings are some in Innate Immunotherapeutics, Ltd., a biomedical company in which another lawmaker is a major shareholder. According to his financial disclosure statements, on Aug. 31 he bought between $50,001 and $100,000 worth of stock the firm. Representative Chris Collins, a New York Republican, is a director of the company, which develops drugs to treat multiple sclerosis. He lists assets in the firm worth between $5,000,001 and $25 million. Price also purchased a smaller amount of stock in Innate Immunotherapeutics in 2015. Collins is also a member of Trump’s transition team. In March, Price invested between $1,001 and $15,000 in Amgen; Eli Lilly and Co.; Pfizer; Biogen; Bristol-Myers Squibb; Zimmer Biomet, a medical device company; Aetna; and Athenahealth. Also that month, Price sold the same amounts in Gilead, Abbott Laboratories, and Thermo Fisher Scientific.

So for readers of Health Care Renewal, this is very familiar. We have discussed ad infinitum the conflicts of interest that may affect physicians, particularly due to financial relationships with big health care corporations. The issue is that physicians swear oathes to put the health of their individual patients first, and to support the public health in general. Yet the interests of, for example, drug, biotechnology, device companies may be at odds with this primary mission. Such companies in this age of promoting “stock holder value” may primarily be about increasing revenue by selling as much of their products as they can, and let the Devil take the hindmost. Yet physicians ought to use drugs and devices judiciously, and only when their benefits for individual patients outweigh their harms. The concern is that physicians who have financial interests in such and other health care related companies may consciously or unconsciously allow their professional decisions to be influenced by their personal financial advantage.

Dr Price appears to be a member of the US House of Representatives full time, and no longer a practicing physician. But he has not relinquished his Georgia medical license (look here). So he should still be bound by his oath as a physician.

Dr Price’s Active Stock Trading

But wait, there’s more. Last week, the Wall Street Journal noted that Dr Price was not simply a long-term owner of stocks, he was an active trader.

President-elect Donald Trump’s pick to run the Health and Human Services Department traded more than $300,000 in shares of health-related companies over the past four years while sponsoring and advocating legislation that potentially could affect those companies’ stocks. Rep. Tom Price, a Georgia Republican, bought and sold stock in about 40 health-care, pharmaceutical and biomedical companies since 2012, including a dozen in the current congressional session, according to a Wall Street Journal review of hundreds of pages of stock trades he filed with Congress. In the same two-year period, he has sponsored nine and co-sponsored 35 health-related bills in the House. His stock trades included Amgen Inc., Bristol Myers Squibb Co., Eli Lilly & Co., Pfizer Inc. and Aetna Inc.

This raises more issues. First, that Dr Price was actively trading these stocks suggests that his financial holdings might have been more salient to him than, say, a long-term investor who just buys stocks and puts them away in a retirement portfolio. This increases the likelihood that his stock holdings, and their recent performance, may well have influenced his decision making.

Moreover, this emphasizes that we should be concerned not so much about the effect of financial relationships on Dr Price’s clinical decisions – in fact, it appears that he is a full time Congressman, and hence is not practicing – but on his decision making as a national legislator with considerable influence on health policy and the public health. As a congressman, Dr Price also took an oath to “support and defend the Constitution of the United States against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; that I take this obligation freely, without any mental reservation or purpose of evasion, and that I will well and faithfully discharge the duties of the office on which I am about to enter.” So the concern is that the immediate profitablity of his actively traded stock portfolio might influence how Dr Price legislates.

As the WSJ article noted,

Mr. Price, an orthopedic surgeon who chairs the House Budget Committee, has played an influential role in shaping health legislation. He sits on the Ways and Means Committee’s health panel, which oversees Medicare. He also is a member of the Republicans’ Congressional Health Care Caucus that has called for repeal of the Obama administration’s landmark health overhaul.

Beyond just the issue of conflict of interest is that of Dr Price’s apparent comfort with the ethical and sometimes criminal track records of the companies from whose stocks he appears to have profited. We on Health Care Renewal have been documenting the ethical misadventures, and sometimes crimes committed by large health care organizations which claim they operate for the good of patients and the public, but seem more to operate for the benefit of their insiders, particularly top management. Many of the companies held by Dr Price have lengthy lists of such bad behavior. See the links above to some individual companues for many more, sometimes sordid details.

If Dr Price, who is not only a physician but a legislator with significant influence on health policy, is unaware of these companies’ track records shame on him. If he owned these stocks with full knowledge of the companies’ track records, more shame on him.

Dr Price’s Tobacco Stocks

But wait, there’s more.

The WSJ article also noted:

Mr. Price also has traded in shares of … tobacco stocks, including Altria Group Inc., whose products are regulated under the Food and Drug Administration, a part of HHS.

An article in Wired implied that Dr Price’s tobacco holdings may have affected his legislative decision making. Price voted against

a law that now requires the FDA to regulate tobacco as a drug.

That now goes beyond just a relatively simple set of conflict of interest issues. At least drug, biotechnology, and device companies make products meant to benefit patients and the public’s health, if used properly and judiciously. For that matter, insurance companies, like Aetna, are supposed to help patients afford needed medical care.

But tobacco companies are different. Although they are legal in the US, there is overwhelming evidence that their products are harmful to health, and this harm is not outweighed by any health benefits, nor any benefits to society other than the money tobacco companies can make from them. Most doctors now would recommend their patients stop smoking and, if they are not smoking, never start to smoke. It is extremely hard to reconcile Dr Price’s professional status and his ownership of tobacco stocks.

A physician legislator with a powerful role in health policy owning tobacco stocks may appear to be abusing his entrusted power for private gain. That is the ethical definition of corruption used by Transparency International (although it is not a legal definition.) No wonder that in a commentary in New York Magazine on Dr Price’s stock holdings suggested that they mean in Dr Price’s eyes

The appearance of corruption is totally fine.

Conclusions

Mr Trump’s ongoing behavior does have some silver linings. It is making the public more aware of the dangers of conflicts of interest and corruption, not just in health policy or health care. And it is also making the public aware how we have to follow the money, all the money that flows around our new plutocrat-in-chief to be, and his rich and well connected cronies.

If we cannot restrain the increasing pile of conflicted and possibly corrupt political appointments, we will be in for much worse than the health care dysfunction Health Care Renewal has been lamenting for more than 10 years.