Dr. Eric J. Topol, a cardiologist with the prestigious Cleveland Clinic Foundation, has been one of the most outspoken critics of the drug companies.

He came into the spotlight after he openly criticized drug company Merck and its painkiller Vioxx, which was withdrawn from the market because of safety concerns.

Dr. Topol has also criticized other drugs and was recently demoted from his position as head of the clinic's medical college. He suggested in a Webcast that his criticism of Merck was a key reason why he was demoted.

Though Dr. Topol is still the chairman of cardiovascular medicine at the clinic, associates say he may leave the clinic altogether.

Conflicts of Interest at the Cleveland Clinic

Dr. Topol's remarks have brought attention to the Cleveland Clinic and its own ties to industry.

While Dr. Topol severed all industry ties after a Fortune magazine article attacked him for having his own conflict of interest (before Vioxx was withdrawn, a hedge fund that listed Dr. Topol on its advisory panel had sold Merck's stock for a short period -- Dr. Topol maintained that he had nothing to do with the fund's action), the Cleveland Clinic has many long-standing corporate ties.

The industry ties affect not only staff doctors and researchers, but also the clinic's chief executive and board. At the heart of the issue -- drug and medical device industries work closely with researchers and doctors to promote new drugs and technology.

The conflict of interest that results is commonplace not only at the Cleveland Clinic but also at many high-profile academic medical centers.

Dr. Topol Under Attack

When Dr. Topol began to openly criticize Merck and other drug makers, he found himself under fire at the clinic.

When his contract came up for renewal, he was put on a form of probation and given a six-month contract rather than the usual yearlong one. Further, the clinic's board of trustees says it has appointed an independent group to review conflicts of interest at the clinic, however, Dr. Topol, who previously held a position on the committee, has been removed.