Editorial: U should lead on conflicts of interest

  • Updated: August 15, 2009 - 10:43 PM

Disclosure, leadership needed to police doctors' ties to industry.

Dr. David Polly

Dr. David Polly

Better known as a leading health care reform architect, Iowa Sen. Chuck Grassley is also pushing for an overdue overhaul on a different medical front: disclosing physicians' lucrative financial ties to industry. Recently, the University of Minnesota found itself swept up in Grassley's crusade.

The Iowa Republican sent a stern letter to U President Robert Bruininks, one of about 30 such inquiries Grassley has made nationwide. The missive opened a window on spine surgeon Dr. David Polly's eyebrow-raising consulting relationship with Medtronic, the Twin Cities-based medical device manufacturer. Among the findings: Polly, a medical school professor, received well over $200,000 a year from the company for four years running. Polly's total compensation? About $1.2 million between 2003 and 2007, an amount one expert called high, but not an "order of magnitude different than what a lot of doctors are getting.''

Therein lies the problem. In today's world, where states like Minnesota look to universities and the burgeoning biomedical field as economic engines, collaborations between researchers and industry are increasingly common. Such cooperation is critical in bringing scientific breakthroughs to the marketplace. But it also can create troubling conflicts of interest, potentially allowing a doctor's financial interest to influence patient care. Safeguards have not kept pace with the proliferation of these consulting arrangements.

"We have not been interested in regulating this; we've been interested in stimulating it,'' said Art Caplan, a well-known University of Pennsylvania medical ethicist. "Management of this area has been completely lacking at every university.''

Polly's payments illustrate why more oversight is needed locally and federally. Among the most unsettling revelations in Grassley's letter is that U officials did not know how much Polly earned from Medtronic. The current policy, which is under review, only requires Polly and other physicians to report that they have received outside payments of $10,000 or more a year. Not even the U's own Conflict Review and Management Committee -- which reviewed Polly's ties to Medtronic and recommended a conflict of interest "management plan" for him in 2006 -- knew Polly's total compensation.

How is it possible to assess a conflict of interest, much less manage it, if officials don't know how much money is involved?

The university should have recognized this policy's shortcomings and reacted before receiving Grassley's embarrassing letter. Frank Cerra, the U's Academic Health Center senior vice president, and Mark Rotenberg, the U's general counsel, told the Star Tribune Editorial Board last week that they are pushing for a stronger universitywide conflict-of-interest policy. But they added that the U is limited by Minnesota data privacy laws in what faculty income information it can make public. Changing these state laws is difficult, as we saw this year at the Minnesota Legislature when an attempt to disclose public employees' outside income faltered.

Still, the U still could have collected the information for internal use and should have done so.

A national law is needed making public industry payments to doctors. Grassley's Physician Payments Sunshine Act -- which Cerra and Rotenberg voiced welcome support for -- is a sensible step that would make doctors' industry ties more transparent. It would require drug, biologic and medical device manufacturers to report certain gifts and payments to physicians and compile the information in a database.

The Sunshine Act is a good start but not a solution. Once the needed information is available, institutions will still have to consider how to manage these conflicts, and define what is acceptable and what is not. Too many medical institutions have shied away from this touchy topic. The University of Minnesota medical school should seize the opportunity provided by Grassley's high-profile letter to not only set its own new standards, but lead the way forward nationally.

  • TIES THAT BIND?

    A groundbreaking 2007 New England Journal of Medicine paper found physician-industry relationships widespread:

    • 94 percent of physicians surveyed nationally reported some kind of financial gift or payment from the pharmaceutical industry. Most of these involved free food or free drug samples.

    • 35 percent had been given some compensation by industry to cover costs for continuing medical education or professional meetings.

    • 28 percent were paid for consulting, lectures or enrolling patients in medical trials.

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Dr. David Polly