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Dollars for Docs Sparks Policy Rewrite at Colorado Teaching Hospitals

The University of Colorado Denver and its affiliated teaching hospitals have launched an overhaul of conflict of interest policies after a ProPublica database revealed extensive ties between its faculty and pharmaceutical companies.

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UC Denver (wools/Flickr)

The University of Colorado Denver and its affiliated teaching hospitals have launched an overhaul of conflict of interest policies after a ProPublica database revealed extensive ties between its faculty and pharmaceutical companies.

At a meeting of the faculty senate last week, Dr. Richard Krugman, vice chancellor for health affairs, said he hoped members would soon consider a policy to clearly ban faculty from delivering talks for drug companies.

Without such a clear rule, he said, the school faces a loss of public trust, damage to its reputation and the specter of it physicians parroting industry-designed materials.

"While we value and want to increase our relationships with industry around [drug] discovery … we're going to just have to say we're not going to be involved with these speakers bureaus because they're primarily marketing," Krugman said in an interview Wednesday.

The meeting followed a ProPublica story last month that detailed how physicians at leading universities and academic medical centers, including UC Denver, were taking drug company money in apparent violation of their institutions' rules. Other universities have indicated they plan similar reviews and crackdowns on faculty who are violating their policies.

ProPublica's Dollars for Docs database identified physicians receiving drug company payments for speaking, consulting and other duties. The data include disclosures from Eli Lilly & Co., AstraZeneca, GlaxoSmithKline, Johnson & Johnson, Merck & Co., Pfizer and Cephalon for various periods during 2009 and 2010.

ProPublica identified 13 UC Denver physicians whom drug companies reported paying to deliver promotional talks. Dr. Michael McDermott, director of endocrinology and diabetes practice, received $117,000 from Lilly.

In an e-mail at the time, McDermott said he was re-evaluating his participation.

Solutions, a health policy news website run by UC Denver's School of Public Affairs, first reported on the faculty meeting, noting that an internal review at the medical school found that 46 full-time faculty members had been paid by drug companies for speaking or consulting. Only four had sought permission from the school to do the work, as required by a 2008 policy.

Krugman attributed the lack of preapproval to a misinterpretation of the policy. "It has identified a weakness," he told ProPublica. "Some would call it a loophole. Others would call it just an unintended consequence of our language."

Until the policy review is complete, Krugman said he would not approve new speaking contracts. Arrangements previously approved could remain in place until the new policy takes effect, he said.

This week, The Denver Post also reported about the ethics reviews at the school and hospitals in the area.

These poor hospitals did not know a thing about this until Propublica told them.  Give me a call and I will line you up for a wealth creating investment in a New York bridge.  These hospitals make deals with hip replacement equipment manufacturers to stock their equipment only. Their executives rake in salaries and benefits in excess of $300,000 (reference the COO at a Ft Lauderdale Hosp).  They dischareg homeless and other poor people prematurely while doing unnecessary procedures for money.  And they do not know that their physicians take bribes from pharmaceutical companies?  I would punish my child if he came to me with such a lie, completely lacking in imagination and disrespectful of my 76 IQ.

Having spent three decades in the pharma/biotech sales arena there are a number of additional facts that you can add to your story.  First, many academic institutions pay poorly, and doctors who are in those environments use speaking to offset their lack of income.  Second, pharma is very smart.  For every new regulation, they create another entity to act as a buffer.  For instance, using third party organizations which purportedly are independent educational businesses, to fund / support specific talks directed at “educating” medical practitioners on their drugs.  Its done with a wink and handshake.  The third party, usually with strong pharma/biotech connections, contacts the pharma company indicating it has physicians wanting to speak in their area of interest.  The contacts usually know each other or have mutual acquaintances.  The money goes through the third party, who pays the speaker their honorarium, and invites the selected audience.  Its “hands off” the pharma / physician connection for both the physician and pharma company.  But the job gets done, and those that emphasize the points that pharma wants emphasized during their talk get asked back to speak again.

Michael-your comment was very good but I would suggest that you go back into this blog and look at the previous expose’ articles on this subject. I believe after reading them you will have some very interesting input that will help the author here go even further into this manipulation of the system.

As to these teaching hospitals revising their conflict of interest issues, hopefully they will be more sincere than our courts or our congress where heads are turned the other way for their brotheren on a daily basis without shame.

This is good news.  As a healthcare professional, I have seen first hand how the Pharma and Medical Device reps work and it is not a pretty picture. 

As the individual in charge of bringing tissue into the hospital, we required the staff physician to defend why the company that they wanted to provide this tissue.  It was astounding at how many decided that the actual manufacturer was no longer quite as important as they originally thought.  The medical facility I work for requires that physicians sign off that they do not have a relationship with a specific company, but they will certainly side-step the process. 

Propublica needs a high five for continuing to doggedly pursue this controversial process.

Question to micheal:  Those who work in academia do not a high salary: really?  Maybe as compared with physicians who are not interested in research and teaching, but they are compensated better than most Americans.  Salary is not the only compensation that academics receive, so that is a little smoke and mirror.  Consider the renumeration they get for scientific advancements they design and patent, writing books, etc.

A Fisher
Regarding academic salaries, when you consider the years of school:  bachelors, medical degree, fellowship, many an additional PhD, physicians join the workforce near 30.  If their interest is in academia, many associate professors with an MD degree on staff at major institutions are earning well under 100k per year, 50 - 70k in some major institutions.  So that would be an interesting fact to research, as it is a motivator to seek outside income.  I am retired recently, and have seen the good and bad from both sides. By and large academic physicians work harder than most, and are very very driven in their respective fields.  Yes those that publish, and design drugs that advance medicine are rewarded, but they don’t earn those rewards automatically, every year, from the beginning of their working life.  For some it never happens, and others may work for years before finding something significant.  In the mean time, they have their school loans to pay back (which are much larger than avg Americans). So, I think to categorize it as smoke and mirrors is broad brush thinking.  The point that needs to be focused upon is fair and balance presentations, and the money trail from pharma to any third party involved in medical education.

While my heart bleeds (to the accompanying sounds of violins) for these poorly paid academic and health care professionals, I’m sure they must have know, or should have known (research and all) the kind of salary they could expect.

Much of the rest of the country is on their knees trying to stay afloat but excuse me if I say the violins sound a little off-key.

Kevin A. McDonald

Jan. 19, 2011, 11:44 p.m.

Good for them, other institutions should follow suit.

These poor long suffering, sacrificial lambs who virtually give their life’s blood to hospitals!  I have not met one in 40 years whom is not in the throes of a Primary Care or Surgical residency.  Structures vary in many institutions and it is quite obvious that a Professor at a major Northeastern School has rewards different to those of a Prof. at Podunk General.  People do make choices and physicians are people.  Institutional employment provides a salary and benefits.  Faculty (private) practice, vacation, sabatical (to some), speaking engagements (of the non shill variety) and a host of other options are available to those who qualify. 
The average income of physicians in the USA is nothing over which anyone but the physician should weep.  Check with the Medical Group Management Association or any other group whose function is to advise on employment of this group and you will verify that the incomes of docs, from the Primary Care giver through to the highly controlled subspecialist paces docs in the top ten percent of earners in this country.  Are there outliers?  Yes!  There always are….on the low as well as the high side.  Like any other profession there are the lazy, the incompetent, the rude, the selfish and generically unacceptable.  Those are not the norm and may be found in any practice setting. 
  Propublica’s comments concern the takers of bribes (speaking fees for shilling a product) and the feigned ignorance of hospital administrators and Boards. Their deceit is harmful and worse.  They are far too many to be labeled as occasional variants.  Far too odious to be ignored…any longer.

Here is another consideration.  A great many of these talks by physicians are given at Continuing Medical Education conferences.  Generally, hospitals sponsor these conferences to help provide their medical staffs with the opportunities they need to stay current in their field and in medicine generally.  For most hospitals, the money available for these conferences is limited and often depends on pharmaceutical and other companies to pay the speakers a fair honorarium, not to mention the cost of travel, etc.

Without these sponsorships, most CME programs would be limited to local physicians.  While this is OK to a point, there is a need for physicians to be able to hear and interact with their peers from other cities and/or circumstances who are experts in a particular medical field.  To take away these sponsorships for teaching physicians is to limit their teaching mostly to their campuses. (Unless the universities are going to take up the slack and put up the money to have their faculty available for CME programs around the country.)

CME programs are under strict rules and guidelines.  For credit to be given, speakers cannot promote one company, drug or product. They can’t use slides and other materials that have a company’s logo, name or other promotional copy on them.  It is true that, like any company, the sponsors need to get something out of it, which they do by paying to display at the conference in a room occupied by all vendors including those who don’t sponsor a speaker.  Good CME programs enforce this and experienced speakers understand and abide by the rules.

The bottom line is that, as is usually true, throwing out the baby with the bath water is not the best way to handle this.  The universities are in the business of educating and they shouldn’t impose rules that over reach and hurt the CME process for all physicians.

Simple fix, put all physicians, medical teachers, specialists,technitions, etc. on fixed salaries, commensurate with their education levels and skill. Eliminate the the for profit insurance broker, shift the damages caused by lax operating procedures of heavy polluters back to THEIR doors, and voile’ the medical costs will be affordable to all.
As long as there is profit in unnecessary procedures, advertising the newest under tested drugs, over medicating, money for nothing insurance policies, and no culpability for infractions committed by industry, there is no fix for the medical debacle. Truly socialized medicine,not the half hearted attempt offered, is what is needed. If Drs. got paid the same for each patient seen, no matter if it is for sniffles or cancer, fat lip or heart transplant, citizen or not, the healthcare costs just might become commensurate with need, the educational loans less onerous.
No BOO’s necessary,or arguments about the quality of care that would create, Golly Gee Shucks, the quality of care being provided now is the best money can buy. Hopefully you can save your ass…ets from their greedy little hands. When your money runs out so do your chances.

Despondent-one

Feb. 1, 2011, 10:10 a.m.

Being a psychiatrist, I’ve seen this patterns for a while. During the Bush years the deregulations turned the sales into the Wild Wild West. My friends who speak for drug companies are good competent physicians. The are very likable and competent. So its a win-win. I do believe they are swayed. They are easier on the prescription pad, they believe in meds more than in personal change and they use polypharmacy to a greater extent. And our field is very subjective, it’s hard to argue with the results. Your remember the story about the Emory psychiatrist who lied on his application making a million in a few years. We all fork the bill. But it is at the heart of capitalism. Selling stuff. And in every domain the are multiple conflicts of interests. Sometimes we are told in unpatriotic to stay home and not spend. I remember from an older psychiatrist how he was going to Paris on the company’s money when the first antipsychotic became available in the 50s. And the colleagues in my country of origin still do it. I think regulators can do something about it, but in the end in about the basic Hypocratic oath and personal moral values.

I owe $300,000 in student loans.  I am $100,000 underwater on my mortgage.  I make $400,000 per year ($4000 per week after deductions) as a specialist physician in an academic medical center.  The private guy (same specialty) down the street makes $1.2 million per year - I know because he tried to recruit me.  Give me a break for doing an occasional dinner talk for a drug company for $1200 a shot 3-4 times per year.

There is an unacceptable degree of selfishness and greed within the sickness care business.  Much like the criminality in business (Banks etc), human life disregard (in so called law enforcement and legal) and intentional miseducation in the so called educational “system”, sickness care has its warts…lots of ‘em.  I agree that it can only be changed from the base upwards.  Forget about most of the so called centers of education when it comes to social change.  They have NEVER led any such movement.  Just as they behaved during slavery and Jim Crow they behave now.  The most radical thing they do now is to be silent.  Anti-social behavior is concentrated in their Boards and Administrations.  Just as the banks knew about Madoff’s Ponzi scheme, you better believe that Hospitals, Pharmaceutical companies and a host of other businesses carry enough of each others anti-patient behavior to fill volumes.  There are well meaning care givers and organizations but their will is outnumbered and out manoevred by their greedy colleagues.  ProPublica is on to a good approach.

This article is part of an ongoing investigation:
Dollars for Doctors

Dollars for Doctors: How Industry Money Reaches Physicians

ProPublica is tracking the financial ties between doctors and medical companies.

The Story So Far

ProPublica is investigating the financial ties between the medical community and the drug and device industry. In October 2010, ProPublica compiled the list of payments that drug companies make to physicians and built a publicly searchable database so that patients could look up their doctors.

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