Park Nicollet Health Services has become the first health care system in Minnesota, and one of an elite group nationally, to require doctors to publicly disclose their financial relationships with drug and medical device companies.

This week's move by Park Nicollet is designed to allay concerns that these relationships -- often forged with thousands of dollars in free meals and travel, speakers' fees, royalties for inventions and professional consultation payments -- pose a conflict of interest by influencing doctors' treatment decisions. Drug and device companies defend the payments, saying doctors' expertise is needed to make their products better.

Typically, the relationships are invisible to patients, but now those treated at Park Nicollet can begin viewing the details at

"I think that transparency is a terrific disinfectant for any conflicts, things that would interfere in the trusting relationship that patients depend on from our physicians and care teams,'' said Dr. Samuel Carlson, Park Nicollet's chief medical officer.

Minnesota has been a trendsetter in physician disclosure, but Park Nicollet's move could accelerate that trend. A 1993 state law that requires pharmaceutical companies to disclose their relationships with Minnesota doctors is getting a fresh look from legislators, who might retool it to add medical device companies.

Meanwhile, a task force at the University of Minnesota's Medical School recently recommended that doctors, researchers and students publicly reveal their industry ties. Most other major clinic systems in the state, including Mayo Clinic and Fairview Health Services, have internal disclosure rules, but have not taken the step of public disclosure.

With more than 1,400 doctors and clinicians at Methodist Hospital in St. Louis Park and in its network of 25 clinics in the Twin Cities, Park Nicollet appears to be at the forefront of a national trend of financial disclosure in medicine.

"Relationships with industry are ubiquitous in all aspects of medicine, medical education and medical research,'' said Dr. Eric Campbell, an associate professor of health care policy at the Harvard Medical School. "There's not a single aspect of medicine today that is not touched by drug, device and biotechnology companies."

Campbell said disclosure is a key component in monitoring these relationships. "You can't manage what you don't know about,'' he said.

In December, the Cleveland Clinic, a prominent research center in Ohio, appeared to be the first major institution nationally to post doctors' financial relationships with drug and medical device companies on its website. Legislation requiring disclosure by industry is pending before Congress.

Some companies, including Merck, Eli Lilly, and Edwards Lifesciences say they will publicly disclose payments to doctors this year. 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.

But Park Nicollet appears to have beaten many to the punch.

"It's been a growing expectation from the community and our patients that there be transparency,'' said Carlson, who noted the relationships "are not necessarily bad, in fact, we have much to gain from industry."

Disclosure not universal

But not every health care system in Minnesota believes overt transparency is the best way to manage these relationships. At the Mayo Clinic in Rochester, for example, patients currently are informed individually if their doctor has financial ties to a drug or medical device company.

A spokesman for Allina Hospitals and Clinics says doctors who practice at its hospitals, including Abbott Northwestern in Minneapolis and United Hospital in St. Paul, are not employees, so mandating disclosure would be difficult. However, Allina's 65 clinics in Minnesota employ about 745 doctors who must disclose their relationships to their employer and abide by a conflict of interest policy.

Park Nicollet is requiring disclosure by all credentialed health care professionals, including doctors, physician assistants, nurse midwives and physical therapists. The amounts are listed in $5,000 increments on the website, which will be updated quarterly. It also includes doctors who conduct research at the Park Nicollet Institute, which conducts about 200 clinical trials a year.

Currently, about 53 doctors and staff are listed on the site, but the number will increase on a rolling basis as professionals are issued credentials.

Doctors to be monitored

These reports will be reviewed monthly by Carlson and Susan Zwaschka, Park Nicollet's general counsel and chief compliance officer. If a relationship surfaces that violates Park Nicollet's conflict of interest policy, then the staff member will be told to "resolve the situation." If the conflict is not resolved, then the staff member could be dismissed.

Sometimes doctors forge relationships with companies that may not violate a conflict of interest policy, but raise questions nonetheless. This month, news outlets reported that Dr. Thomas Zdeblick, a surgeon and researcher at the University of Wisconsin, received more than $19 million in payments over a five-year period from Fridley-based Medtronic Inc. to develop and promote the company's spine products. Zdeblick reported the relationship to the university, but not the dollar amount, saying only that he made more than $20,000.

If a similar situation occurred at Park Nicollet, Carlson said, "it would instantly rise to the level of serious examination. The entire issue is framed by the perception of our patients. Are the royalties so substantial that our patients would question whether the physician can make impartial decisions on their behalf? We would have to look at all the issues and make a decision."

Janet Moore • 612-673-7752