Republican gubernatorial candidate Jack Ciattarelli calls himself a Main Street businessman; a “hands-on, roll-up-your sleeves CEO” who built two successful companies.
Indeed, one of them, Galen Publishing, was in fact located on W. Main Street. His businesses had little to do with downtown Somerville and Galen was no small-time operation. It was a medical publishing company worth millions.
Despite a charismatic personality and three terms in the New Jersey General Assembly, Ciattarelli has struggled with name recognition as he heads toward his November showdown with the Democratic incumbent, Gov. Phil Murphy. The Fairleigh Dickinson University Poll earlier this summer found 70% of New Jersey registered voters said they did not know enough of Ciattarelli to have an opinion of him and 17% conceded they’ve never heard of him.
In his commercials and on the stump, he has stressed his long-time Jersey roots.
“Here’s Phil Murphy’s problem,” Ciattarelli declared after winning the Republican primary in June. “He wasn’t raised here, never went to school here, never owned a business here.”
The candidate, though, has not said much about his own business, other than to note that he always met his payroll and hired fellow New Jerseyans, while repeatedly describing his endeavors in interviews as “Main Street businesses.”
What his company did was produce continuing education materials for major universities — much of it funded by millions in grants from some of the biggest names in the pharmaceutical industry, records show.
Under a contract with Galen, the University of Tennessee licensed and accredited continuing education materials produced as part of “The University of Tennessee College of Pharmacy Advanced Studies in Pharmacy.” According to records filed with Tennessee General Assembly’s Fiscal Review Committee, Galen secured the funding using its contacts and partnerships in the pharmaceutical industry, leveraging its connections with more than two dozen pharmaceutical companies.
“Galen Publishing is the only vendor in the country with the facilities, wealth of industry contacts, access to live seminars and the editorial expertise to provide the services for which the university would lend its name to enter into this partnership,” school officials wrote in justifying the non-competitive contract to the Fiscal Review Committee.
It’s not unusual for continuing education credits mandated by many professional organizations to be underwritten by companies. However, critics say relationships can present a conflict and may be little more than surreptitious marketing tools used by the drug companies.
The university, which maintained editorial oversight and overall approval, was paid 8% of all grant money secured by Galen for the use of its name and accreditation on the materials.
Between 2008 and 2017, when Ciattarelli sold the firm, $13.2 million in grants were awarded for the program. The university retained $1.04 million and paid Galen just over $12.2 million, according to records describing the contract.A spokeswoman for the Ciattarelli campaign said Galen had agreements with other universities that were offered the opportunity to put their name and stamp on similar publications.
“Jack and Galen were innovators in the continuing medical education space,” said Stami Williams in a statement. “Jack created the notion of a continuing education journal that prestigious educational institutions could label as their own and use to raise their profile and increase communications with the relevant medical community. He trademarked these journals and then offered various educational institutions the opportunity to put their name and stamp on the publication.”
Because Galen was the only entity offering this service and owned the trademark to the “Advanced Studies in Pharmacy,” any contract for use of that registered trademark had to be a sole-source contract, she said.
Among the pieces published included a number that focused on pain management — some that appeared to downplay the dangers of opioids.
In one, an author noted: “Misuse or diversion of pain relievers is a significant problem, especially among adolescents and young adults. Concerns about opioid dependence, addiction, or non-medical use often create barriers to effective pain management.” But he continued: “The risk of opioid misuse is low among patients with chronic pain who do not have preexisting substance use disorders.”
Other universities, including Johns Hopkins and Harvard did the same with continuing education journals in their respective fields, she said, with Galen producing the Johns Hopkins Advanced Studies in Medicine, Johns Hopkins Wilmer Eye Institute Advanced Studies in Ophthalmology and Harvard University Advanced Studies in Dentistry.
While they may be common, such arrangements represent a built-in bias because pharmaceutical companies are paying to educate professionals on topics on which they stand to profit, argued Adriane Fugh-Berman, professor of pharmacology and physiology at Georgetown University.
“It’s not education. It’s all advertising and it’s very well disguised,” said Fugh-Berman, who heads PharmedOut, a group that monitors pharmaceutical industry marketing efforts.
She said doctors, nurses and pharmacists are generally required to do continuing education and estimated there are hundreds of companies that offer programs, learning modules, seminars and other continuing education material, much of it funded by pharmaceutical companies.
“Some focus on talks and conferences and some on publishing and some do both,” she said.
Despite promises of “firewalls” between marketing opportunities and education, however, she said there always appear to be marketing messages.
“They are often pretty subtle and often you can’t tell what the marketing messages are,” she observed. Pharmaceutical companies are not so direct as to push branded drugs in such forums, but rather educate pharmacists or doctors that there is a need for a type of drug.
That offers the opportunity of a fertile field for a pharmaceutical company’s salesforce, which later may call to sell a drug for which the continuing education materials have made the case to prescribe.
“That’s what continuing education is all about,” she said.
University of Tennessee would not respond to specific questions about the arrangement with Galen.
“The university maintained this contract for many years and provided licensing and accreditation for continuing education materials in the pharmaceutical industry. The contract was not renewed because the company was sold to a new company,” said Peggy Reisser, a spokeswoman for the University of Tennessee Health Science Center. The contract continues, she added, with another company.
Williams said the topics for continuing education came from University of Tennessee faculty and never from drug manufacturers. Galen, she said, then took the idea for a continuing education class, created a grant application with input from faculty and submitted it to pharmaceutical companies with interests in those areas.
“Those companies would either agree to fund the continuing education grant or reject the grant request. If a grant was funded, university faculty responsible for the continuing education program would then prepare the content for the training or for direct publication in the journal,” she said. “The content never focused on a specific drug, but instead addressed all relevant drugs.”
Those pieces were not written by the pharmaceutical companies, but rather by pharmacists or doctors with relevant expertise in a given therapeutic area. The author had ultimate responsibility for their own work product, campaign officials noted, while adding that the university’s College of Pharmacy program chairperson had responsibility for ensuring “the entire program is consistent with the learning objectives” and the university’s standards for academic excellence and was compliant with Accreditation Council for Pharmacy Education standards.
Williams said over the course of the ten-year contract, the university published more than 100 continuing education pieces.
“Less than a handful dealt with the issues of pain management and opioids which is an extremely important areas of study for pharmacists,” she said in her statement, adding again that each was proposed “by a faculty member as a relevant area for continuing education.”
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