U of M med school ethics plan aims to curb influence of medical industry money

Most of the 25 people on the conflict of interest task force were University of Minnesota medical insiders - doctors, researchers and medical students. But at least one person came in with a different perspective.

"I was probably the most outside outsider, maybe the only real outsider on this committee," said Gary Schwitzer.

Schwitzer isn't a medical doctor, he's a professor in the U of M's school of journalism.

Schwitzer has spent a lot of time investigating conflict of interest in the medical field in his years as a health journalist. But this time he wanted to look at the issue through the eyes of consumers.

In general, Schwitzer said most consumers have no idea what happens between doctors and pharmaceutical companies, whether it's in Minnesota or elsewhere in the country.

"If we went out on the street and told people some of what went on, they would be shocked," he said.

Shocked at what Schwitzer considers the cozy deals between pharmaceutical companies and doctors. What are consumers to think, he asks, when a doctor receives thousands of dollars in fees to act as a consultant for a pharmaceutical company, and then prescribes drugs made by that same company?

Those are some of the potential conflicts of interest task force members considered in their recommendations to the university, Schwitzer said. "This is a beginning...(it) may have raised more questions that it answered," he said. The recommendations are in draft form at this point and haven't been released publicly. Minnesota Public Radio news obtained a copy of the document.

The plan does contain bans on gifts to doctors, but it does not stop doctors from accepting paid positions as consultants for medical companies. Rather the recommendations focus on making those relationships transparent.

One recommendation would require university doctors to disclose all financial involvements they have with companies. Currently anything under $10,000 isn't considered a "significant financial interest", and doesn't have to be reported.

Another recommendation would require doctors inform patients what financial relationships they have with a drug company before they treat them with a product from the same company.

Theplan would also order the the medical school to create a website to show the public how the University manages issues of conflict of interest.

"That would be useful, but it wouldn't be as useful as saying, 'The payments are not allowed'. That would be much more useful," said Dr. Carl Elliot, a professor in the University of Minnesota Department of Bioethics.

Elliott wasn't on the task force. But he's seen the recommendations and doesn't think they go to the root of the problem.

"If the problem is that you think getting all this money from a pharmaceutical company is a conflict of interest, than the solution is to eliminate the money," Elliot said. "The solution is not to say, 'Alright you can still take the money, but you have to report it to someone'. I can't see how that's going to fix anything."

It's hard get a handle on the problem, or to know if there really is a problem, because it's difficult to track down how much money doctors and researchers at the U of M get from drug and medical firms.

A report from the Journal of the American Medical Association in 2007 showed doctors throughout Minnesota received nearly $31 million in payments from pharmaceutical companies from 2002 to 2004.

Dr. Deborah Powell, dean of the university's medical school, declined to comment on the recommendations. She directed questions to task force co-chair Dr. Leo Furcht.

"I'm sure that many say they don't go far enough and others that would say it's over-reaching," Furcht said.

Furcht calls the recommendations a first step toward creating a more a transparent, open culture when it comes to financial deals between doctors and medical companies.

Furcht claims relationships between the medical school and medical companies is a necessary part of developing new treatments and devices.

He says ending those relationships outright is the not best option.

"Some patients see that their physician is working closely with a large, highly regarded company in the field, that they may actually be better than the doctor down the street and it's actually the inverse of what you might suspect."

Even so, Furcht admits industry interests and medical education have become too intertwined.

"I think that what the field is calling for is revisiting this and essentially unwinding some of these relationships that are frankly unnecessary and put the relationship on a more higher plane and a more professional level," he said.

One place the university task force is attempting to unwind industry from medicine is in continuing medical education, or CME.

Doctors from across Minnesota attend CME classes in order to keep their licenses current. Many of those continuing ed classes are paid for by drug firms or medical companies.

Last year at the University of Minnesota, medical industry money paid for half of the school's $2.3 million continuing medical education budget. The U of M task force has recommended that within five years, no industry funds be used for CME.

U of M bioethicist Dr. Carl Elliot applauds that move. It may be tough for some doctors to deal with, he said.

"They've come to see that as a perk of the job, that their expenses, their registration fees, their entertainment, their meals will all be subsidized by someone who's willing to buy their good will. It's a clear conflict of interest we should just do away with it," he said.

The U of M isn't the only medical school dealing with the issue of conflict of interest. Schools across the country are in the process of rewriting their polices. The impetus was a report in 2006 in the Journal of American Medical Association that called for colleges to revamp their conflict of interest policies to avoid any influence by pharmaceutical companies on patient care, education or research.

That was followed by a New York Times report in June 2007 that raised questions about four Minnesota psychiatrists who received payments from pharmaceutical companies even after they were disciplined by the state medical board. At least one had spent time teaching at the U of M.

A task force at the University of Pittsburgh's medical school recently rewrote that school's conflict of interest policy, and it's considered one of the best in the nation.

The new policy doesn't ban arrangements like consulting contracts between doctors and companies, but it requires prior approval from the university, said Dr. Barbara Barns, who's in charge of industry relationships at the school. "Those agreements are reviewed by the appropriate department chair or administrator and then by our legal counsel, who then render advice to the appropriateness of the relationship," Barns said.

The University of Pittsburgh medical center has also banned industry support of continuing medical education.

Fourth-year University of Minnesota medical student Josh Lackner, who served on the University of Minnestota task force, welcomes restrictions on the medical industry's involvement at the university. But Lackner doesn't want the effort to stop with the draft recommendations.

"I think there needs to be an ongoing evaluation of what's going on. And I think one committee's policy recommendations while good are not the final answer, it's needs to be the beginning and not the final word," Lackner said.

The recommendations have been emailed to members of the university's medical school community along with a request for input. University of Minnesota medical school leaders say they don't have a timeline to act on the recommendations, but would like to see some action taken in the next year.

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