Medical school conflicted over disclosures

  • Article by: JANET MOORE , Star Tribune
  • Updated: December 28, 2008 - 10:38 PM

Opinions vary on whether those proposing changes in the University of Minnesota's conflict-of-interest policy should themselves be free of conflicts.

The disclosure of financial relationships between doctors and drug and medical device companies has become an issue of fevered debate.

That debate hasn't escaped the University of Minnesota's medical school, which is wrestling with a proposed new policy governing those relationships -- and the embarrassing revelation that Dr. Leo Furcht, co-chairman of the task force crafting the new rules, was disciplined for a violating the U's current policies.

But do others on the committee have financial relationships with drug and medical device firms?

The university requires faculty to disclose financial relationships of more than $10,000. Earlier this year, the Star Tribune requested those disclosures under the state's public records law, but the university declined, saying they were private personnel data.

In its draft report, the conflict of interest task force recommended that medical school doctors and researchers disclose their financial relationships with industry on a public web site. When the Star Tribune asked for disclosures of the 26 members, the U again declined.

So the Star Tribune asked the members directly. Sixteen responded (one could not be reached).

Ten said they had nothing to disclose and six reported various relationships with drug and medical device companies -- from royalties for inventions to grants for clinical research to equity stakes in start-up firms. (Furcht did not respond.)

Medical School Dean Dr. Deborah Powell said this month that she chose members for the task force who had a wide swath of experience, including a journalism professor, a bioethicist, the head of a local medical device and biotech organization and a medical school student.

She said it was important to include medical school representatives who had experience dealing with industry.

Several task force members with industry ties responded enthusiastically with their own disclosures. "This is a discussion that has to occur, and it has to occur in front of the public," said Dr. Matthew Putnam, a U professor of orthopedics who serves on the task force. "The whole point of the matter is what's best for the patient.''

Putnam has patented technologies in his field, received royalties for his inventions, served as a paid consultant for several medical device companies and has been involved in several fledgling start-up companies. "The value I lent to the [task force] group did, in some ways, come from the fact that I have invented things,'' he said.

The task force's draft recommendations have been circulated among medical faculty and students, and the dean has received hundreds of comments. A smaller committee will distill the recommendations, some of which may be approved by the Board of Regents. Work on the report likely will continue through next spring.

Public disclosure on the Web

The proposed policy bans gifts from industry, faculty ghostwriting in medical journals and elsewhere on behalf of industry as well as industry funding for courses that keep faculty updated in their fields. One proposal with wide appeal calls for public disclosure on the Internet of industry relationships.

"It's gaining a lot of interest and traction with the faculty. They see it as a way to make it very easy to enter information, and to classify it,'' Powell said. "I think it will meet our needs for better disclosure.''

But a bioethicist at the U said disclosure alone is not enough, and that a task force revising rules on financial relationships with industry should itself be free of conflict of interest.

"The idea is that as long as these relationships are made public, the problem is solved," said Carl Elliott, a professor at the U's Center for Bioethics, who is not a member of the task force. "How much good does that really do? Is a public bribe really all that much better than a secret bribe?" He said Furcht should be removed from the committee.

Several members of the committee said privately that Furcht should have disclosed that he was disciplined, but few thought the recent revelation will change the crux of their final report.

The kinds of relationships between doctors and industry vary. Drug companies often fund clinical research of their products at medical schools. But in the past year, star researchers at top institutions, including Emory and Harvard universities, have come under fire for failing to report or for under-reporting financial relationships with drug firms.

In some cases, these relationships are encouraged by the university, especially those that commercialize homegrown technology or drugs that result in the university reaping a cut of the royalties.

Medical device companies long have argued that relationships with doctors ensure that their products are safe and effective. They pay millions of dollars for such information, although some of these relationships recently have prompted investigations by the Justice Department and Congress.

Many are changing policies

The U is not alone in wrestling with these confounding, often controversial, relationships. Earlier this month, the Cleveland Clinic said it will add the financial disclosures of its doctors and researchers on its website, including equity stakes, royalties and consulting arrangements of over $5,000 a year.

The Mayo Clinic in Rochester doesn't plan to post that type of information on the Internet, said Marianne Hockema, administrator of the Mayo Clinic's conflict of interest review board. Currently, patients at Mayo get a packet of information before treatment that includes information about their doctors' ties to industry. "If they don't feel comfortable, they can call a telephone number and we happily tell them of any relationship their doctor may have."

Some drug companies, including Merck and Eli Lilly, say they will publicly disclose payments to doctors in 2009. Heart valve maker Edwards Lifesciences said last week it will do the same. Following a settlement with the Justice Department, the nation's top makers of hip and knee implants post financial relationships with doctors on their respective websites.

A hodgepodge of states, including Minnesota, require drug companies to disclose their payments to doctors in those states. Meanwhile, Sen. Charles Grassley, R-Iowa, has co-sponsored legislation requiring all drug and medical device companies to post their financial relationships with doctors on a national website.

Janet Moore • 612-673-7752

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