Two critics' initial comments on the U's med-ethics policy

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AlexiusHoratius via Wikimedia Commons

Better ethics — but with wiggle room

Last week when the University of Minnesota released the revised conflict-of-interest policy for its medical staff, I wrote a summary of it and looked at some criticisms of the old policy.

It’s still a bit early to get a full evaluation of the changes, and critics caution that they need a full, detailed reading to suss it out fully.

But officials from two organizations that look at such policies — The Pew Charitable Trusts and the American Medical Student Association (AMSA) — have given me an initial idea of what they think looks strong and weak.

Both gave credit to the U for revamping its policy, and they saw definite improvements. Still, they found some policies vaguely worded, leading them to wonder whether faculty and industry reps will have a little too much ethical wiggle room.

“Sometimes policy wording is very nice, but when you see the nitty-gritty of how it’s applied, things aren’t what they seem,” said Tim Anderson, director of AMSA’s scorecard for conflict-of-interest policies. “Many policies are couched in legal language, but the best policies are the ones that are clear and straight forward.”

Here are a few points they mentioned:
 
 

Allan Coukell, Director, Medical Safety Portfolio, The Pew Charitable Trusts:

What he likes: Disclosure. He applauded the requirement that staffers publicly disclose to patients what financial relationships they have with the drugs or devices they prescribe.

What he’s wary about: Industry-sponsored medical talks. He didn’t find any absolute prohibition on faculty giving talks that involve some sort of payment. 

“That’s not what we’d consider a strong policy,” he said. “It’s not consistent with the Association of American Medical Colleges’ recommendation that companies don’t pay for travel to industry-sponsored events. Our longstanding position has been that (faculty) ought not to be paid speakers involved in promoting a product. And it’s not clear to me that this policy would have that effect.”

He pointed to the University of California – San Francisco, which does not allow its faculty to participate in speakers’ bureaus.

  

Tim Anderson, AMSA scorecard director:

What he likes:

  • The food-and-gift policy. It restricts those freebies to “pretty narrow circumstances,” he said.
  • The outright ban on ghostwriting. Only 20-25 percent of medical centers have a policy in which it’s not acceptible. Ghostwriting “is like plagiarism in a way, but surprisingly in the top 50 medical schools, there are many cases of it.”
  • The policy on consulting. He likes that the university appears to be moving with the national trend of allowing faculty to be paid only at the going rate for consultants. In the past, star medical faculty were paid much more — “tens of thousands of dollars for doing very little work” — and relationships between faculty and consultants were “very sketchily drawn out” with no university oversight. 

Then again: Freebies don’t appear to be completely restricted. “Through the use of food and gifts, marketing reps have time with physicians and students. It’s a marketing approach — and not a substitute for unbiased education.”

So will the changes be enough to bump up the provisional C grade of the U’s old policy? Anderson said the new scorecard will reveal all when it comes out late this year.