Thursday, January 6, 2011

Stanford Doctors On the Take from BigPharma in Violation of University Policy

Artical By Lisa M. Krieger
MercuryNews Dec. 20, 2010 article

A dozen physicians at Stanford University's School of Medicine are under investigation by the school's disciplinary board for their too-cozy relationships with drug companies.
These physicians delivered speeches paid for by drug companies, in violation of school policy, according to a public database reported by the nonprofit online investigative website ProPublica.
"A review is under way," said Stanford School of Medicine Dean Phil Pizzo, who in 2009 created a policy prohibiting such behavior among the university's 1,500 physicians.
"They now recognize what they did was wrong," he said. "If we find someone who continues to violate policy, we will consider disciplinary action."
Violators include Alan Yeung, Stanford's chief of cardiovascular medicine, who was paid $53,000 from Eli Lilly & Co. to speak at a "Healthcare Professional Education Program" in an appearance that included another $1,463 for travel and a $375 consulting fee. He reportedly quit speaking for the company last fall.
Also named in the ProPublica reporting was child psychiatrist Hans Steiner, now retired, who was paid $109,000 by Eli Lilly to talk about Strattera, a drug that treats attention deficit hyperactivity disorder. In a response to the ProPublica report, he said he assumed the policy didn't apply to him once he became an emeritus professor, but he will now comply.
They were among 17,000 doctors nationwide who were paid a total of $257.8
million by seven companies in 2009 and the first two quarters of 2010, according the ProPublica database. In California, about 3,000 doctors received an estimated $28.6 million in payments from pharmaceutical companies for speeches promoting brand-label drugs to fellow doctors, the report said.
"The vast majority (of Stanford faculty) are paying attention to our guidelines," said Pizzo.
The violators have been referred to the senior associate dean for academic affairs at the medical school.
Many Stanford physicians are paid consulting fees by drug companies, which are disclosed to the university and not prohibited, because they improve companies' ability to design and test drugs, ultimately helping human health. For instance, Kiki Chang, director of the Pediatric Bipolar Disorder Program, was paid $5,936 to consult for Eli Lilly; oncologist Robert Carlson was paid $4,665 to consult for Pfizer.
The Mercury News tried to contact some Stanford doctors, but calls were not returned by deadline.
The names of doctors moonlighting for drugmakers were private until last year. So far, seven drugmakers have started disclosing payments. All will be required to disclose the information by 2013 as part of the Physician Payments Sunshine Act.
The practice is legal, but it creates the perception of conflict-of-interest because doctors promote certain drugs to peers and get paid by drug companies to do it.
The drug company representatives say the speaking engagements are designed to supply doctors with the most up-to-date information about new drugs, or new data about older drugs, so doctors have a better sense of their effectiveness, interactions and side effects. They also say the practice is designed to better serve patients by educating doctors about illnesses and the drugs available to combat them.
But there is widespread concern that the payments may induce doctors to advocate for the companies' brand-name drugs, rather than lesser-priced generic alternatives.
Stanford's Pizzo first issued guidelines governing physician behavior in 2006, and clarified them in 2009. These policies have been publicized 17 times in the dean's online newsletter.
When alerted to the ProPublica database, Pizzo conducted a preliminary investigation, which suggested that "some individuals "... had understandable reasons for confusion. Others, though, offered explanations why their activities continued that are difficult if not impossible to reconcile with our policy, and here we have concerns," said Pizzo.
"This is unacceptable, certainly for anyone with a Stanford title," he said.
Stanford's medical community is large and diverse, with 1,500 physicians playing different roles, Pizzo said. There are decade-long relationships with drug companies that "don't unravel with the stroke of a pen. They take time."
Moreover, the school must rely on the honor system for compliance. It does not inspect personal tax returns, for instance.
"At the end of the day, we are involved in a trusting relationship with our faculty. And we expect them to be straight and honest with us in their disclosures," said Pizzo. "We count on an honest interpretation by them of what we do."

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