Although the Stanford University School of Medicine already has one of the most comprehensive policies in the country governing the interactions between academic faculty and the medical industry, yesterday, the rules got stricter.
On Monday, the University planned to introduce a rule that would prohibit its volunteer teaching staff — called adjunct faculty — from giving paid speeches drafted by the makers of drugs or medical devices, according to the New York Times.
The policy, enacted in 2006, is intended to limit potential industry influence on day-to-day clinical practice and medical education, according to a Stanford press release. As of March 15, 2010, the 660 community physicians who serve as adjunct clinical faculty at the Stanford University School of Medicine now must abide by the medical center’s policy on industry interactions. This kind of policy seems extremely harmful to physicians in training and patients because it prevents adjunct clinical faculty— community physicians who volunteer their time— from teaching at the school if they have ties to industry.
Prior to last week, Stanford’s policy primarily governed full-time faculty members, because Stanford did not want to restrict the practice or income of unpaid adjunct faculty members, Dr. Pizzo said. He didn’t answer however, how Stanford will be able to find or pay for physicians to work at the University? Even more troublesome, what kind of experts will they be able to use to teach physicians, residents, and medical students, and to work with patients if they have no kind of clinical or research experience with industry?
Specifically, the new rules prohibit faculty members from participating in industry speakers’ bureaus in which drug and medical device makers pay a physician to give company-prepared speeches to doctors about company medical products. The policy also prohibits Stanford faculty members from accepting free gifts, including drug samples for patients.
The new policy also bans industry representatives from patient-care areas and prohibits faculty from publishing articles ghostwritten by industry representatives, along with other provisions.
Despite these new restrictions, Dr. Philip A. Pizzo, the dean of Stanford medical school, noted in an interview that the medical school welcomes “interactions with industry that are positive and collaborative.” Contrary to his belief that such interactions are “positive and collaborative” he still feels that there is a “line that should not be crossed.” In order to prevent physicians from crossing this ‘imaginary’ line, Dr. Pizzo asserted that the medical school had to prohibit full-time and part-time faculty from engaging is in marketing.”
Part of his reasoning came from a NYT “article about an adjunct faculty member who had earned almost $75,000 in six months last year as a speaker for the drug maker Eli Lilly.” Such a response seems burdensome considering it is only one case and Lilly now publishes a quarterly database that lists the fees paid to individual physicians for speaking and consulting work on behalf of the company.
The medical school also cited being “worried” that members of the public might not understand the difference between a full professor, who was required to abide by the school policy, and an adjunct professor, who was not required to follow the policy but still carried a Stanford title. It seems that a simple press release stating the difference may have been more in order then simply throwing everyone under the bus.
Interestingly, we have already seen the effects of these kinds of policies at Harvard Medical School, when asthma specialist Dr. Lawrence M. DuBuske resigned from his job at the Brigham and Women’s Hospital in Boston, according to The Boston Globe. Accordingly, Dr. Pizzo has already predicted that adjunct may also choose to separate from Stanford instead of following the policy.
While Dr. Pizzo believes that a few cases demonstrate a “gradual deterioration in how physicians have been perceived,” he is merely exaggerating. Trying to exclude physicians who donate and volunteer their time to educate physicians and help patients based on their valuable experience with industry is problematic. There are strict guidelines regarding disclosure and transparency of such work already, and numerous CME programs ensure that physicians are not “marketing” at programs. With physicians likely to continue working with industry, the impact on Stanford’s Medical School remains uncertain.
What also remains uncertain is why Stanford went from saying it is not “appropriate to intrude in the private affairs of doctors since they all have private practices,” to it being necessary. It is also hard to believe that physicians who make their “best effort not to advertise themselves inappropriately,” are unavoidably associated with Stanford titles. Numerous times experts and witnesses at Congressional hearings and in the media have stated that “their views do not represent” those of the company or entity they work for. As a result, why should it be any different when physicians make the same kinds of disclosures?
I am concerned that Stanford has chosen to intrude into the private practice of medicine by its unpaid community faculty in banning their use of drug samples in non Stanford affiliated practices when no hint of University connection is present. The School’s interest in preventing public embarrassment stemming from industry marketing should not outweight the private physician’s duty to his patient.