An internal, nonpublic NIH report written in August 2004 and recently obtained by the Associated Press said that the agency's Division of AIDS is "a troubled organization" and that its managers "spend incredible amounts of time feuding" and engaging in other behavior detrimental to NIAID's fight against HIV/AIDS, the AP/San Francisco Chronicle reports. "To have the senior management ... behave in this manner, spend incredible amounts of time feuding, and writing numerous long e-mails while seemingly unaware of the need for appropriate behavior, decorum and enforcement of good management practices and the rules of supervision and concerns about appearance of reprisal clearly indicate a serious problem," the report, which was written by a special adviser to NIH Director Elias Zerhouni, said. The report also said that "turf battles and rivalries between physicians and PhD scientists" have been widespread for "far too long" in the agency. It recommended that NIH require sensitivity training for senior managers and provide instruction about "inappropriate personnel procedures," according to the AP/Chronicle.

Fishbein's Concerns Substantiated
The report appears to substantiate many of the claims of former NIH employee Jonathan Fishbein, who was officially fired on Friday despite objections of many members of Congress, the AP/Chronicle reports. The report raises concerns that firing Fishbein would give the "appearance of reprisal" because he claimed misconduct in the reporting of an NIH-funded study on the use of the antiretroviral drug nevirapine among pregnant HIV-positive women in Uganda (Solomon, AP/San Francisco Chronicle, 7/3). Fishbein in January told a panel of the Institute of Medicine in Washington, D.C., that the Uganda study was "so poorly conducted" that it "potentially put the lives of hundreds" of participants and infants at risk. NIH -- which maintains that nevirapine is safe for single-dose use in HIV-positive pregnant women to reduce the risk of vertical HIV transmission -- asked IOM to conduct a review of the study. NIH hired Fishbein to improve its research practices, but the agency earlier this year decided to fire him for poor performance during a probationary period. However, Fishbein said he believes he was fired in retaliation for his refusal to overlook research shortcomings. An IOM panel in April released a report saying that there is no evidence that the Ugandan trial had any serious flaws (Kaiser Daily HIV/AIDS Report, 4/11).

Report Also Criticizes Fishbein
The report said Fishbein without explanation was forced to begin reporting to NIH Deputy Director Jonathan Kagan after complaining about Kagan's conduct. After receiving authority over Fishbein, Kagan moved forward with efforts to fire him, according to the AP/Chronicle. However, the report also criticized Fishbein for not taking enough time to adapt to the "culture" of the NIAID, adding, "It seems apparent that both sides behaved badly, that a new senior employee did not orient himself about the division and that the most senior people engaged in inappropriate behavior."

Reaction
Fishbein's attorney, Stephen Kohn, said on Friday that he had not seen the internal report but that he largely supports its conclusions. "NIH's internal admissions are unprecedented and damning," Kohn said, adding, "NIH must fix its troubled management and stop harassing the whistleblowers." NIH declined to comment on Fishbein's firing except to say that his last day was Friday, according to the AP/Chronicle. Sens. Charles Grassley (R-Iowa) and Max Baucus (D-Mont.) last week wrote a letter to NIH saying, "Retaliation against an employee for reporting misconduct or voicing concerns is unacceptable, illegal and violates the Whistleblower Protection Act," adding, "Moreover, it would have a chilling effect on other NIH employees who might makes truthful but critical comments about the NIH" (AP/San Francisco Chronicle, 7/3).

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