Wednesday, October 11, 2006

The American Medical News Reports Stanford's New Conflict of Interest Policy in a Vacuum

This week's American Medical News print edition featured a front-page article on Stanford's new conflict of interest policies (available here, requires subscription.) As we noted earlier, this policy bans all "personal gifts" to physicians, even as small as pens or coffee mugs, from pharmaceutical or device companies; all funding to attend CME events; all direct funding to students and trainees; and sales representatives in patient-care areas or visiting physicians without prior appointments.

The American Medical News article suggested that the only concerns raised at the school about the new policy were related to loss of funding for educational events, and the need for students to learn how to deal with drug representatives.

It contained not a hint that there had recently been other issues raised about conflicts of interest at Stanford.

However, we have previously noted the irony of Stanford's new policy in light of the San Jose Mercury News investigation, written by Paul Jacobs and published in July, which showed that many Stanford faculty and leaders are affected by conflicts of interest that are much more intense than those created by accepting free pens, mugs, and lunches (see posts about this investigation here, here, and here).

Some of the data and cases reported by Jacobs in the series were:
  • "The school's 700-plus faculty members last year disclosed 299 potential conflicts of interest related to their research, according to figures provided by Stanford."
  • "Potential conflicts occur throughout the school's ranks. More than a third of the school's administrators, department heads and other leaders -- at least 26 out of 67 reviewed by the Mercury News -- have reported outside financial interests related to their research within the last four years. "
  • "One researcher has founded six companies, most based on research that came out of his own lab. He is a managing partner of a venture capital firm focused on medical research and sits on the boards of several other companies. "
  • "And the physician who until January chaired the department of gynecology and obstetrics is a longtime director of Wyeth, which manufactures controversial hormone replacement therapy for women -- therapy she defended in 2002 when potentially serious health risks were emerging."
  • The Associate Dean for Research "holds stock options in and is a consultant to MedImmune, which makes an influenza vaccine he is studying under a federal grant." He also "a paid member of MedImmune's scientific advisory board and holds stock options...."
  • The Chair of Psychiatry is currently running a federal grant on mifepristone as a treatment of depression, and has previously been the senior author of two related articles. Although he acknowledged that he helped found and still has a "financial interest" in Corcept Therapeutics, he did not fully disclose that he "took a seat on the board of directors and a part-time post as chairman of the company's scientific advisory board, a job that now pays him $60,000 a year. He and his family were granted 3 million Corcept shares for $1,000 -- today worth nearly $12 million." He had been accused of making exaggerated claims about Corcept's products in scholarly articles which did not reveal the extent of his involvement with the company.
So at Stanford, a junior faculty member will not be able to accept a coffee mug with the Wyeth logo, while a senior faculty member can serve on the board of directors of Wyeth.
I would have hoped that the American Medical News reporter might have dug around a little to determine the background of Stanford's new policy. Juxtaposing it to the results of Paul Jacobs' previous investigative reporting produces a very different impression than simply reporting the new policy in a vacuum.
In my humble opinion, the problem is not that the Stanford policy is too strict. Instead, I submit that the policy is much too tough on students, interns and residents, and junior faculty, given how leniently it treats senior faculty and academic leaders. If the conflict causes by accepting a mug with a company logo is so grievous that it cannot be tolerated, why is it acceptable to serve on the board of the same company?
But maybe the operative slogan was "do as I say, not as I do."
It's a pity that the American Medical News reporter failed to dig up the facts needed to appreciate these ironies.

1 comment:

CL Psych said...

Great story! I appreciate your coverage of psychiatry, where I believe you are referring to Dr. Alan Schatzberg at Stanford. I may have to run a post on him, since I've already been discussing another highly industry-entangled psychiatrist (Charles Nemeroff), who is also involved with Corcept. Keep up the excellent work...

Clinical Psychology and Psychiatry