Faculty Perspective: Stanford Conflict of Interest Policy

The recent drive towards more stringent regulations on physician-industry collaboration at academic medical centers (AMC) often appears as a one-sided conversation promoting the idea that interactions create conflicts that need to be regulated or severed.  However, other views do exist. 

The excerpt below comes from a faculty member from Stanford, an institutions that recently implemented more stringent regulations for its adjunct faculty that bans, among other things, participation in company sponsored peer-to-peer education and use of medication samples in their personal office.  Violations of the new ban, as outlined by the organization, would result in immediate termination of the faculty member's contract.

This piece highlights an important point that is often not discussed: Insurers play an enormous role in shaping physician behavior and they should not be the only source of information that is freely transmitted. 

It is likely that more of these sentiments will begin to emerge as the details and motivations driving these policies come to light:

The repercussion of banning drug samples and speaker bureau lectures at Stanford goes beyond the apparent.

Currently, managed care health insurance companies and HMOs exert inordinate amount of power that dictates what physicians must and should prescribe, often 100% biased towards the generic drugs. In most cases, these faceless people or self-described experts are not even physicians. Creating a firewall between adjunct clinical faculty (ACF) and pharma / biotech reps would further push our profession into the hands of managed care and entrench their power. Superior branded drugs although approved by FDA will not see the light of day; thus further reducing the incentives of pharma and biotech to conduct risky R&D to generate life-saving drugs that will never reach patients.

Secondly, Stanford is training a generation of medical students exposed to one viewpoint – full-time academics.  This viewpoint often skews towards generics as sufficient treatment in all cases, and lacks familiarity with branded-drugs since they are not on the hospital formulary.  Despite extensive research experience, they often lack the real-world clinical experiences of the ACF clinicians who see a full panel of patients every week.

Banning drug samples is an insult to our sensibilities and our constitutional rights of freedom of speech, trade and choice of best therapies. That includes many good generics as well as promising new breakthrough therapies that patients need.

If Stanford’s mission is to educate future physicians then ACF members who conduct peer-to-peer lectures are directly serving this noble mission; we are educating colleagues on the pharmacotherapies through didactic information and real-world experience. This relationship must continue if we are going to have a viable medical practices and an R&D pipeline from the pharma / biotech industry that serves future patients.

I am for free-market open dialogue and ethical collaborations between clinicians and medical industry. The notion that only academic medical centers and their Deans of Medicine know best must be debunked.

AMC's deliver only 8% of total healthcare in the U.S. To think that they speak for American physicians and can dictate how practicing physicians should deal with pharma / biotech on a daily basis should be shunned, and their assertion that these industries do not have merit or bring value must be challenged.

Marketing is not bad. It disseminates crucial information. Academicians are not the only ones who could discern a superior drug from a so-so drug. Marketing fosters free market competition and excellence. Everybody, including Stanford University, its medical school and the medical center, engages in marketing.

Ironically, full-time professors who gained national prominence collaborating with industry are now demonizing the very source of their academic achievement. If this is not double standard, then what is it?

Will the ACF Council allow full-time academics and the Dean’s Office to dictate how we should practice medicine outside of the Stanford campus? Where is freedom and liberty?