Millionaire MD Consultants? – Big Pharma Promises Better Disclosure

JulieBergerBy Julie Burger

University medical centers are cutting down on relationships with drug and device manufacturers.  Less free pizza, less free pens.  That’s great, since studies show that even nominal gifts can influence prescribing and practice habits.  But it turns out that cold hard cash rather than trinkets might be the real culprit.

Conflict of interest and government grant funding rules say that investigators on federally funded studies must report whether they receive $10,000 or more a year from, for example, the drug company which makes the drug being studied.  A Congressional investigation spearheaded by Sen. Charles Grassley (R, IA) has highlighted several troublesome alleged undisclosed conflicts of interest incidents: psychiatrist Dr. Charles B. Nemeroff of Emory University reportedly failed to disclose $1.2 million in outside income from drug makers (including money from GlaxoSmithKline) while running a $3.9 million taxpayer-funded study to test GlaxoSmithKline drugs; Drs. Joseph Biederman and Timothy Wilens of Harvard each earned at least $1.6 million in consulting fees from drug makers but reportedly stated they earned only several hundred thousand dollars; Dr. Melissa DelBello of Univ. of Cincinnati allegedly reported around $100,000 from 8 drug companies over two years, while one alone had paid her $238,000.

I don’t know about you, but I would sure notice an extra million dollars in my bank account.  Even a cool hundred K would make a noticeable impact.

University administrators claim they have no way to monitor disclosures made by their employees and don’t want to ask for tax records to verify.  Barring passage of the Physician Payment Sunshine Act which would require a drug companies to create a registry of payments made for review by public eyes, here are three simple steps universities and/or the government could take:

1. Conduct a random audit of faculty/physicians.  If it’s too offensive to request tax records (and I might concede it might be), have the audit conducted by a third party.  Make an example of anyone found non-compliant.  Refuse to hire anyone found non-compliant by a former institution no matter how good or how much cash they can bring in for the institution.

2. Require drug companies to report all payments made to faculty and staff before their drug reps are allowed on the institution’s premises. (Kudos to Eli Lilly which has said that is has adopted a policy that will result in a publicly available internet database of payments it makes to physician researchers for speaking engagements or consulting fees.)

3. Enforce rules which allow the NIH to pull all funding for a university which has been found to have grossly violated conflict of interest standards or failed to effectively enforce the rules among its employees.  One or two such examples and we would see institutions (successfully) scrambling to fix the problem.

Self-regulation and self-disclosures didn’t work, now it’s time to try something that will.

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