David Egilman, a clinical professor at Brown University who frequently testifies in lawsuits against powerful corporations, is no stranger to controversy. But in December 2017, something especially fateful happened. He published a peer-reviewed paper.
The paper argued that a Johnson & Johnson subsidiary, DePuy, had run a poorly designed study and had manipulated data in order to make its hip replacements seem more effective. To support his thesis, Egilman used documents that he had seen and analyzed as an expert witness on behalf of patients who were suing DePuy, alleging that their hip replacements had failed and left them unable to walk.
At the bottom of his paper, Egilman disclosed his role in the litigation. He also wrote that the lawyers for the plaintiffs weren’t involved in, and didn’t pay for, his paper, which appeared in the journal Accountability in Research.
The paper sparked a chain reaction: Johnson & Johnson demanded a retraction, Brown ordered the professor to distance himself from the institution, and a volley of claimed conflicts of interest ended with Egilman’s removal from the classroom. A nine-member faculty committee eventually found no direct evidence that any company had pressured Brown to take action against Egilman, but the committee members wrote that the “fact pattern is inherently suspicious.”
Brown denied that any outside meddling had forced its hand. “We fully and unequivocally reject any suggestion of any external influence at all on our process or decision making,” Brian E. Clark, a Brown spokesman, wrote in an email to The Chronicle.
The case highlights the conflicts for universities that employ researchers who study — and engage in advocacy against — powerful companies. It underscores the risks to researchers, like Egilman, who are not tenured. And it shows how, even in the absence of obvious, extensive financial ties between universities and companies — in documents The Chronicle obtained about Egilman’s case, there’s no mention of any particular relationship between Johnson & Johnson and Brown — a dispute like this “opens the door to the perception of corporate influence,” as the faculty committee wrote.
That door opened when Johnson & Johnson asked Accountability in Research to retract Egilman’s paper. The DePuy study that Egilman had criticized was scientifically sound, Jim Lesko, a biostatistician at Johnson & Johnson, wrote in a letter to the journal’s editor in chief, Adil E. Shamoo, that STAT first published.
Moreover, Lesko wrote, Egilman hadn’t fully disclosed his own conflicts of interest: In addition to being a professor at Brown, Egilman, a physician and epidemiologist, has his own firm, Never Again Consulting, which does research for advocacy groups and lawyers. (Other authors of the paper are noted as working for Never Again Consulting.)
While professors at other universities analyze company documents to reconstruct controversial events and reveal motivations, as Egilman does, few in medicine and public health have taken their research as far into advocacy as he has. By one estimate, Egilman has given more than 600 depositions and testimonies over a 35-year career, earning more than $5 million, part of which, he told Science, he gives to charity.
Accountability in Research reviewed its own process for publishing Egilman’s paper, to see if anyone on the staff had made mistakes. “The paper went through the normal process exactly, and we had competent reviewers,” Shamoo said. “As far as we’re concerned, the case was over.” He found no need even to make edits, or to add notes. The paper remains unretracted.
‘Inherently Suspicious’
Then Brown got involved.
In January 2019, university officials sent Egilman two letters demanding that he remove the notation of his Brown affiliation from the Accountability in Research paper. Brown policy encourages faculty members to engage in private consulting, including founding and running their own businesses, and says they should disclose if a publication resulted from outside paid work. It doesn’t say faculty members shouldn’t indicate their Brown ties at all.
The Chronicle asked Clark, the spokesman, if the letters had been intended to tell Egilman to stop affiliating himself with Brown. Clark said he couldn’t answer that question directly, nor others about this series of events.
I believe that the course was canceled as a consequence of complaints about me made by corporations or their agents.
“We are not at liberty to disclose details related to personnel, which we do not consider public,” he wrote in an email. “For that reason, I can’t share internal documents or respond to all of your questions in depth.” Still, he wrote, “all professors with faculty appointments (regardless of their employee status) are permitted to use their faculty titles to identify themselves in professional communications they make.”
But then, in February 2019, Brown officials discontinued Egilman’s course, “Science and Power,” which covers the corporate misuse of science. Egilman had taught the elective in the School of Public Health in the spring and fall semesters of 2018, and at the medical school from 2012 to 2016.
Last summer Egilman filed a grievance. “I believe that the course was canceled as a consequence of complaints about me made by corporations or their agents due to my expression of opinions that were adverse to their economic interest in the course and/or in public,” Egilman wrote in July 2019 in a complaint to the university’s grievance committee that The Chronicle obtained. Egilman declined to be interviewed by The Chronicle.
Brown’s university grievance committee, made up of nine faculty members, formed a medical-school subcommittee to deal with the med-school portions of Egilman’s complaint. The Chronicle obtained the main committee’s report but not the med-school subcommittee’s. The main committee interviewed and sent written questions to those who had made the decisions about Egilman’s affiliation and course — deans in the School of Public Health and administrators in the Office of the Vice President for Research.
The committee found no direct evidence of corporate pressure in Brown’s treatment of Egilman, but that doesn’t mean it didn’t happen, according to David Lowe, a professor of physics and the committee’s chair. The committee was “limited in its investigative powers,” Lowe wrote in an email to The Chronicle, and couldn’t rule out the possibility of undue influence.
The case seemed to escalate more quickly and drastically than the known facts would suggest it merited, Lowe and the other committee members wrote in their report. In light of the controversy over Egilman’s Accountability in Research paper, the journal’s publisher, Taylor & Francis Group, sent a “rather trivial query” to Brown’s Office of Research Integrity.
“If there were concerns about Dr. Egilman’s conflict-of-interest statement or affiliation on the article, this should have been worked out in discussions between Dr. Egilman, the chair of his department, Dr. Jeffrey Borkan, and the Office of Research,” the grievance-committee report says. Borkan is chair of family medicine, the department in which Egilman has his appointment. “Instead, neither Dr. Borkan nor Dr. Egilman were consulted, and the situation escalated into Dr. Egilman being issued a cease-and-desist letter and having his course canceled. This fact pattern is inherently suspicious and opens the door to the perception of corporate influence.”
President’s Rejection
Brown’s president rejected the grievance committee’s findings — and its recommendations that the letters sent to Egilman be retracted and his course reconsidered.
The committee “found no evidence that Johnson & Johnson or any other corporation or any identified ‘external considerations’” had influenced the letters and course cancellation, the president, Christina H. Paxson, wrote. She upheld every decision the committee recommended overturning.
Lowe maintains his position. “The committee stands by our report, which disagrees with some of President Paxson’s conclusions,” he wrote to The Chronicle. “The report offers support to the contention that if the retraction request from the Johnson & Johnson employee had not been made, then the course PHP 1050 would not have been canceled when it was.”
Still, Lowe sympathized with Paxson’s caution: “The evidence was not 100-percent clear, so I can understand how President Paxson would disagree if she applied a more exacting standard of proof.”
The committee stands by our report, which disagrees with some of President Paxson’s conclusions.
The grievance committee also saw potential evidence that the university’s reaction was disproportionately harsh. “Science and Power” was discontinued in large part because deans in Brown’s School of Public Health, who met to talk about the course, had believed Egilman’s affiliation with Brown was going to be terminated, the committee found.
Egilman has had various appointments in Brown’s medical school since 1986. But committee members couldn’t quite figure out how real was the possibility of his nonrenewal. “It remains unclear whether this was simply a mistake, or whether there had been an expression of intention not to renew his position in the medical school,” they wrote.
Not allowing Egilman to cite his affiliation in papers is out of step with the usual practice for Brown’s clinical faculty members, the committee wrote, and ending “Science and Power” was a loss: “The course was well reviewed by the students, and described by Dean Operario, chair of the Public-Health Curriculum Committee as a ‘compelling’ course for undergraduates interested in public health. It is also one of the few public-health courses that focuses on the topic of ethics.”
Nevertheless, Paxson wrote, there had been no guarantee that the class would be renewed. Egilman wasn’t owed due process in that decision. Brown hadn’t violated his academic freedom, as the grievance committee concluded. She accepted only recommendations from the med-school subcommittee, meant to clarify clinical professors’ rights and responsibilities. “The university,” wrote Clark, “is fully confident in the decisions made in this recent grievance matter.”
