The latest victim to fall to the irresponsible and questionable journalistic practices of the Pew funded ProPublica was the University of Colorado, Denver, and its affiliated teaching hospitals. After discovering “extensive ties between its faculty and pharmaceutical companies,” the University is apparently “overhauling its conflict of interest policies.”
According to a story released by ProPublica, Dr. Richard Krugman, vice chancellor for health affairs, said at a meeting of the faculty senate that “he hoped members would soon consider a policy to clearly ban faculty from delivering talks for drug companies. Apparently, Dr. Krugman believes that without such a rule, “the school faces a loss of public trust, damage to its reputation and the specter of it physicians parroting industry-designed materials.”
ProPublica identified 13 UC Denver physicians whom drug companies reported paying to deliver promotional talks.
Of course, both Dr. Krugman and ProPublica failed to acknowledge that the Food and Drug Administration (FDA) regulate promotional or commercial events, which require companies who hire speakers to control the content of such presentations so that individuals do not speak about unapproved uses of products. They both also fail to recognize the educational value many doctors find in attending such commercial events and the significant benefit patients would receive from doctors learning about new treatments, clinical data, and therapies.
What is perplexing about Dr. Krugman’s comments is that on the one hand, he wants the University ” to increase their relationships with industry around drug discovery,” but on the other hand, he doesn’t want “to be involved with speakers bureaus because he believes they are primarily marketing.” This paradox is problematic because part of the drug discovery process is educating physicians about the new drugs, discoveries, and clinical data so they are aware of what options they have available to treat their patients.
Who does Dr. Krugman want to teach doctors about these new discoveries so that patients will receive the benefits, companies will earn back what they invested, and the cycle of finding new therapies and improving old or current ones can continue?
Solutions, a health policy news website run by UC Denver’s School of Public Affairs, first reported on the faculty meeting, noting that an internal review at the medical school found that 46 full-time faculty members had been paid by drug companies for speaking or consulting. Only four had sought permission from the school to do the work, as required by a 2008 policy. Krugman attributed the lack of preapproval to a misinterpretation of the policy.
Until the policy review is complete, “Krugman said he would not approve new speaking contracts. Arrangements previously approved could remain in place until the new policy takes effect.”
According to an article from The Denver Post, National Jewish and Denver Health are also reviewing and tightening ethics rules at their institutions. National Jewish spokesman William Allstetter told the paper that the payments “raise questions in the public mind.” He said that “both the ethics committee and senior management at the hospital want to make sure policies address potential or perceived conflicts of interest.”
Perhaps the most disturbing comments that arose from this story however came from Dr. Krugman, who told the Denver Post that working with industry is a problem “If even the perception is out there that someone, because of their relationship with a company, is changing what could be their objective practice of medicine.” However, when he asked if there were “actual harms to patients,” he admitted, “I don’t know.”
How can the University of Colorado and its affiliated hospitals be considering policies to ban physician-industry collaboration to “protect the public” when they do not even know whether such relationships actually harm patients? Do patients and the public understand that if doctors are not educated through commercial events or drug representatives or if they do not attend continuing medical education (CME), their doctors may not be able to treat them with the best standard of care?
Interestingly, in Colorado, doctors are also required to report relationships worth more than $5,000 to a state database, kept by the Board of Medical Examiners. While some of the drug- company disclosures from ProPublica that were checked against the state database showed some “holes,” Chris Lines, spokesman for the state Department of Regulatory Agencies overseeing the Board of Medical Examiners, said that 90 percent of physicians are complying. Mr. Lines said that the Department does not “see a crisis.”
Ultimately, what these stories highlight is more “Tabloid Medicine” from ProPublica. Dr. Krugman wants to slow innovation and collaboration in Denver because he thinks there is a “perception” of wrong, rather than any evidence of actual harm. This approach is counterproductive and it will only drive out the underpaid academics that presently practice in these hospitals. Moreover, as Dr. Krugman himself admitted, the medical school “does not have the resources to investigate all the private-company relationships among its 2,250 doctors.”
Any overhaul of the ethics policies will likely require more staff, more paperwork, more resources, and more money. This means either they will waste their time since they don’t have adequate resources, or they will end up taking resources and money from research and health services that could be going to truly helping patients. Until anyone can show harm done to patients from physician-industry collaboration, whether through promotional speaking, research, or consulting, policies at hospitals and academic medical centers must not go too far to stifle innovation.
If the mission of hospitals and academic medical centers is to improve public health and maintain trust from the public, there should be as much transparency about any proposed changes to ethics guidelines as there is for industry payments. The last thing patients need are policies that would create obstacles for physicians and faculty to collaborate with industry, which would lead to fewer educated physicians with less experience and exposure to breakthroughs in medicine.