Univ. of Minnesota bioethicist tests limits of academic freedom

Carl Elliott would argue that he's simply doing what he was hired to do.

After all, he's paid to teach and write about medical ethics.

But if he didn't have tenure, he admits, he'd probably lose his job in a heartbeat.

Elliott, a bioethics professor at the University of Minnesota, has emerged as one of the most relentless critics of his own academic institution.

In the past few years, he has waged a contentious — some would say reckless — campaign against the U's psychiatry department, which he blames for the 2004 death of a mentally ill patient.

Elliott is convinced that the department's research is putting patients in danger, and he has used every means at his disposal to spread that message: in national magazines, campus protests, lectures and his sometimes incendiary blog, Fear and Loathing in Bioethics. In one blog entry, he posted an image of Goldy Gopher in a photo montage of serial killers.

University officials have not been amused. They accuse Elliott of whipping up hysteria with "false and unfounded" allegations, and undermining research efforts in the process. And while the university hasn't tried to fire him, it has reprimanded him for "unprofessional conduct," a move that he's now challenging under the tenure code.

By his own account, Elliott has alienated some of his closest colleagues. Within the U's Center for Bioethics, where he has worked since 1997, he says the tension is so palpable that he dreads setting foot in his office. He does most of his work from coffee shops.

Yet at age 53, Elliott seems more determined than ever to test the limits of academic freedom. "The fact is, I'm totally ashamed of the way the University of Minnesota has behaved," he said. He believes it's his job, as a professor, to speak out. "We're paid to call them as we see them, even if it happens to be uncomfortable for the people who are paying our salaries."

On a brisk morning in May, Elliott stood beside an empty coffin outside the McNamara Alumni Center with a few dozen protesters. They carried white flowers and signs ("Investigate Medical Research") as they prepared to march on the U's Board of Regents meeting inside.

The protest was billed as a vigil for Dan Markingson, a 27-year-old man who committed suicide while in a U psychiatric study 10 years ago.

"That study killed him," Elliott told the crowd. "To the University of Minnesota, Dan was not a patient. He was a commodity."

Elliott repeated what has become, for him, a familiar refrain: That Markingson, who had schizophrenia, was coerced into an industry-funded drug study over his mother's objections. And that when he took his own life, the university refused to honestly examine how its own actions and conflicts of interest may have played a role.

"They don't want to know about Dan Markingson. They don't want to know whether there have been other Dan Markingsons," he told the protesters. "What we have to do is make sure that they can't keep looking away."

Four protesters, in white lab coats, tried to carry the coffin into the regents' meeting, but they were stopped at the door. Elliott later posted a photo on his blog with the headline: "Last time: A coffin. Next time, self-immolation?"

University officials say Elliott has distorted the facts and unfairly cast the U in the role of villain.

"Having somebody die during a clinical trial is tragic," said Dr. Aaron Friedman, the former dean of the University of Minnesota Medical School. "[But] this was not a scandal."

Friedman points out that in the 10 years since Markingson's death, there have been multiple investigations — including at least two that began this year. So far, none has found evidence that the young man was coerced into the study or treated improperly, according to the university. Yet the demands for more investigation, from Elliott and his allies, continue.

"Carl has not liked the outcome of up to four different investigations up until now," said Friedman, "so his argument is, keep looking until I get one that I like."

By his own admission, Elliott tends "to get obsessed" with his work. But this case, he acknowledges, has become "sort of all consuming."

When asked how much of his time he spends on it, he laughed. "A lot," he said.

From early in his career, Elliott, who is also a physician, has been writing about what he calls the corrupting influence of drug-company money on medical research. He even wrote a book on the subject: "White Coat, Black Hat: Adventures on the Dark Side of Medicine."

He first read about the Markingson case in a 2008 investigative report in the St. Paul Pioneer Press. The three-part series raised questions about recruitment tactics, conflicts of interest and lax oversight in the drug study that Markingson was enrolled in when he died.

Elliott started digging into the case himself and wrote a scathing report, "Making a Killing: The Deadly Corruption of Clinical Trials," in Mother Jones in 2010. He concluded that the Markingson study was part of a long, troubling history of industry-sponsored research that put profits ahead of the interests of patients. He argued that the U owed Markingson's family a full accounting.

"Carl is like having the atomic bomb," said Mike Howard, a friend of Markingson's mother, Mary Weiss. The university would stonewall the family when it tried to get answers, Howard said, but "Carl has been something that the university just can't dismiss."

Elliott began peppering the university with public data requests for thousands of documents, and made the Markingson case the focus of his classroom lectures, blog posts and public speeches. He asked donors to stop giving money to the U until it opened a "proper investigation."

The U, meanwhile, kept insisting that the matter had been thoroughly investigated. Elliott countered that only one outside agency, the Food and Drug Administration, actually probed the study itself, and that its conclusion — that there was no misconduct — was flawed.

By 2013, Elliott's campaign was getting international coverage in medical journals. Last fall, more than 175 prominent doctors, researchers and ethicists from other universities signed a letter urging the U to conduct a fresh inquiry.

"I felt kind of an obligation, as an academic colleague and a friend, to show some support," said Trudo Lemmens, a professor of health law and policy at the University of Toronto, who wrote the letter. The intent, he said, was "to send a signal to the institution that the external academic community was keeping an eye on this." Even Arne Carlson, the former Minnesota governor, has weighed in on Elliott's side.

Inside the University of Minnesota, though, the subject has been bitterly divisive. Elliott recalls "fairly unpleasant" arguments with colleagues who told him: "Carl, you're taking this too far."

To Elliott, though, this was exactly why professors have academic freedom.

"There's virtually no other class of job where you're given the kind protections that we're given to teach and write about uncomfortable and controversial things," he said. "The sad thing, I think, is how even though we're given this extraordinary privilege, how rarely it is that people choose to use it."

At the Medical School, the two psychiatrists involved in the Markingson study — Dr. S. Charles Schulz and Dr. Stephen Olson — say they feel under siege.

Schulz, the department chair, says he can't even bear to read Elliott's published accounts anymore. "It's too painful," he said.

Both he and Olson say that Elliott gives only one side of the story and that he ignores the facts that don't support his case.

"I think [people] believe that because Carl Elliott is a professor of bioethics and a member of the Center for Bioethics, that he must be telling the truth," said Olson. But "he's not pursuing this in an academic way. I don't think it's conduct that becomes a faculty member and a peer."

Olson says Elliott has falsely implied, for example, that the researchers were using the study to line their own pockets. In fact, he notes, the Markingson study was like every other research project at the U: The sponsor paid the university to cover its costs, including a portion of the researcher's salary.

"I don't know why there hasn't been blowback from the rest of the university," said Olson. "But nobody goes public, because I think they don't want to get caught in the crossfire."

In the meantime, the controversy seems to have had a chilling effect on research.

"I personally think it's created a huge culture of fear," said Dr. Michael O'Sullivan, an assistant professor of psychiatry at the U. "I personally avoid anything to do with research. Why? Because I don't want to end up on the TV or the newspaper."

Elliott doesn't buy it.

"People who are doing scientifically sound, ethical research should have nothing to worry about," he said.

But he notes that pharmaceutical companies have been caught time and again rigging drug trials and suppressing results. "If what I'm doing is discouraging people from working with the pharmaceutical industry, I think that's a good thing," he said.

So far, academic freedom has protected Elliott's job. But last winter, the university claims, he crossed a line. It accused him of using a "fabricated letter" in a speech about the Markingson case at Hamline University and demanded that he issue a retraction.

The 2004 letter, addressed to Weiss, Markingson's mother, appears to be from a university lawyer disputing her right to her son's medical records. The U says it's a forgery; Elliott says he doesn't believe it, and he refused to issue a retraction. He called it an attempt to discredit Weiss, adding: "I won't be part of it."

Elliott received a letter of reprimand in August from Dr. Brooks Jackson, the current dean of the Medical School, citing him for "significant acts of unprofessional conduct." The reprimand is on appeal.

Leigh Turner, a U medical ethicist who supports Elliott, calls it a classic pressure tactic against a whistleblower. "You just kind of harass, intimidate, make things uncomfortable or something until finally they choose to leave," he said.

But Elliott shows no signs of giving up. His wife, Ina, isn't surprised. "It's more than a job," she said. "It's way more personal now."

Elliott agrees. "I feel like I need to see this thing out."

Maura Lerner • 612-673-7384