Wednesday, September 13, 2006

Stanford's New Conflict of Interest Policy: No Coffee Mugs and Pens, But Consulting Contracts, Directorships, and Stock Options are Fine

With much fanfare, as reported by the New York Times, Stanford University announced it will "prohibit its physicians from accepting even small gifts like pens and mugs from pharmaceutical sales representatives under a new policy intended to limit industry influence on patient care and doctor education." Also prohibited will be "accepting free drug samples and from publishing articles in medical journals that are ghost-written by industry contractors. The policy would also apply to sales representatives from makers of medical devices and other companies, not just pharmaceutical companies. Company representatives would be barred from areas where patient treatment and doctor education occur...."

Dr Philip A Pizzo, the medical school dean, proclaimed, “We want to secure the public trust to value what happens in academic medicine.” Interviewed by the Los Angeles Times, he said, "we were really seeking to do the right thing. We want to set a standard."

On the other hand, " The new policy does not cover consulting agreements between faculty members and companies aimed at developing drugs or medical devices. Those are governed by an existing conflict-of-interest policy. Such interactions are especially important at Stanford, where many professors have been involved in starting or advising companies in nearby Silicon Valley." However, "a Stanford spokeswoman said having a financial interest is not necessarily a conflict if the faculty member is not providing patient care. "

That seems like a curious point of view, because a faculty member could have great influence on patient care without providing it directly. Stanford faculty, of course, teach students and residents. And they write articles in respected medical journals and given talks at national and international venue.

In fact, only two months ago, Paul Jacobs authored an expose of conflicts of interest at the Stanford medical school and teaching hospitals in the San Jose Mercury News. Some of the anecdotes reported in the series (see posts here, here, and here) 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.
  • Dr Pizzo defended the continuing involvement of Stanford and its faculty with commercial firms "to bring the fruits of university research to the public. This process has resulted in many medical innovations and advances that have improved the lives of millions of Americans."
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.
Is it "doing the right thing" to prohibit minor conflicts of interest affecting mainly trainees and junior faculty, while letting senior faculty and administrators preserve their large conflicts of interest? What sort of hypocritical "standard" does it set to prohibit junior faculty from being influenced by pens and coffee mugs when making clinical decisions, but allowing senior faculty to be influenced by five-figure consulting income, and seven-figure stock option holding when writing papers, speaking to national audiences, and teaching trainees?


Anonymous said...

Bristol-Myers and H-P's announcements concerning corporate behavior serve as a reminder that Enron was not an aberration. Led by Bill Frist MD, HCA is going private, removing a level of scrutiny concerning corporate practices. Our local nonprofit hospital refuses to release any information, not required by law, concerning it's pay scales for executives or other financial dealings.

As a business person I understand pens and coffee mugs are throwaways. Food buys you face time which can influence a persons behavior. Samples are used by many practices to supplement their patients medical needs due to income.

Stanford has simply tried to appear to make an effort to control conflicts while leaving financially lucrative contracts in place for the university and it's senior staff. All this is teaching younger staff, in all walks of business is, game the system, and the only thing wrong is getting caught.

Steve Lucas

Anonymous said...

I agree this policy is risible. I wonder if this is simply Ivy league moral relativity and arrogance at work.

The Ivy League has a bad track record in a number of areas.

e.g., "At universities, little learned from 9/11" in the Boston Globe.

InformaticsMD said...

Universities do seem to have a problem with ethics in a number of spheres. See here and here, as well as sites like this, as examples.

Donald Kagan at Yale penned this the other day: "As Goes Harvard" in which he observes:

Both Harry Lewis and Derek Bok have entered a devastating judgment on contemporary university leadership—more devastating, and more self-incriminating, than they appear to know. For all their hand-wringing, and for all their veiled criticism of faculty committees and even of professors as a class, neither of these seasoned administrators is prepared to level a direct indictment of the real rulers of colleges and universities today [the imperial faculty].

On wonders who the real emperor is. Sometimes the problems seem to be uniformly spread.

Anonymous said...

Im just glad to say that looking into UCLA I have figured out what it is that I want to do. Becoming a position in the marketing career is something quite intense that I would definitely love to get into.
I also took into note about how universities have different payment options for different races. But do you really call that being racism?