Conflict of Interest or Conflict of Virtue, You Decide

In October of 2006, the Stanford University School of Medicine implemented a program called SIIP. The acronym stood for Stanford Industry Interactions Policy. This policy governs interactions largely in the clinical and educational arenas with pharma, biotech, and medical device companies. The provisions in this policy address gifts from these industries, access of sales and marketing reps on campus, and industry support of education.

Stanford was among the first institutions to embrace such a policy. Considering the scrutiny that academic institutions and physicians are under, it's a wonder that more institutions are not promulgating the importance of this type of policy, or are they? The concern that Stanford has is that all interactions between physicians and industry must be ethical, cannot create conflicts of interest that could result in compromising patient safety, data integrity, the integrity of the educational and training program, and the reputation of faculty members at the institution. Individual physicians must consciously and actively divorce clinical care decisions from any perceived or actual benefits expected from a company. Stanford believes that it is unacceptable for patient care decisions to be influenced by the possibility of personal financial gain. It comes down to the old adage, "give a surgeon a hammer, everything becomes a nail." More on that later.

The concerns for Stanford include:

Gifts and compensation (Buying dinner, fee for attending a dinner presentation, etc)

Financial support for educational and other activities (Reps paying for educational programs that involve use of company products, i.e. AO Courses as an example)

Full disclosure of relationships with industry (Consultancies, Stock Options, Royalties, Honorarium's, etc.)

Access to the facility by sales and marketing representative

Providing scholarship or any other educational funding to residents

The Dean's concerns are legitimate in that a faculty member's relationship, whether it be a full-time or adjunct professor, could tarnish the University's image. Immediately, the Jeff Wang/UCLA, Zdeblick/Wisconsin and Polly/Minnesota scenario come to mind. Philip Pizzo's concern is the deteriorating image of the surgeon in the eyes of the public let alone the potential affect it can have in patient care. But we're not here to rehash old news. The purpose of the post is to ask our readers their opinion on the interaction between physician and company. Does a conflict of interest exist? Can a physician's judgement be influenced by their financial ties to a corporation and the success of a product? Have surgeons behavior, mostly influenced by commercial remuneration, distorted the fine line between outcomes and clinical marketing? Should there be two sets of guidelines, one for private practice, and one for academia? Or should there be stricter rules on how a surgeon can market his skills? In the larger picture, medicine has become no different than other areas of business, where everyone has a spokesperson for a brand. The real question is, if they weren't getting paid, or did not have a financial stake in a product, or a company, would they really care? Would they really use some of these products?

Maybe, Dr. Pizzo is on to something, or, maybe he is just missing out on an opportunity to maximize Stanford's ability to generate capital by commercializing the department at the medical school? It's an interesting time within the industry. Wall Street and it's analysts' have lowered the bar for the industry as a whole, yet, forecasted that the spine cartel should achieve their financial objectives by adjusting revenue and foreign currency in hope that the industry is still appealing to lure future investors, and, also to drive up the value of their own investments in these companies.

So in the spirit of debate, are you hearing other major academic institutions across the U.S. addressing their concerns about the commercial relationships between their faculty members and the industry? Or, is this an isolated situation?

The sacred Hindu scripture known as "the Gita" once said, "the fruits of action, are emphatically not the point of action." TSB wants to know want our readers think?