University of Wisconsin – Physicians Revolt on “Conflict of Interest Policy”

Physicians at the University of Wisconsin-Madison Medical School are no longer taking lightly the recently drafted foundation rules to restrict their financial relationships with drug companies. In fact, as the Journal Sentinel reported this morning from records they obtained, including emails, “it was apparent that the conflict of interest policy, which went into effect last year, divided doctors at the university.”

Paper Sues University for Physician Dissenter Emails

The Sentinel was able to get ahold of such emails by suing the university and the foundation in December after both entities initially refused to release the documents. The paper argued that “faculty comments were public records under Wisconsin law and sought a court order to obtain them. To settle the lawsuit, the newspaper agreed to accept the 41 e-mails with the names of the doctors blacked out. The foundation also provided a separate list with the names of the 28 doctors who wrote the e-mails. The foundation also agreed to pay the newspaper’s attorneys’ fees of about $12,400.”

What is shameful about such a practice is that the Sentinel is stealing money from UW that could be used to research and help patients or train doctors, not sell news (if you can even call it that).   

The Sentinel is on a witch hunt attempting to “out” those who oppose the draconian university policy.   Whatever happened to academic freedom and anonymity?  Where is the right to be able to discuss an issue amongst peers without fear of retribution from your local paper.   I thought we lived in America where you could express your thoughts freely, this is a travesty disguised as freedom of the press.  These types of lawsuits constitute an abuse of the constitution. 

The Emails

After receiving emails “submitted last fall by 28 UW doctors to the UW Medical Foundation, the Sentinel found that although some doctors “supported strengthening the policy, many of the doctors who commented on the proposed policy argued against it, and staunchly opposed it.”

The Sentinel claims that “the policy came after a series of stories in the Journal Sentinel about UW doctors who had been working for drug and medical device companies and prescribing their products to patients without disclosing their financial ties.”

Sentinel Bias

The problem with the stories that the Sentinel produced (including this one), as we have noted before, is that they take an anti-industry perspective only, and do not consider two very important factors. First, the Sentinel ignores the fact that policies at UW, journal and publication policies, federal and state laws, as well as different company policies all conflict in what they ask physicians to report. This creates confusion for physicians, which is one reason why organizations such as the ICMJE has come out with a universal form to be used going forward. What that means is, doctors are trying to be transparent and disclose such ties, but the system itself is causing problems.

Second, the Sentinel only chooses to describe the numbers and not the details when it comes to such payments. Instead of focusing on the impact a consulting arrangement has for a company to help bring a product through the pipeline, or the amount of doctors trained at a CME event and its impact on patient care, the Sentinel ignores the benefits of industry-physician collaboration.

What is more problematic, and clearly demonstrative of the Sentinel’s anti-industry tone, is their claim that UW was “accepting millions of dollars a year from drug companies for questionable CME courses that it sponsored.” Exactly what kind of evidence-based evaluation did the Sentinel do to determine such courses were questionable? Did they look at patient outcomes or how physicians perceived such programs? Probably not, since they were probably too busy suing the University of Wisconsin Foundation.

Witch Hunt

Let’s review the emails, one doctor stated that the UW policy is “insulting and such regulations make it no longer possible for him “to afford to work for UW,” especially since he had kids. This doctor also noted that the policy “was being forced on him and other physicians by “self-appointed witch-hunters” without a faculty vote.”

Product Education Dinner Meetings

Echoing this concern, other doctors noted how they have “learned meaningful information at dinner talks.” As a result, numerous doctors were opposed to being told they could not attend such talks and accept a “modest meal.” These doctors were extremely dissatisfied, and stated that “dinner talks outside of work hours and participation in them should not be dictated by an employer.” In fact, doctors disagreed with UWMF telling them “who they can have dinner with and who pays for the dinner.”

It led many to ask the question of whether there was still a democracy with a policy such as UW’s, especially since “several of the e-mails were from doctors who complained of being cut off from doing speaking for drug companies.”

Moreover, to do so is unnecessary as one doctor, who does five to seven of the talks a year, pointed out because doctors “don’t do commercials.” This doctor was professionally “insulted” by the fact that UW created a policy in the assumption that his “patient care is unduly biased” by drug industry relationships.

Orthopedic Exception

Some doctors were concerned about the “special exemption carved out for orthopedic surgeons and others who implant medical devices because the provision allows them to be paid from device manufacturers for making presentations,” while those who work with drugs are still prohibited. The exemption however, runs out after 18 months. The exemption also highlights the unique expertise and experience needed at all stages of developing a medical device because at every point, companies must work with physicians to constantly update and test such devices

Samples

With regards to free samples from a company, one doctor believed his “integrity was insulted” by the fact that some held the contention that “getting free samples from a company would cause the doctor to write more expensive prescriptions for the drugs of that company.”

Conclusion

In looking at comments from UW doctors, it is clear that many are outraged by the foundation’s conflict of interest policy, and the impact it has had on their training, patient care, research, and CME. Who wouldn’t be? The foundation has “placed signs in its clinics and offices telling patients that their doctor might have a financial relationship with a medical company and that the information would be provided upon request.” They basically are labeling their doctors as unethical, and using a framing bias to assert that such relationships are wrong.

Accordingly, UW has clearly overreacted to the “news stories and an inquiry from Senator Grassley (R-IA), who has been investigating conduct of drug and medical device companies.”  Grassley, who once was considered a conservative republican, an advocate for freedom?

At a time when more doctors are needed, and the number of patients is going to grow exponentially, taking away basic freedoms from physicians and interfering with their practice is unacceptable. As one doctor noted, “Do we really want to function like Cuba or Venezuela?”