News

Stanford docs found in violation of school policy

Investigation shows more than a dozen took drug-company fees for talks

Stanford University Medical School Dean Philip Pizzo has sent a reminder to medical school staff after an investigation found that some Stanford physicians had violated the school's own policy by giving paid promotional talks for drug companies.

The disclosures about Stanford were included in "Dollars for Docs," a national investigation by Pro Publica, a philanthropy-supported news staff that produces what it calls "investigative journalism in the public interest."

The journalists compiled data from drug companies that disclosed payments to doctors for promoting their drugs. The payments, from seven companies including Pfizer, Merck, AstraZeneca, GlaxoSmithKline, Eli Lilly, Johnson & Johnson and Cephalon, totaled $282 million across the country.

The database included 3,072 payments to physicians in California, totaling $28.58 million.

"Receiving payments isn't necessarily wrong, but it does raise ethical issues," Pro Publica said.

Pro Publica said its investigation found that more than a dozen Stanford doctors "were paid speakers in apparent violation of (Stanford) policy -- two of them earning six figures since last year."

Stanford's policy, enacted last year, bans doctors from giving paid promotional talks for drug companies.

Professor of Cardiology Alan Yeung, who earned $53,000 from Eli Lilly & Co. in 2009 and the first half of 2010, said he has quit speaking for the company.

"I take full responsibility for this error," he told Pro Publica. "Even though I felt that these activities are worthwhile educational endeavors, the perceived monetary conflict may be too great."

Professor of Psychiatry Hans Steiner earned $109,000 from Lilly for talks about a drug for attention-deficit hyperactivity disorder.

Steiner told Pro Publica he had wrongly assumed he was not subject to Stanford's policy, having become an emeritus professor last year, but now, "I fully intend to comply."

Pizzo said some doctors had "understandable reasons for confusion about Stanford's policies and have already addressed them.

"Others, though, offered explanations why their activities continued that are difficult if not impossible to reconcile with our policy, and here we have concerns."

— Palo Alto Weekly staff

Comments

Like this comment
Posted by slap on the wrist?
a resident of Stanford
on Dec 21, 2010 at 7:07 pm

Are they going to give the money back? Or is this just a slap on the wrist?


Like this comment
Posted by Chris Zaharias
a resident of Crescent Park
on Dec 21, 2010 at 8:57 pm

Put me on the record as follows: let doctors speak publicly for free, let them speak funded with big pharma $$, let them do whatever they want. Think about what happens if we as a society prevent doctors from making add'l revenue from speaking on behalf of medical products they believe in:

1. They feel that much more pressure to prescribe costly treatments in order to reach their personal fin'l goals/obligations;
2. Big pharma has to resort to more challenging methods of getting their products out there = lobbying govt;
3. Less sought after doctors and medical professionals do the shilling for big pharma, resulting in relative knuckleheads doing the work & with potential for more costly errors in judgement wrt which pharma cos to align with.

People forget that everyone's got to - and is gonna - make a living. Stanford doctors have the distinct pleasure of living in one of the most expensive places in the world, a place where many good doctors literally feel like they can't afford it. People of the Stanford community - do you want those doctors to go to Fresno, to Portland, to Walla Walla? No, you don't, so let them shill as they may, and apply your own judgement and medical interrogation to figure out your path to good health & wellness.


Like this comment
Posted by A Noun Ea Mus
a resident of Professorville
on Dec 21, 2010 at 9:19 pm

Well Chris I suppose a fancy and high-class prostitute is preferable to one picked up off a dingy street corner and more likely to be infected and with criminal intent.

But prostitution is still the game.

Do we want our high class prostitutes to be driven away and our male citizenry forced to lower their standards?


Like this comment
Posted by PA Resident
a resident of Old Palo Alto
on Dec 21, 2010 at 9:25 pm

Chris-

Do I want "those" doctors to go to Wala Wala, Fresno, or Portland?

Answer: Yes.

There are a lot of good doctors who reside here, and live modestly and within their means.






Like this comment
Posted by PA Resident
a resident of Old Palo Alto
on Dec 21, 2010 at 9:28 pm

A Noun Ea Mus -

Good one!


Like this comment
Posted by Jack
a resident of Crescent Park
on Dec 22, 2010 at 3:03 am

Stanford is like that. Its just about money now. No integrity. The hospital is no where near as good clinically as UCSF, and many of the researchers mediocre careerists. Sure some are amazing but that is a minority. Stanford should be far more discriminating in picking their doctors. Just the quality, not the careerists.


Like this comment
Posted by JA3+
a resident of Crescent Park
on Dec 22, 2010 at 10:07 am

Non-compliance with stated -- written -- policy is very difficult to justify. Non-compliance by intelligent, highly paid individuals is nearly impossible to justify.

Failure to amply disclose the source and amount of any and all speaker fee income where some of such income derives from a source or sources likely to benefit from your statements is unwise. Clearly, there's a possible conflict of interest and the failure to amply disclose such conflict -- early and often -- leads to a taint: a taint on the speaker and on his employer; on the speaker's statements; on the source of the payments. It's a lose-lose-lose.
_____

"Others, though, offered explanations why their activities continued that are difficult if not impossible to reconcile with our policy, and here we have concerns."

I, for one, would like to hear more about such concerns; are these concerns subject to Freedom of Information requests?

Will the Weekly dig more here? Or will Pro Publica?


Like this comment
Posted by parent
a resident of Leland Manor/Garland Drive
on Dec 22, 2010 at 11:19 am

Today's doctors practice drugs, not medicine. This should not come as a surprise. Americans do love our drugs.


Like this comment
Posted by watchthosepensions
a resident of another community
on Dec 22, 2010 at 11:19 am

Jack: get ready for a long ambulance ride when you have a medical emergency and don't want Stanford care. By the way, if you read the article, you would see that UCSF had the exact same problems and confusion about faculty speakers:

Dr. David Jablons, UCSF’s chief of thoracic surgery, earned $94,000 delivering speeches for Lilly. In an e-mail, he said he uses Lilly’s slides to discuss its lung cancer drug but would “unquestionably refuse to give the talk” if he was asked to say something he didn’t believe.

In a series of e-mails, Dr. Neal Cohen, a vice dean of UCSF’s medical school, gave different interpretations of its policy.

Initially, Cohen wrote that Jablons complied with the intent of the policy because he “uses evidence-based scientific data with which he agrees.”

Asked how that squared with UCSF’s policy, Cohen replied: “The scientific credibility and lack of commercial focus of material presented is the critical issue, not who prepares the slides.”

Pressed about whether any faculty member could be out of compliance given such an interpretation, Cohen appeared to change his stance. He said he didn’t believe that UCSF faculty should be giving paid speeches in which the companies prepared or controlled the content via slides.

“We are educating our faculty about the policy and are taking active steps to re-examine the policy language to clarify it,” he said, as well as coming up with a better plan to enforce it.


Like this comment
Posted by Emeritus Professor
a resident of Greater Miranda
on Dec 22, 2010 at 12:14 pm

The vast majority of Stanford physicians are dedicated to their patients and put the patients' welfare as their first priority in my experience over the last 35 years working there. If a few of the physicians missed the very large number of publications of the Stanford Policy then internal policing of the policy is the way to change that. Claiming that Stanford clinicians are crass and only interested in themselves is not only untrue of the great majority of the faculty it is unfair to those who devote their lives to helping patients and stay on a "salary" instead of the rewards of private practice.


Like this comment
Posted by L. D. Torres
a resident of College Terrace
on Dec 22, 2010 at 12:54 pm

This is a clear conflict of interest. In a real world, people will get fired or will resign as a result of this. I hope the people involved will do the right thing.


Like this comment
Posted by anonymous
a resident of Duveneck/St. Francis
on Dec 22, 2010 at 1:48 pm

Thank you, local news media, for shining a spotlight on this unethical behavior.


Like this comment
Posted by Sylvia
a resident of Midtown
on Dec 22, 2010 at 1:51 pm

It's often said that "ignorance of the law is no excuse". But in these cases, I doubt ignorance was the problem. Those are some significant amounts of cash received by doctors from Big Pharma. And we're supposed to believe this fact won't influence them when prescribing for their patients?

This is analogous to the American voters being expected to believe that those big campaign contributions from medical insurance companies didn't influence the Blue Dog Democrats when they wrangled over and ultimately weakened the Health Care act.


Like this comment
Posted by anonymous
a resident of Community Center
on Dec 22, 2010 at 9:58 pm

[Post removed by Palo Alto Online staff.]


Like this comment
Posted by A Noun Ea Mus
a resident of Professorville
on Dec 23, 2010 at 11:41 am

This isn't about Standford vs. UC (Big Game of "who's more in bed with Big Phama). It's a nationwide problem how Big Pharma has essentially corrupted the professional practices of MD's everywhere. Corruption is often subtle and incremental. Big Pharma has sent out an army of ex-cheerleaders and samples, trinkets and junkets. "Me too" drug development and marketing to bypass generic conversions......

The exposure of "Seeding Studies" has been a particularly revealing and embarrassing (or infuriating) last straw for many . Studies designed not to scientifically test new drugs or devices, but designed for marketing objectives....

Web Link

Web Link

This whole issue needs to be addressed not just by individual hospitals and institutions. It should be a matter of basic professionalism (and licensure revocation for violators in addition to big fines).

For more information see the website for "No Free Lunch"

Web Link

Brief description..

"We are health care providers who believe that pharmaceutical promotion should not guide clinical practice. Our mission is to encourage health care providers to practice medicine on the basis of scientific evidence rather than on the basis of pharmaceutical promotion. We discourage the acceptance of all gifts from industry by health care providers, trainees, and students. Our goal is improved patient care."

Some professionals have a burning sense of shame and outrage over how they have been played by such strategies and tactics....


Like this comment
Posted by Pat
a resident of Old Palo Alto
on Dec 23, 2010 at 10:27 pm

It is important to remember that these doctors, whether currently employed at Stanford or not, are probably still seeing patients. Dr. Steiner is a child psychiatrist. Can you imagine letting him "treat" your child given his conflicts of interest! You would never know in who's interest he is working - your child's or the drug company that is paying him to promote their drugs.


Like this comment
Posted by Wife of M.D.
a resident of Palo Alto High School
on Dec 23, 2010 at 11:59 pm

Contrary to popular belief, physicians aren't paid a ton of money, especially at Stanford (academic center), vs. private practice. And with medical costs these days, even private practice physicians aren't paid a lot. Notice there are "boutique" physicians out there, trying to earn more money. Somehow, people seem to think that since it's health care, physicians should donate their time to help people. Compare them to the professionals who charge $300/hour for their services. Physicians don't charge their patients per minute and they certainly don't earn $300/hour. Most physicians earn $120,000-$250,000 and for the amount of disclipline, schooling and rigor, that's not a huge salary. Physicians really should be paid more, so we can continue to churn out top physicians. Face it, if someone can become a top lawyer, venture capitalist, or physician, the profession which pays most will likely be chosen, and it aint gonna be the career in medicine. Bottom line is: if you don't have your health, nothing else matters.


Like this comment
Posted by Morris
a resident of Barron Park
on Dec 24, 2010 at 7:48 am

> "Receiving payments isn't necessarily wrong, but it does raise
> ethical issues," Pro Publica said.

And those "ethical issues" would be?

While this sort of information is "interesting", there is nothing in the data that suggests that anyone who received these payments falsified any data, or promoted unsafe drugs, or research, by virtue of their presentations. A more interesting bit of research on the part of Pro Publica would be to find out what drugs were being promoted by which doctors, and then see if these drugs were involved in problems that resulted in their recall due to the drugs proving unsafe once on the market.

Pro Publica seems hung up on the fact that some doctors received some money for perhaps publicly endorsing drugs that they might have some knowledge of. What would Pro Publica's position be if these doctors did not accept any kind of payment for their giving these sorts of public endorsements?

It's not possible for the drug industry to develop drugs, etc., without field testing, and that means dealing with doctors, and ultimately patients. If there is fraud, or malfeasance, in this process--will Pro Publica be able to detect that doing this sort of research?

By publishing this data, Pro Publica is trying to somehow darken the doctors, and pharmaceutical companies, that have done nothing wrong.


Like this comment
Posted by Walter_E_Wallis
a resident of Midtown
on Dec 24, 2010 at 5:03 pm

Walter_E_Wallis is a registered user.

I concur with Morris. While some physicians might bend the truth for a buck, I suspect that most of the paid endorsers genuinely believe in what they peddle.


Like this comment
Posted by Peter Carpenter
a resident of Atherton
on Dec 24, 2010 at 9:07 pm

Wallis states:", I suspect that most of the paid endorsers genuinely believe in what they peddle. "

Belief is not the issue, complying with the well known and reasonable rules of the Medical School is the issue. Believing that I have the right to kill somebody does not make killing either legal or acceptable to the society of which I am a member.


Like this comment
Posted by Guidelines are a joke
a resident of Stanford
on Dec 25, 2010 at 11:03 am

I work at the Medical Center in a research lab--we do not deal with patients--most of us are Ph Ds. WE are not allowed to take a donut from the company that we buy our tissue culture supplies from, yet the medical doctors continue to feather their nests with 5 and 6 figure payments. These doctors should be disciplined and Pizzo should resign.


Like this comment
Posted by A Noun Ea Mus
a resident of Professorville
on Dec 25, 2010 at 1:03 pm

For those interested.

Free online slide show from a conference about the ongoing problems

Web Link


Like this comment
Posted by Morris
a resident of Barron Park
on Dec 26, 2010 at 9:54 am

> Free online slide show from a conference about the
> ongoing problems

Looked at the first slideshow (about 132 slides). There was a lot of hand waving, but no clear evidence of wrong doing, or suppression of "good science" by the pharmaceuticals that were being referenced in a clearly negative way.

One point came up a couple times, which might be worth considering:

** There were employees (presumably qualified scientists) of pharmaceutical companies involved with some of the studies being referenced as in the "problem area" (or some such). The slideshow's author did not actually review these studies and claim wrong doing--just suggested that because a pharmaceutical was involved, that there must be wrong doing.

The suggestions about how to deal with this "problem" included, amoung others. separating pharmaceutical employees from "studies". This opens a lot of doors, since the implication is that anyone who works for a pharmaceutical company is either a "crook", or not capable of conducting valid "science". This kind of a solution is worth kicking around, but there are implications. For instance, if pharmaceutical companies should not be allowed to fund this sort of research via allowing their (otherwise qualified) employees to be on these sorts of "teams"--should educational facilities be allowed use their emp0loyees to be involved in problem solving that involves selling more of their product--"education"? It would seem that what's good for the goose is also good for the gander.

Stanford has a right to make any policies it wants. However, the rest of us don't necessarily have to agree with them, or to help them enforce their policies.


Like this comment
Posted by JA3+
a resident of Crescent Park
on Dec 27, 2010 at 12:14 pm

Peter Carpenter said:

"...complying with the well known and reasonable rules of the Medical School is the issue."

+1


Like this comment
Posted by Morris
a resident of Barron Park
on Dec 27, 2010 at 12:29 pm

>> Well known policies

> Stanford's policy, enacted last year, bans doctors from
> giving paid promotional talks for drug companies.

> Pizzo said some doctors had "understandable reasons for
> confusion about Stanford's policies and have already addressed them.

Apparently not all that well known to the people affected by these rules.

This whole matter is a private affair inside the Stanford Medical School/Administration. No public laws were broken. No malfeasance has been implied. No one has died because of implied, or real, medical malpractice associated with these paid presentations.

In the long run, this is more of a question of just how valuable ProPublica is going to be if this is all that they intend to do with their "research" than an "expose" of "Stanford Docs Gone Wild".


Like this comment
Posted by A Noun Ea Mus
a resident of Professorville
on Dec 27, 2010 at 1:22 pm

My guess of what happened is that Standford issued a "for public" policy that they would be "shocked, shocked" if such paid speeches were being given. But behind the scenes a bit of winking was going on. Now served up ala guise as confusion over the rules.

ProPublica just said "your winning sir".

Of course it's all a private affair and none of us outside Standford should be the least concerned.


Like this comment
Posted by anonymous
a resident of Stanford
on Dec 27, 2010 at 4:33 pm

I agree with 'Guidelines are a joke' Many medical school and medical center employees comply with this, and many of us make less PER YEAR doing our jobs ethically than what some of these docs are getting paid by the drug companies. They should be fired for violating Stanford's policy. Just like 'Guidelines are a joke' has said, we can't even eat a donut from a vendor . . .


Like this comment
Posted by Elizabeth
a resident of Midtown
on Dec 28, 2010 at 11:07 am

Personally I think it's time to disallow all pharmaceutical ads on tv. They are programming the population to illness and to giving away their power to doctors. Can you say "homeostasis?"

We took cigarette and alcohol ads off tv and it's definitely time to do the same with the pharmaceutical industry to be reined in!


Like this comment
Posted by jb
a resident of Leland Manor/Garland Drive
on Dec 29, 2010 at 1:44 pm

A LOT of money is at stake in the drug industry. They make a lot, they pay a lot, and they keep a lot.

Health care reform conversations have hardly touched on reining in the costs charged by the drug and equipment companies or or the costs of insurance itself. We're trying to save money without asking these entities to participate. "Let's starve and blame the doctors instead," they say. (This, of course, does not excuse the doctors who violated the policy of not shilling for them.)

A recent article about UCSF's work on a cure for Chagas disease showed how a non-profit approach to drug development could result in good work at significantly lower costs. Ironically, drug companies give grants to universities for research because they know that grad students will do excellent, supervised work for practically free. (They will get a degree out of the bargain.)

After all, the drug companies aren't in the business for their health, you know! And they have fought tooth and nail to keep us from purchasing their identical products from Canada. Sometimes they even say that the purity of the products couldn't be verified (!!), so cheap drugs from Canada could be risky purchases.

Sell in the states and sell high. Use doctors as salesmen. By drug company standards, the doctors will do it for cheap, and they'll do it well. Everyone trusts a doctor and colleague.


Sorry, but further commenting on this topic has been closed.

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