A detailed report by David Heath from the Center for Public Integrity has revealed that the late Pat Buffler, the well-known and much-loved University of California Berkeley epidemiologist, served as a consultant for private industry for many years without publicly disclosing these activities and relationships. Because of the large number of these relationships, her failure to disclose them in journal articles or grant applications, and the variety of tasks she performed for industry, the article raises the possibility that Buffler rendered opinions that were influenced by the money she received rather than the scientific evidence itself. (See related article—An exclusive interview with investigative journalist David Heath). [Ed. In the interest of full disclosure, The Epidemiology Monitor acknowledged in its obituary last fall its high regard for Pat Buffler.]

Standard of Evidence

However, establishing beyond a shadow of a doubt that her opinions were actually slanted or tainted by money received is a difficult, if not impossible standard to meet. Because of her death, Buffler was not interviewed by Heath about the allegations and thus could not offer any alternative explanations for her views or activities in question in various roles as expert witness, advisor, or report writer. Indirect evidence or a pattern of behavior are all that is left to go on, perhaps with the exception of personal testimony among persons in a position to judge.

Suspicion

One highly suspicious set of  opinions is the one she rendered in a lead based paint lawsuit in California. In advance testimony, she wrote that “…there are many indicators that the risk of injury to children living in homes with lead-based paint is low, and that the risk to children from lead based paint in homes is not probable or imminent. There is a dramatically declining number of children with elevated blood levels, including a declining number of ‘state’ cases [Ed. those meeting a specified case definition], despite the fact that the numbers of children who are being screened is markedly increasing...”

This statement appears to suggest that Buffler is questioning the causal relationship between exposure to lead and chidren’s health. However, reading the original document, Buffler was rendering an opinion about whether or not an abatement plan was justified, and not about the relationship between lead exposure and health. In fact, her report recognized the importance of lead and highlighted the remarkable progress made in reducing risk over the years. Hers appeared to be more a risk-benefit argument against a home lead abatement plan than about a causal role for lead. One can more easily imagine differences of opinion about the payoff from abatement plans than about the causal role of lead.

On the Other Hand

In another example from the same expert opinion, Buffler estimated the likelihood of children being harmed by lead in homes with lead based paint as 1 in 58,400 and this estimate is incorrect according to other experts more familiar with the lead literature. During the proceedings, Buffler’s credentials were questioned since she had never studied or published on lead. The judgment by some experts quoted by Heath is that Buffler should have known better.

Surprise

The allegations about Pat Buffler have come as a giant surprise to many who knew and worked with her and had no inkling of her numerous relationships with industry. “We are heartbroken about her death,” said one colleague, “and these revelations only add to the heartbreak.” According to the colleague, “no one had a clue about what she was doing and it was a shock to everyone.” Similar reactions were reported by other colleagues in Heath’s report.

Theories

Some who spoke with the Epidemiology Monitor believe that Buffler must have been leading a double life to have so many accomplishments in epidemiology and public health while at the same time having so many undisclosed relationships and activities with industry sources. Interestingly, Heath told the Monitor that what was unique for him in writing his expose is that while there was a lot of apparent surprise caused by his revelations, he said Buffler’s activities were “not well-buried” and he did not have to scratch very deeply to find what he found but others around her did not see.

Pattern of Post-Mortem Attacks?

A discussion of Buffler’s activities is hampered by the fact that she died unexpectedly last fall and some are made uncomfortable discussing allegations about her when she is not around to explain her activities. Some are even suspicious that a pattern may be emerging of criticizing prominent epidemiologists after they pass away as occurred for Richard Doll after his death. One epidemiology colleague who knew Buffler well called the Heath report “post-mortem assassination”.

Triggers for Investigation

However, the investigation of Buffler’s activities were undertaken months before her death, according to Heath, and were unrelated. He told the Monitor that he undertook the investigation because he was a reporter covering environmental issues and was looking into connections between industry and environmental science. In doing so, Health told the Monitor that he kept running into cases where Buffler was involved in some fashion. Also, Buffler had a reputation among plaintiff attorneys, and they had some documentation about her work. These developments indicated to Heath that further investigation was promising, and he undertook the extensive work reported by Center for Public Integrity.

Conflicts of Interest

Another colleague confided that plenty of epidemiologists are serving as paid consultants and should perhaps not be surprised by the revelations about Buffler. “If you are getting $500 an hour to give your opinions, it defies credibility that you are not being influenced in some fashion by the advice you give,” according to our source.

Other epidemiologists who spoke with The Epidemiology Monitor have expressed grave concerns about the extent to which the field is being corrupted by the influence of lucrative assignments for private industry. Another revelation in December about the activities of Paolo Boffetta, another well-known and well-liked Italian epidemiologist has fueled the current high level of concern about conflicts of interest throughout the field (see related article in this issue).

Implications for Epidemiologists

Other than shock and surprise, the actions taken by the epidemiology profession or other organizations such as the National Institutes of Health or research universities in a position to issue guidelines or make other interventions are limited to date. In the works are calls for removing the offending epidemiologists from positions of responsibility as editors or public officials.

Effective Measures

However, what truly effective measures can be taken is still unclear. One well placed epidemiologist told us that the answer is not in more guidelines. “We have guidelines up the kazoo and they have absolutely no clout.´ Also,  “industry’s influence is pervasive in setting up journals,  selecting editors, and failing to disclose conflicts of interest. Industry has deep penetration in public health institutions,” added this observer who claimed not to be shocked by the revelations about Buffler.

The observer noted “institutions nod and wink about conflicts of interest because they are funded and do not want to jeopardize their sources of funding.” The observer added, “our field is very corrupted by the need for money and there are personalities with a duality to them. It is time to name names and bring this out into the open. Epidemiology is in a very bad place now and professional integrity has become a very serious matter. Alarm bells are ringing, and writing books about this is not doing enough. We need a hue and cry about this,” concluded the observer. ■

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"Obviously keeping secrets about influences of any sort is bad in itself. But the pervasive underlying problem is that noted in the last paragraphs. My defining image of academic public health was how the discussions of "research" at the faculty meeting of a major SPH (one Prof Buffler herself helped build) consisted of nothing but celebrating grant income and talking about how to get more. There was literally no mention of actual research.
 
When the mindset is all about celebrating more money, with work being merely a way to get more money, why is it any surprise that the field attracts (or creates) people who follow the money? 

But it does not stop there. The dominant money (the grants) are treated as if they have no influence on what research is done and what results are sought, when the diametric opposite is true. When the pervasive attitude is that seeking the overtly and explicitly corrupting money (that which is based on doing particular research that the funder favors and getting the "right" answers) is the goal of the profession, it seems rather hypocritical to get so excited about hidden speculative conflicts of interest that result from relationships."  - Carl V. Phillips