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Medical Schools Plug Holes in Conflict-of-Interest Policies

Reacting to ProPublica’s Dollars for Docs coverage, Stanford and other schools discipline doctors, rewrite policies and increase scrutiny of drug-industry ties.

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Stanford University, pictured above, disciplined five faculty members at its medical school for violating school policy by giving paid promotional speeches for drug companies, according to a university spokesman. (Flickr user: janandersen_dk)

Stanford University has taken disciplinary action against five faculty members at its medical school after determining they violated school policy by giving paid promotional speeches for drug companies, a spokesman said.

The move followed a ProPublica investigation in December that found Stanford and other teaching hospitals weren't enforcing their own conflict-of-interest rules.

At Stanford, which has one of the nation's toughest policies, ProPublica identified more than a dozen faculty members—including medical staff leaders—who were paid speakers.

Paul Costello, a Stanford spokesman, declined to identify the disciplined faculty members or discuss their penalties. But in a written statement he said the "actions are significant" and have affected or could affect the doctors' compensation or positions.

Stanford is one of several medical schools that took action against faculty members, overhauled conflict-of-interest policies or provided additional education to staff members following ProPublica's report.

Conflict-of-interest policies have become increasingly common at medical schools and teaching hospitals, reflecting concerns that promotional talks undermine the credibility of both the physicians giving them and the institutions they represent.

Yet when it comes to enforcing the policies, ProPublica found, the schools largely have relied on the honor system, allowing physicians to interpret the rules as they see fit.

We found physicians who were violating school policies by comparing staff lists of a dozen medical schools and teaching hospitals with our Dollars for Docs database. The database contains the payments publicly reported by seven drug companies for speaking and consulting by doctors. (An eighth firm has since been added; ProPublica will publish an update to the database in coming weeks.)

Among them was Dr. Alan Yeung, Stanford's chief of cardiovascular medicine, who earned $64,000 from Eli Lilly & Co. in 2009 and 2010. Yeung was also the vice chairman of the Department of Medicine but left that position in February, Costello said. He declined to say whether the move was related to Yeung's violation of the policy.

Yeung did not respond to a request for comment. In an email last year, Yeung said he had stopped speaking for Lilly. "I take full responsibility for this error," he said.

At the University of Colorado School of Medicine, the executive committee approved new rules this week explicitly prohibiting physicians from participating in drug company speaker's bureaus.

The medical school's 2008 policy banned faculty from speaking on behalf of companies if "the content of the lectures, slides, references or educational handouts is subject to approval by industry representatives." But university officials said some faculty apparently didn't fully understand it.

The new rules "clearly prohibit participation in marketing" but allow appropriate "research and educational opportunities," spokeswoman Jacque Montgomery said in an email.

University of Colorado officials interviewed the 13 medical school physicians identified by ProPublica as paid speakers and "accepted their good faith interpretations of the policy," Montgomery said. None were terminated or suspended, she said.

The medical school's dean plans to launch an educational campaign to ensure faculty members understand the new rules.

The Association of American Medical Colleges, a trade group, does not track how its members enforce conflict-of-interest policies. But the issue has become a hot topic, said Heather Pierce, the group's senior director for science policy and regulatory counsel.

Among schools that have checked their faculty against drug company databases, she said, "the number of truly problematic situations is relatively small."

Changes in federal rules and laws may require even more disclosure of payments to medical school faculty—and potentially more monitoring by school officials.

The National Institutes of Health is formulating rules that may require schools to disclose researchers' conflicts of interest online. As it stands now, a federal law will require all drug and medical device companies to publicly report their payments to physicians beginning in 2013.

"Our member institutions are continuing to work to ensure that their policies best reflect their practices, all toward the goal of ensuring that physicians and researchers maintain public trust," Pierce said.

Among other schools identified in ProPublica's story last year:

  • The University of Pennsylvania said it is in the process of clarifying its policy after ProPublica found 20 Penn speakers in its database.

    Penn's 2006 policy states that faculty "should not participate in industry marketing activities." Penn's chief medical officer, Dr. P.J. Brennan, had said he interpreted that to prohibit delivering drug-company lectures, but in a recent email, he said the clarifications will make this explicit.

    Susan Phillips, chief of staff for Penn Medicine, said no faculty members were disciplined, but there is now a "heightened awareness of the policy and what it means."

  • The University of California, San Francisco, said its compliance office has looked into about 15 possible policy violations since ProPublica's article, but spokeswoman Amy Pyle said she could not discuss the outcome of the reviews, even in general.

    In a statement, Pyle said the school is beefing up its conflict-of-interest office and is in the process of creating a central system to track faculty and employee conflict-of-interest disclosures. The school also continues to educate faculty members about its policy, she said.

  • The University of Pittsburgh said it evaluated the contracts of 22 faculty members ProPublica identified as speakers. "All potential instances of non-compliance with our policy are investigated and appropriately addressed on a timely basis," said Dr. Barbara Barnes, an associate vice-chancellor in charge of industry relationships, in a written statement. "We are also adding additional resources to help us educate employees about the requirements of the policy, to provide consultation on specific issues, and to monitor compliance."

    Spokeswoman Wendy Zellner declined to say whether any faculty members had been disciplined.

Trisha Torrey

May 19, 2011, 12:17 p.m.

An excellent reminder that having a policy, enforcing a policy, and trusting the people whose wallets are affected by the policy to self-enforce are often mutually exclusive.

I’d love to see Pro Publica take on the many state licensing databases that allow providers to report their own malpractice or discipline. Who’s minding those stores?

You folks rock.  Thanks.

Trisha Torrey
Every Patient’s Advocate
http://www.EveryPatientsAdvocate.com  and Patients.About.com

Thank you Propublica for the great work you are doing on corruption in medicine?  I hope this is just the beginning.  You’re making a difference.

Patrick Courneya

May 19, 2011, 6:07 p.m.

Thank you for this and the other fine work you are doing.  I love your model of journalism supported by the public served.  I appreciate your giving this topic attention.  As a member of a family physician group that became tired of the barrage of marketing delivered in our offices, we completely stopped all “drug rep” visits and sampling over 20 years ago.  Despite the loss of this important “educational” service provided by the pharmaceutical industry, we have been and remain one of the top performers in outcomes for our diabetic and heart disease patients in publically reported measures.  I have fallen victim to the recommendations of respected physicians giving lectures I much later learned were paid speakers for the industry.  I fear my enthusiastic use of medications in response to those lectures could have harmed the patients I am dedicated to serving.  I become angry just thinking about it.

Keep up the great work!

I’d love to see Pro Publica take on the many state licensing databases that allow providers to report their own malpractice or discipline. Who’s minding those stores?
I fear my enthusiastic use of medications in response to those lectures could have harmed the patients I am dedicated to serving.
Anyway thank for your great article

href=“http://www.drumsupplies.us/ludwig-drum”>harry65</a>

dr.r.r.naik@gmail.com

May 20, 2011, 8:24 a.m.

American medical system is highly respected world over, and shall remain so for times to come by. There isn’t an iota of doubt. In every profession a handful of professionals resort to short cuts and bring disrepute to the profession.The common public should rest assured that there is a very strong ethical control over all the members of the medical profession. It is noticed with a sense of immense pleasure and pride that the allegations are not denied, even by institutions of such great repute and assured of remedial measures. This is where the American Medical system deserves the respected bestowed on it.Hope things will settle down. It is a great public service by Pro Publica. The public on their part should take these types of episodes in their stride because before a drug in put on sale, or a medical appliance is permitted for public consumption, a very stringent array or tests are conducted. This is a case where a number of equally effective products are available, a practitioner has chosen to recommend a particular brand, in preference to other equally effective brands on the market.So far as this decision is concerned there is nothing unethical. But encashing this decision is wrong from professional point of view, This is an ethical fault not a technical fault. Hence the public need not fear of adverse consequences to their health.

Trisha Torrey

May 20, 2011, 8:41 a.m.

Excuse me, Dr. R. Naik…  what rock have you been living under?

Deborah Lagutaris

May 20, 2011, 6:07 p.m.

.(JavaScript must be enabled to view this email address) is a shill most likely in the pay of an astroturf PR company, or even more pathetic, an unpaid right-wing troll.  I vote for paid shill.  The text is polished, grammatical, properly spelled, and rhetorically complex.  An unpaid troll would more likely be less polished.

Interesting how educational institution executives cleverly draft rules that apply to others while not themselves or their institutions at large. 

This pharmaceutical industry focus and disciplining these faculty members seems to me to be a little on the hypocritical side.  If the intent is to eliminate conflict of interest, Stanford and other institutions should just eliminate all financial or in-kind support from any industry, not just pharmaceuticals and devices.  Any individual or group (department) relationships with commercial entities should be considered a potential for conflict, including participation on any paid company advisory boards or Board of Directors.  In fact, any consulting or advising ought to be done for free (including paying there own expenses to participate) to avoid any impression of impropriety. I wonder how much other faculty members are making in compensation consulting or speaking for other industries that could also represent conflicts or at the very least be inappropriately implied endorsements by Stanford.

These pharmaceutical industry speaking engagements are small potatoes compared to the amounts of money spent at these institutions, often going to specific departments and principle investigators, to support staff and institution imposed overhead, for clinical trials.  Oh, and let’s not forget the “unrestricted” $3 million CME grant Stanford decided to take from Pfizer after publicly expressing concerns about the financial influence of the pharmaceutical industry. 

Maybe there should be a look at potential conflict of interest situations throughout the institution, starting with executive and administrative departments.

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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