Over the weekend, Dan Diamond for the Washington Post that Vivek Murthy, MD, nominated for Surgeon General and to help the Biden COVID-19 response, received 2.6 million dollars in pandemic consulting fees and speaking engagements since January 2020. Murthy received $400,000 from Carnival cruise lines for consulting, over $400,000 in cash and another $400,000 worth of stock from Airbnb, nearly $300,000 from Estee Lauder, and $600,000 from Netflix. The article notes, "most of Murthy's consulting work came after Biden effectively cinched the Democratic nomination in April 2020, after rival Sen. Bernie Sanders dropped out of the race, and he was sometimes touted in speeches as a Biden adviser."
What's the problem?
These payments are a serious conflict of interest, and an example of the swamp that Americans want to drain. These companies aren't paying exorbitant fees for advice or services provided. Sars-Cov-2 is a great threat, but no one has two million dollars of special advice. Most experts know that distancing, ventilation, hand hygiene, cleaning, and masking are key. As for Carnival cruise lines, my advice would be simple: don't run cruises. That advice is free, by the way.
If these payments cannot be for services rendered, what are they for? They are payments for influence. All of these companies have pending issues right now with the Biden transition and administration. For example, Carnival wants to reopen their cruise ships, so they want Federal exemptions, and attainable ventilation standards; Airbnb wants to use Murthy's name and title to assure customers it's safe to stay; Netflix has a dual interest: they want customers to purchase their services, making lockdowns good for business, but they simultaneously must produce shows, so would be great; the list goes on.
Murthy is that impact these company's profits. If someone gave me $400,000, I would hate to anger them. Payments of this magnitude inherently compromise Murthy's ability to think only about what is best for the public. These conflicts should disqualify him from the post of Surgeon General.
What is financial conflict of interest?
If a company profits from certain activities but not others, and you take money from that company, a conflict has been created. If Pfizer pays a doctor $200,000 in speaking fees, that doctor has a conflict any time they talk about or prescribe Pfizer drugs or any other drug that could be used in conjunction with or in lieu of Pfizer drugs. If Pfizer gives the money to a cancer patient advocacy organization who then gives it to the researcher, the conflict still exists, particularly if the source of funding is obvious to all involved.
Murthy received over $150,000 for a book. To me, this isn't a conflict. For example, someone could write an argument for or against saturated fats. That person doesn't have a conflict when they say it a second time because they were free to choose initially. In contrast, if pharmaceutical company Celgene pays you, then the direction of bias was always towards promotion of their drugs.
Personal payments -- those that Netflix and Carnival gave directly to Murthy -- are more problematic than research payments, where a to run a study.
Finally, small donors do not concern me. If a politician raises money five dollars at a time, as some do, that's not a conflict. Getting $5,000,000 from Chevron is. Philanthropic and non-profit research funding is a conflict if the funder has skin in the game -- for example, their finances are tied to a research conclusion. However, if they are not in that market, no conflict exists.
I am concerned when there is a revolving door between government and industry. Previously, Jeff Bien, now a Stanford fellow, and I studied the relationship between U.S. FDA reviewers and pharma. We the single most common job for someone who left the FDA was pharma. Can someone regulate forcefully if they know they may someday work on the other side of the table?
The silence is deafening
Conflict of interest is problematic whether the person is on your "team" or not. Yet, many have been silent about Murthy. Elizabeth Warren famously criticized then FDA commissioner nominee Dr. Scott Gottlieb for financial conflicts -- and I was sympathetic to that criticism -- but , "Warren's office did not respond to repeated requests for comment about Murthy's financial disclosures."
In May of 2020, Buzzfeed that the former CEO of JetBlue donated $5,000 to help fund the Santa Clara seroprevalence study. This money was not paid to the researchers personally, but a . Many academics on Twitter were harshly critical of the conflict. In Murthy's case, the sum of money is 400 times larger, and was paid to the nominee directly. Yet, Twitter has been quiet.
Of course, Twitter and Dr. Gottlieb and JetBlue are perceived as being from the other team, while Murthy is perceived as being on our side. Standards of conflict of interest should not be selectively applied based on political affiliation. Every person critical of Gottlieb who is not critical of Murthy is engaged in hypocrisy.
Conflict is a serious issue
I have a disclosure. I am the author of at least exploring financial conflict of interest, and I think a lot about it. For example, I have lectured at major pharmaceutical companies and declined all payment, room and board, and travel. I even packed my own thermos of coffee and ate nothing. I did this because I believe -- and the evidence shows -- that these conflicts affect the . I also wanted to show junior folks that it is possible to avoid personal ties to biopharmaceutical companies, and interact productively with them.
Yet, the message of the surgeon general nominee is the opposite. The nomination says it's absolutely fine to accept lavish sums of money for "advice," and then accept a position that allows for decisions that might be interpreted as "paying them back." Young people have lost a role model.
What if he didn't know he was going back into public service?
Some ask if these payments are problematic if Murthy did not think he would return to government service. Or alternatively, shouldn't Murthy be paid for advice?
Again, it's disingenuous to pretend the size of these payments is for advice. Even without a future position, these companies likely believe Murthy has significant influence in the democratic machine. He may know the Biden administration's plans for occupational standards, and shape them. If he thinks favorably about these companies, he may influence policy to their benefit.
Pandemic profiteers
There is a broader ethical issue: profiteering from a pandemic is offensive. Americans have lost jobs in record number and many are scrambling just to get enough food. At the same time, some are enriching themselves by consulting for teachers' unions, state and local governments, and businesses. If you are making money from suggesting restrictions, you might not be in the best position to tell society when restrictions should end. This problem extends beyond Murthy.
Government is a swamp
There is an old saying that politicians go to Washington to do good but stay to do well. This reflects the growing American sentiment that government is a swamp. The folks who work to promote the public interest quickly join the companies they used to regulate. They regulate favorably while in office, and afterwards, help companies find the loopholes. Americans are frustrated by this phenomenon. Although the last administration claimed to want to drain the swamp, it . The Surgeon General nominee's conflicts of interest make that swamp larger.
We must call out conflict of interest regardless of political party or whether or not we like Murthy. There are tens of thousands of public health experts who have received zero dollars for giving COVID-19 advice -- we must pick our advisors from this set. We need a political party willing to cut the ties of corporate interests from the work of public servants. The Surgeon General used to be "America's doctor," but now he appears to look more like Netflix's and Carnival's doctor. Faith in public institutions is at stake at Thursday's confirmation vote.
, is a hematologist-oncologist and associate professor of medicine at the University of California San Francisco, and author of .