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Second Washington U doctor comes under Sen. Grassley's scrutiny

This article first appeared in the St. Louis Beacon, June 4, 2009 - A second surgeon at the Washington University School of Medicine is the target of inquiries from Sen. Charles Grassley, R-Iowa, over his financial arrangements with the manufacturer of medical equipment.

The latest questions came in a letter from Grassley, the ranking GOP member on the Senate Finance Committee, about payments to Dr. Daniel Riew from the company Medtronic Inc. The letter was sent by Grassley to Washington U. Chancellor Mark Wrighton on May 21.

Riew says the discrepancies cited by Grassley are a matter of timing, not any attempt to withhold information.

In the letter, Grassley says he has asked several companies to disclose the payments they had made to physicians, including Riew, as part of his effort to bring greater transparency to the issue of money paid to doctors by medical companies and to see whether conflicts of interest exist. He notes that the numbers submitted by Medtronic do not match disclosures made by Riew.

Specifically, Grassley said that according to documents submitted by the university from 2006, "Dr. Riew indicated that he received compensation of less than $10,000 from Medtronic. In fact, Medtronic reported to me that there was not a single year from 2003 to 2007 for which Dr. Riew received less than $10,000. In fact, he received well over $10,000 in compensation during each of those years."

Further, Grassley expressed concern about the fact that the university, as it included in a letter to him in December 2007, "does not collect the amount that a doctor is paid by private companies."

Noting that Medtronic said that it paid Riew $133,000 in 2005, while Riew characterized the amount as more than $50,000, Grassley added:

"The substantial difference in these sums also begs the question -- without knowing the amount of a conflict, how can Washington University 'manage' a potential conflict when it comes to NIH grants?"

In an e-mail response to questions about the Senate inquiry, Riew said:

"The year-vs-year difference is mostly due to the fact that companies report the actual payments after their fiscal year ends, while at Washington University, I am asked to disclose what I have received or what I expect to receive in the coming 12 months. The corporate and university reporting cycles do not coincide, further confusing the matter. It should not be surprising if these additional projections, which by definition are educated guesses, do not match precisely with after-the-fact, tax-year-based corporate reports.

"However, I'd like to emphasize that I received consulting income for 5 years and I disclosed the income for those 5 years. Over the 5-year period, my disclosures were complete. I will do all I can to help the university respond completely and thoroughly to the questions in Sen. Grassley's letter."

Riew noted that the university's disclosure form asks:

"Do you, your spouse, or dependent children receive or anticipate receiving within the next 12 months personal income from a company or organization whose activities could possibly relate in any way to your research, patent or licensing activities?"

Grassley concludes his letter to Wrighton asking that the university provide the Senate committee by June 11 detailed information about Riew's grants, including amounts he was paid as salary, whether he reported any potential conflicts of interest, how the university ensured that any such conflicts were "managed, reduced, or eliminated" and whether Riew violated any guidelines governing clinical trials and the reporting of such conflicts.

Riew is the chief of the Surgical Spine Center and director of the Cervical Spine Institute at Washington University. There, he is a colleague of Dr. Timothy R. Kuklo, who has also drawn Grassley's attention for his connection to Medtronic.

In that case, as first reported by the New York Times last month, questions were raised about the efficacy of a bone-growth product sold by Medtronic, where Kuklo had been a paid consultant. He published a study that reported that the product had much higher success in healing the shattered legs of wounded soldiers at Walter Reed Medical Center than other doctors there had experienced, according to a summary of an Army investigation of the matter.

Grassley has asked the Army to submit all of its information concerning Kuklo's research.

The research involved was conducted before Kuklo joined Washington University. He has not responded to requests for comment on the reports.

But colleagues have defended him, including Riew. The St. Louis Post-Dispatch reported last month that Riew stands by the work that Kuklo has done and that media reports of the Medtronic connection have painted an incomplete picture.

"I've known him since he was a fellow in our department," Riew was quoted as saying. "He has very high integrity and is an incredibly hardworking person. He's a wonderful partner and he's a terrific surgeon."

Dale Singer began his career in professional journalism in 1969 by talking his way into a summer vacation replacement job at the now-defunct United Press International bureau in St. Louis; he later joined UPI full-time in 1972. Eight years later, he moved to the Post-Dispatch, where for the next 28-plus years he was a business reporter and editor, a Metro reporter specializing in education, assistant editor of the Editorial Page for 10 years and finally news editor of the newspaper's website. In September of 2008, he joined the staff of the Beacon, where he reported primarily on education. In addition to practicing journalism, Dale has been an adjunct professor at University College at Washington U. He and his wife live in west St. Louis County with their spoiled Bichon, Teddy. They have two adult daughters, who have followed them into the word business as a communications manager and a website editor, and three grandchildren. Dale reported for St. Louis Public Radio from 2013 to 2016.