In the past weeks, Prof Dorit Reiss of Hastings law school in San Francisco has been bombarding the blogs with many hundreds of comments in relation Katie Couric’s broadcast on HPV vaccine - likely in excess of a thousand.
(KatieCouric.com: Rosie Perez
Katie Couric.com: What Are Your Thoughts on Gardasil
KatieCouric.com: Conversation Continued
HuffPo: Furthering Conversation)
So many, in fact, that it is hard to imagine how it could not interfere with her normal professional routine. Whether or not Reiss has been able to perform her normal professional tasks during this period there is an issue of whether her advocacy may be conflicted by the sponsorship and institutional affiliations of her employer, examined here by Christina Waldman.
In an exchange a few days ago (Dec 8) between University of California (UC) Hastings Associate Law Professor Dorit Reiss and "Vince Brown" on KatieCouric.com, Brown accuses Reiss of being “paid to post” in favor of vaccines. Reiss replies: "Not really. My lawschool [sic] would pay me the same salary whether or not I post here." Brown persisted, and Reiss confirmed, “I am sorry you had trouble understanding my comment. No, no one is paying me to post here.”
Be that as it may, the institutional activities of Hastings have latterly become bound up in partnerships between UCSF/UC Hastings and Kaiser Permanente, the largest managed health care organization in the US , the head office of which is just across San Francisco bay in Oakland.
According to Wiki:
“UCSF is administered separately from Hastings College of Law, another UC institution located in San Francisco. In recent years, UCSF and UC Hastings have increased their collaboration, including the formation of the UCSF/Hastings Consortium on Law, Science, and Health Policy.”
The Consortium “offers impressive opportunities” for students in education, research, and clinical studies, including internships/externships with Kaiser Permanente and others. (8/28/13 press release). (Paper by Consortium members, “Price Transparency in the Health Care Market)
A November 14, 2013 press release announced a new center for the study of uses for the human genome, a joint endeavor of Kaiser Permanente, UC San Francisco and UC Hastings College of Law. To this end, the National Human Genome Research Institute provided $778,000.
One of the papers most frequently cited by Reiss in her defense of HPV and Gardasil vaccine was conducted by Kaiser Permanente or behalf of Merck:
Author Affiliations: Kaiser Permanente Vaccine Study Center, Oakland (Dr Klein, Messrs Hansen, Emery, and Lewis, and Ms Deosaransingh), Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Drs Chao and Jacobsen, Messrs Slezak and Takhar, and Ms Sy), Department of Pediatrics, South Bay Medical Center, Kaiser Permanente Southern California, Los Angeles (Dr Ackerson), and Pharmacy Analytical Service, Kaiser Permanente Southern California, Downey (Dr Cheetham); and Department of Epidemiology, Merck Sharp and Dohme, Whitehouse Station, New Jersey(Drs Velicer and Liaw)….
Financial Disclosure: This study was funded by Merck & Co. Dr Klein receives research support from Merck & Co, GlaxoSmithKline, Pfizer, Novartis, and sanofipasteur for unrelated studies. Dr Jacobsen and Mr Slezak received research funding from Merck & Co for another study related to HPV4. Mr Slezak served as an unpaid consultant to Merck & Co. Dr Chao received research funding from Merck&Co, Amgen, and Pfizer for unrelated studies. Drs Velicer and Liaw are employees of Merck & Co.
Role of the Sponsor: The study sponsor, Merck & Co, provided substantial input into the study design and analytic plan. In collaboration with the Kaiser Study Team, the sponsor reviewed data analyses and helped draft and revise the manuscript. The Kaiser Study Team investigators made final decisions regarding manuscript edits.
The CDC and Kaiser Permanente work together closely on a multitude of projects. (Morgellons and
Raymond J. Baxter, Kaiser Permanent’s senior VP for community benefit, research, and health policy, is also on the board of the CDC Foundation.
Here are 15 “studies and working groups being conducted as part of the CDC-funded Clinical Immunization Safety Assessment (CISA) Network.” These include studies on febrile seizures, on the role of immunization with influenza or hepatitis b vaccines in children’s Bell’s Palsy, and others
Evidently, there is a network of interests here which endangers public accountability. Dorit Reiss’s employer is not simply a school of law; it is affiliated to major promoters of the vaccine program and has a strategic role in developing health policy. Meanwhile Reiss, herself, seems to have great difficulty in perceiving any kind of conflict. In a 2011 paper Reiss advocated the benefits of agency capture :
Observers of the administrative state warn against “capture” of administrative agencies and lament its disastrous effects. This article suggests that the term “capture”, applied to a close relationship between industry and regulator, is not useful – by stigmatizing that relationship, judging it as problematic from the start, it hides its potential benefits. The literature on “capture” highlights its negative results – lax enforcement of regulation; weak regulations; illicit benefits going to industry. However, this picture is incomplete and in substantial tension with another current strand of literature which encourages collaboration between industry and regulator. The collaboration literature draws on the fact that industry input into the regulatory process has important benefits for the regulatory state. Industry usually has information no one else has, and has more incentive to give that information to a friendly regulator. Furthermore, working with industry can substantially improve the impact of regulation; voluntary compliance is cheaper and can be more effective than enforced compliance, and industry can help regulators minimize negative unintended consequences. This paper suggests that instead of engaging in name-calling, we should focus on identifying when a close industry-regulator relationship will work in the public interest, and when it is likely to undermine it. That is an empirical question.
It is an interesting question where--in due concern about the dissolution of the proper boundaries between state, institutions and business--“name-calling” is an issue, rather than for instance transparency. Could it be that developments in her own institution have given rise to the need for justificatory representations?
Although Reiss may claim to act simply as a concerned parent the UC Hastings website features and publishes her vaccine advocacy activities linking to articles on other sites.
A profile on the UC Hastings website states:
Professor Dorit Rubinstein Reiss is quickly becoming the nation’s foremost legal expert about the potential for tort liability for parents who choose not to vaccinate their children. In addition to running her own blog on the subject, Before Vaccines, Professor Reiss has penned multiple Op-Eds and articles about the dangers of choosing not to vaccinate. Her latest piece in the Recorder discusses California’s new bill AB2109, which goes into effect January 2014, and changes the requirements for parents who want to utilize California's personal belief exemption and send their children to school without the required childhood immunizations.
Despite the many protestations, notably from Karen Ernst of Voices for Vaccines for which Reiss is a “parent advisor” she only seems to claim amateur status when it suits her.
Christina Waldman is a New York attorney and mom who shares Dr. Andrew Wakefield's concern for vaccine safety as a priority in public health. She is concerned about the health of her future grandchildren, who will be expected to receive many more vaccines than her own children did 30 years ago