"I don't have a problem with doctors making $3,000 or $5,000 a year on the side, but it's a totally different thing when they're making $80,000." Even more distasteful is that the slides used in many of these presentations are created by the drug makers--not the speakers. "That's like ghost-talking." - Dr. Robert J. Alpern Dean, Yale School of Medicine shill (slang) n. One who poses as a satisfied customer or an enthusiastic gambler to dupe bystanders into participating in a swindle. v. tr. 1. To act as a shill for (a deceitful enterprise). 2. To lure (a person) into a swindle. (Updated 11-May 2008) "Current self-regulation will not satisfactorily protect the interests of patients. More stringent regulation is necessary, including the elimination or modification of common practices related to ... continuing medical education, funds for physician travel, speakers bureaus, ghostwriting, and consulting and research contracts." Brennan TA, Rothman DJ, Blumenthal D et al. "Health industry practices that create conflicts of interest: A proposal for reform." JAMA 2006;295:429-433. ### Robert "Chip" Schooley Michael Saag Dr. Robert "Chip" Schooley sits comfortably alongside Drs. Volberding, Hirsch and Mellors on the federal panel which draws up national guidelines for the treatment of HIV infection. And as do only Volberding and Hirsch, he doubly serves on the treatment guidelines panel of the International AIDS Society-USA as well. Like the rest of them, a lifelong leader of the AIDS Clinical Trials Group federally funded research network, for years he has overseen (and does so currently) the Executive Committee of that body. He is an associate editor of the Infectious Diseases Society of America (IDSA)'s premier journal, Clinical Infectious Diseases, as well as on the editorial board of Dr. Doug Richman's little journal, Antiviral Therapy. In lieu of seeing patients or keeping up on the medical literature, he appears to spend the lion's share of his time (we have requesting an accounting of his time from the University of Colorado's ethics office) amassing money, trips and dinners from the following companies with HIV products to study, promote and sell -- in exchange for advising them on their development and marketing strategies: Achillion Pharmaceuticals (a company in which he also owns stock or stock options) Bristol-Myers Squibb Gilead Sciences GlaxoSmithKline Merck & Co. Pfizer Roche-Trimeris Vertex (a company in which he also owns stock or stock options) Monogram Biosciences (formerly ViroLogic) (a company in which he also owns stock or stock options) Dr. Schooley is apparently either a poor or unenthusiastic public speaker, as he serves on no pharma speakers bureaus at this time. He and John Mellors must have the same stockbroker, for many of their holdings overlap: Schooley owns stock or stock options in Achillion Pharmaceuticals (c. 2004), AnorMed (c. 2005), Tanox (c. 2005), Vertex and Monogram Biosciences (formerly ViroLogic). Dr. Michael Saag is the sweet, sometimes maladroit Southern guy of whom it is sometimes painful to think as having ill intentions (ditto for the lanky and bumbling, ah-shucks Joe Eron for that matter). Yet at his UAB HQ in Birmingham he has managed to amass a not inconsiderable AIDS empire. And in the early days he was one of World Health Communications' (1990s public relations surrogate for GlaxoSmithKline when it was Glaxo-Wellcome) most eager to please partners. Most of his AIDS activities are notably second tier: he serves on the International AIDS Society-USA treatment guidelines panel but not the Department of Health & Human Services one; he is only a board rep. to the Infectious Diseases Society of America (IDSA) for the field professional society, the HIV Medicine Association; and the only journal he has going for himself is the modest AIDS Research and Human Retroviruses -- for which he serves, modestly, as Senior Clinical Editor. He can, however, proudly lay claim to the title of Editor in Chief for the IAS-USA's Cases on the Web. Still one wonders, given all the pharma consulting and speaking gigs he is signed up for, how in the world he could ever have time to think -- let alone see actual patients. In lieu of seeing patients or keeping up on the medical literature, he appears to spend the lion's share of his time (we have requesting an accounting of his time from the medical school's ethics office) amassing money, trips and dinners from the following companies with HIV products to study, promote and sell -- in exchange for advising them on their development and marketing strategies: Boehringer Ingelheim Bristol-Myers Squibb Gilead Sciences GlaxoSmithKline Ortho Biotech/Johnson & Johnson Panacos Pharmaceuticals (new entry) Pfizer/Agouron Roche-Trimeris Schering-Plough Shire Pharmaceuticals Tanox Inc. (new entry) TherapyEdge Tibotec-Virco (JNJ) Vertex (new entry) Monogram Biosciences (formerly ViroLogic) Dr. Saag's downhome earnestness and infectious enthusiasm make him a much sought after peer educator, and he serves on speakers bureaus for nearly all the HIV companies... Abbott Laboratories Boehringer Ingelheim Bristol-Myers Squibb Gilead Sciences GlaxoSmithKline Hoffmann-La Roche Ortho Biotech/Johnson & Johnson Pfizer/Agouron Pharmacia & Upjohn Schering-Plough Shire Pharmaceutical TherapyEdge Tibotec-Virco (JNJ) Triangle Pharmaceuticals Trimeris-Roche Monogram Biosciences (formerly ViroLogic) ...for which he is paid an estimated $2,000-3,000 for a 45-minute slide show that has been prepared for him by the pharma or diagnostics company sponsoring the dinner, weekend gold junket or conference symposium. He reports owning no stock or stock options in drug or diagnostics companies with HIV products. Joseph J. "Flip" Eron, Jr. Roy M. "Trip" Gulick One of 2-3 ambitous Young Turks of the AIDS Inc. research and punditry complex, Dr. Joe Eron, Jr. serves at the very top of the AIDS Clinical Trials Group, the federal committee that decides what drugs should be tested and how. Along with Dr. Schooley, Joe is on the editorial board of Dr. Doug Richman's little journal, Antiviral Therapy. In his free time he receives money, trips and dinners from the following companies with HIV products to study, promote and sell -- in exchange for advising them on their development and marketing strageties: Abbott Laboratories Boehringer-Ingelheim GlaxoSmithKline Merck & Co. Roche Tibotec-Virco (JNJ) Trimeris-Roche Joe explained, via a summer 2005 email, that he does not have time for drug company speaking gigs. (With 6-7 teenaged kids running around the house, who would? Unless he were to hire out servants to care for the children the way his CME godfather, Jeffery L. Drezner, does.) Still, despite his naive earnestness about having nothing to hide, he seems to have no compulsion against wasting precious research monies—and the good will of clueless patients—conducting huge marketing trials for the big donors to the NIAID´s AIDS clinical trials network, when he could be using these resources much more productively...) He writes that the only stock in pharma and/or diagnostic companies he might own is through his mutual funds. Ambition (and sycophancy) writ large, Dr. Roy "Trip" Gulick is the undisputed heir apparent to the Volberding throne. A Young Turk to the power of 10, it boggles the mind to think that this guy can do all this and still maintain a medical practice. (But then how do any of them? How did Volberding?) Take a deep breath: Gulick heads up the Antiviral Drugs Advisory Committee for the Food and Drug Administration (FDA) which votes thumbs up/thumbs down on new drug approvals -- power to wield if ever power there were. (He says he's considering resigning.) He's on the Board of Directors of the International AIDS Society-USA. He is Vice-Chairman of the AIDS Clinical Trials Group (ACTG), the federal clinical research network that decides what drugs should be tested and how. He's on the editorial board of Doug Richman's "Topics in HIV Medicine," and he was just recently appointed to that august body the writes HIV/AIDS treatment guidelines for all the HIV docs in the country. In lieu of seeing patients or using his Eagle scout determination to explore new and better ways to approach treatment of this disease, he appears to spend the lion's share of his time (we have requested an accounting of his time from Cornell Medical School's office of ethics) amassing money, trips and dinners from the following companies with HIV products to study, promote and sell -- in exchange for advising them on their development and marketing strategies: Abbott Labs Boehringer-Ingelheim Bristol-Myers Squibb Gilead Sciences GlaxoSmithKline Merck & Co. Panacos Pharmaceuticals Progenics Pharmaceuticals Roche Schering Tibotec-Virco (JNJ) Trimeris Monogram Biosciences (formerly ViroLogic) He also enjoys being flown around the country giving medical update talks on behalf of... Bristol-Myers Squibb Gilead Sciences Merck Roche Trimeris ...for which he is paid an estimated $2,500-3,500 for a 45-minute PowerPoint presentation, handed to him just minutes before, and prepared by the drug or diagnostic company that has sponsored the elegant dinner, the weekend gold or scuba junket, or the snazzy satellite symposium. He reports owning no stock or stock options in drug or diagnostics companies with HIV products. Paul A. Volberding Constance Benson David D. Ho Venerable godfather of the AIDS Inc. research industrial complex, Dr. Paul Volberding heads up both guidelines panels for the treatment of HIV/AIDS: the Health and Human Services federal panel as well as the treatment guidelines panel of the professional organization the International AIDS Society-USA. He also oversees the federal clinical research network that decides what drugs should be tested and how. Along with Dr. David Ho, he serves as editor of one of the two key AIDS medical journals in the country. In lieu of seeing patients or keeping up on the medical literature, he appears to spend the lion's share of his time (we have requesting an accounting of his time from the University of Colorado's ethics office) amassing money, trips and dinners from the following companies with HIV products to study, promote and sell -- in exchange for advising them on their development and marketing strategies: Boehringer-Ingelheim Bristol-Myers Squibb Gilead Sciences Immune Response Corp. (recently renamed, yet again, Orchestra Therapeutics) Ortho Biotech/JNJ Pfizer He is also jetted about the country giving medical update talks on behalf of... Bristol-Myers Squibb Gilead Sciences GlaxoSmithKline ...for which he is paid an estimated $4,500-6,000 for a 30-45 minute PowerPoint presentation prepared for him by the sponsoring pharma or diagnostics company. He owns stock or stock options in the Immune Response Corp., now known as Orchestra Therapeutics. Chairperson, Executive Committee of the Adult AIDS Clinical Trials Group Member, Scientific Agenda Steering Committee of the Executive Committee of the AACTG Board Member, International AIDS Society–USA (1997-) Member, Metabolic Complications Guidelines Panel, International AIDS Society–USA Member, Board of Directors, Foundation for Human Retrovirology, de facto steering committee and business arm of the field's annual Conference on Retroviruses and Opportunistic Infections, (1997-) Dr. Benson's disclosure statement (updated March '07) on the website of the International AIDS Society-USA (where she serves on the Board of Directors alongside Paul Volberding, husband Robert Schooley, Doug Richman, Roy 'Trip' Gulick, Michael Saag, Joel Gallant and Judy Currier) notes that she serves as a paid consultant for the following HIV companies: Boehringer Ingelheim Gilead GlaxoSmithKline Merck Pfizer Her disclosure statement for October 2006 also included: Tibotec-Virco (a subsidiary of Johnson & Johnson) We are in the process of checking with the folks at the International AIDS Society-USA what the details of their newly instituted disclosure policy are, i.e., why the Tibotec-Virco relationship no longer requires reporting. Is there, for example, a statute of limititations of, say, 12 months? Her spouse or partner (Dr. Robert T. "Chip" Schooley), in the same disclosure, reports serving as a scientific advisor to Abbott Labs, Gilead Sciences, GlaxoSmithKline, Merck, Monogram Biosciences, Pfizer, Roche-Trimeris, Tanox, and Vertex, and owns stock options in Monogram Biosciences (formerly ViroLogic) and Vertex. Dr. David Ho is the program committee chair of AIDS' annual medical conference, Conference on Retroviruses and Opportunistic Infections, and thus is responsible for deciding what scientific papers are accepted, presented and discussed. (Prior to him, this position was held variously by Robert "Chip" Schooley, Constance Benson -- see entries below -- and Paul Volberding.) Along with Dr. Volberding, he is also editor of the Journal of Acquired Immune Deficiency Syndromes. In lieu of seeing patients or keeping up on the medical literature, he appears to spend the lion's share of his time (we have asked the Irene Diamond Foundation, his principal foundation benefactor, for an accounting of his time) amassing money, trips and dinners from the following companies with HIV products to study, promote and sell -- in exchange for advising them on their development and marketing strategies: Abbott Laboratories GlaxoSmithKline Monogram Biosciences (formerly ViroLogic) He also enjoys being flown around the country giving medical update talks on behalf of.. Abbott Labs Boehringer-Ingelheim Gilead Sciences Merck & Co. ...for which he is paid an estimated $4,500-6,000 for a 30-45 minute PowerPoint presentation prepared for him by the sponsoring pharma or diagnostics company. He owns stock or stock options in Monogram Biosciences (formerly known as ViroLogic). Martin S. Hirsch Douglas D. Richman John W. Mellors Dr. Marty Hirsch sits comfortably alongside Drs. Volberding, Hirsch and Mellors on the federal panel which draws up national guidelines for the treatment of HIV infection. Along with Volberding and Schooley, he is one of three of our top-tier pharma shills to also serve on the other (if lesser) treatment guidelines panel: that of the International AIDS Society-USA. While he cut quite an imposing figure (alongside the likes of Tom Merigan, Larry Corey and the storied Margaret Fischl) during the founding and subsequent 10 years of the AIDS Clinical Trials Group, he has since stepped back. He is on the editorial board of both of Dr. Doug Richman's journals, Antiviral Therapy and Topics in HIV Medicine. In lieu of seeing patients or keeping up on the medical literature, he appears to spend the lion's share of his time (we have requesting an accounting of his time from Harvard Medical School's ethics office) amassing money, trips and dinners from the following companies with HIV products to study, promote and sell -- in exchange for advising them on their development and marketing strategies: Bristol-Myers Squibb GlaxoSmithKline Schering-Plough Dr. Hirsch's generally scornful demeanor ill suits him for public speaking where the goal is to win over an ambivalent or perplexed audience. He reports owning no stock or stock options in drug or diagnostics companies. Founding Member and Expert Reviewer, Antiretroviral Guidelines Panel, International AIDS Society-USA; Founding Member and Board of Directors, International AIDS Society-USA; Founding Member and Chairman, Resistance Testing Guidelines Panel, International AIDS Society-USA ; Founding Member and Board of Directors, Foundation for Retrovirology and Human Health (de facto steering committee and business arm of the field's annual Conference on Retroviruses and Opportunistic Infections); Editor in Chief, Topics in HIV Medicine; Editor in Chief, Antiviral Therapy In lieu of seeing patients or keeping up on the medical literature, he appears to spend the lion's share of his time (we have requesting an accounting of his time from the UCCCSD´s medical ethics office) amassing money, trips and dinners from the following companies with HIV products to study, promote and sell -- in exchange for advising them on their development and marketing strategies: Abbott Laboratories Boehringer Ingelheim Bristol-Myers Squibb Gilead GlaxoSmithKline Idenix Merck Monogram Biosciences (formerly ViroLogic) Novirio Pfizer Roche-Trimeris Takeda He reports owning no stock or stock options in drug or diagnostics companies with HIV products. AACTG Executive Committee; AACTG Research Agenda Committee (formerly Primary Infection Committee); AACTG Scientific Agenda Steering Committee; Scientific Program Committee, Conference on Retroviruses and Opportunistic Infections (1997-); Founding Member and Expert Reviewer, Department of Health and Human Services Antiretroviral Therapy Guidelines Panel (1996-); Executive Committee, Foundation for Retrovirology & Human Health (de facto steering committee and business arm of the field's annual Conference on Retroviruses and Opportunistic Infections) Dr. Mellors owns stock or stock options in the following companies with HIV products in development: Achillion Pharmaceuticals Depomed, Inc. Pharmasset, Inc. Dr. Mellors owns patents or has patents pending with: Emory University National Cancer Institute University of California - San Diego University of Pittsburgh Diane Havlir Judith S. Currier Chair, AACTG Executive Committee; Chair, Conference on Retroviruses and Opportunistic Infections (2000-2002); Co-Chair, Conference on Retroviruses and Opportunistic Infections (1997-1999); Board of Directors, International AIDS Society-USA (1997-); Board of Directors, Foundation for Human Retrovirology (the de facto steering committee and business arm of the field's annual Conference on Retroviruses and Opportunistic Infections) (1997-); AACTG Scientific Agenda Steering Committee; Special Contributions Editor, Topics in HIV Medicine (see Richman) She reports owning no stock or stock options in drug or diagnostics companies with HIV products. AACTG Executive Committee; Scientific Program Committee, Conference on Retroviruses and Opportunistic Infections (2003-); Board of Directors, International AIDS Society-USA; Executive Committee, Foundation for Retrovirology & Human Health; Expert Reviewer, Metabolic Complications Guidelines Panel, International AIDS Society-USA (2001-); Editorial Board, Topics in HIV Medicine (see Richman) HIV Advisory Board, imedoptions.com, clinicalcareoptions/hiv.com & clinicaloptions.com (pharma funded conference reporting and Continuing Medical Education (CME) websites) She reports owning no stock or stock options in drug or diagnostics companies with HIV products. (If you were bringing in an additional $50,000-$100,000 a year with very little effort, shuttling about rich countries extoling the merits of lifelong polypharmacy to clinicians less clever, less compeling than yourself -- loads of fancy dinners & hotels, business class travel, furtive financial exchanges, would you stray from the script?) (see also, 4/18 NPR feature: "Trained Monkey On the Take")