Eli Ehrenpreis
Chicago, Illinois, United States

During my medical training in the 90s, Amy Sage was a real standout. She was a fellow in the gastroenterology program at the university hospital. She was tall, muscular, and had blonde hair. She had quite a presence at work, parking her motorcycle on the street near the hospital, walking the halls in her white coat, leather pants and low boots. She also had a PhD in biochemistry.

While the other GI fellows tended to crumble after a bad encounter with the department chief, Amy was just fine. With her special interest in liver diseases, her research and outstanding clinical skills, she should have gone right to the faculty at Harvard after her training was over. Instead, she spent an extra couple of years doing a second fellowship in nephrology, working in the physiology lab at night. Amy Sage is the only person I know who is board certified in both of these specialties.

Amy and I lost touch after residency. She disappeared into a small private practice in a middle-class suburb, and I did not see her again until the fall of 2012. I was walking down the strip in Las Vegas toward the Convention Center and was just passing the Bellagio’s arching water displays when Amy walked up and grabbed me by the collar. She was shaking a colorful brochure in my face.

“You need to do something about this. You’re a big shot and I’m not. I need you to do something to stop all of this!”

Her face was flushed with emotion, while I was melting from the Nevada sun and the sudden confrontation. I was a resident again, worshiping Amy Sage, my senior, who was now tightening her grip on my shirt.

The brochure advertised a free dinner that evening. “Treatments for the Difficult Patient” was being presented by William J. Murdoch. Murdoch was one of the architects of a study that everyone was talking about. His paper on combining drugs to suppress the immune system was already changing clinical management, but Amy and I continued to have extreme reservation about how the study had been conducted and its results interpreted.

But today her anger was directed at something else: Murdoch’s conflicts of interest. Any speaker at a scientific meeting needs to list these, so that in theory the audience can make a rational decision whether the speaker’s relationships with drug companies will improperly influence the content of the presentation. In keeping with this policy, the brochure mentioned that Murdoch had financial ties with more than sixty different pharmaceutical companies.

“Academic physicians aren’t supposed to be on drug company payrolls. I have followed your career. You never did this.”

She eventually eased her grip on my shirt collar. I asked her the specifics of her anger. She said “As you know, I have taken a scholarly approach to being a doctor. I delayed so much of my life for my ideals. I now realize the way some people have become famous in this business and how their research gets published. Academic medicine looks more and more like a fantasy to me now. I am telling you this because you were always kind to me. I have regrets. Please appreciate my pain.”

Even as we spoke, another well-known physician with ties to many drug companies, accompanied by a group of fawning admirers, walked slowly past us.

Our conversation resumed that evening over a few drinks. Amy and I agreed that Murdoch should not be lecturing to physicians about how to prescribe medications because of his many conflicts of interest. He also should not be the section chief at a famous university hospital or sit on the board of FDA committees. He should have been disqualified from becoming the editor of a major scientific journal.

Amy acknowledged that this systemic problem was too large for me to fix, especially after I explained that though I work in academia, I remain relatively unknown in my field. I don’t get many government grants and am not a member of any important committees. Acceptance of my research ideas has been a challenge. The editors and reviewers of my work don’t really get me.

I let Amy know that I respected her for being an outsider and an original thinker.

“Research isn’t done to make you famous, or wealthy and its rewards come from within, from your patients and from the people that you love.”

Sometime later, Murdoch was deposed as chief from his university and now is no longer invited to give lectures at national meetings.