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APRIL 1, 2009

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Stanford medical school to provide online disclosure of faculty's consulting activities

BY ROSANNE SPECTOR

STANFORD, Calif. - The Stanford University School of Medicine announced today that it would be posting on its Web site the medical- and research-related consulting activities for some 1,200 physicians and faculty affiliated with the medical school.

The new policy is slated to go into effect later this year and will make widely available to the public information that clinicians and researchers already disclose annually as part of the school's procedures to manage conflicts of interest.

'Industry collaborations are critical to furthering research efforts and innovative patient care, but at the same time, concerns over these activities are eroding the public trust,' said Philip Pizzo, MD, dean of the medical school. 'I hope that steps to increase transparency will resonate with those we serve, educate and work with - and reinforce that trust.'

The decision places Stanford at the forefront of a movement to increase transparency in medicine and biomedical research. Stanford's plan is similar to that announced in December by the Cleveland Clinic, the first medical center to make consulting relationships public.

'This is part of a larger trend of increasing emphasis on transparency,' said David Rothman, PhD, director of the Center for Medicine as a Profession at Columbia University. 'What's important about what Stanford is doing is instead of waiting for government to mandate transparency, it's acting in advance of that. It's showing that medicine is ready to put its own house in order even without federal legislation.'

The policy applies when faculty members or other Stanford physicians receive consulting payments for speaking or other honoraria of $5,000 or more per year from a commercial entity for activities related to their professional activities. By the end of the year, the school will report these relationships in the online profiles for such faculty and physicians, which will be updated annually. 'Access to information about physicians' interactions with industry is key to fostering strong doctor-patient relationships, as well as increasing public confidence in the medical community,' said Pizzo.

Also noted in the online profiles will be any companies from which the researcher or clinician has the right to receive royalties for inventions or discoveries; in which the person holds equity as a result of activities as a founder, inventor or consultant; and for which he or she serves as a director or holds other fiduciary offices.

The policy follows efforts by U.S. Sen. Charles Grassley, R-Iowa, to highlight undisclosed drug company payments to physicians. The Iowa lawmaker has proposed legislation that would require pharmaceutical and device companies to make public such payments. According to Rothman, who studies conflict-of-interest policies, some states have already enacted such measures, and a number of drug and device companies have begun voluntarily publishing on their Web sites specific dollar amounts given to physicians.

The medical school's decision complements other efforts at Stanford aimed at limiting the potential influence of industry in its research, clinical and educational activities. Notable among these is a prohibition against Stanford physicians accepting biomedical industry gifts, including drug samples, anywhere on the medical center campus or at off-site clinical facilities where they practice.

That policy, enacted in October 2006, is intended to separate the educational work of the Stanford University Medical Center from marketing, while retaining important relationships with industry in a proper context. As a key part of that policy, it bans pharmaceutical, bio-device and related industry representatives from patient care areas and medical school facilities except for in-service training on devices and equipment and by appointment only. Since then, other U.S. medical schools and teaching hospitals have put in place similar policies, and last year the Association of American Medical Colleges advised all medical schools to enact policies eliminating gifts from industry to faculty, staff, students and trainees.

Last year, in another move to prevent undue commercial influence on educational courses and clinical care, the school stopped accepting support from pharmaceutical or device companies for specific programs in continuing medical education - courses taken by physicians to remain licensed to practice. Stanford's new policy allows industry support for CME only when provided for broad areas, not for a specific course, topic or program. Stanford is one of the very few U.S. academic medical centers to enact such restrictions.

The online disclosure of business relationships is the latest step in the School of Medicine's efforts to separate personal financial relationships and interests from medical research, clinical care and teaching. The school is beginning to gather this year's annual disclosures now and plans to post the information online in the coming months at http://med.stanford.edu/profiles/ and at http://stanfordmedicine.org (under 'find a physician'). To learn more about Stanford's policies on collaborations with industry, go to http://med.stanford.edu/coi/.

'Many of us hope that what Stanford is doing now will be contagious and that other academic medical centers will follow suit,' said Rothman. 'The best ways I know to make sure education is not contaminated by marketing is to restrict industry access and gifting of doctors, which Stanford's already done, and to render transparent the relationship between physicians and industry. I see this [policy on posting the disclosures] as the second shoe.'

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The Stanford University School of Medicine consistently ranks among the nation's top 10 medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://mednews.stanford.edu. The medical school is part of Stanford Medicine, which includes Stanford Hospital & Clinics and Lucile Packard Children's Hospital. For information about all three, please visit http://stanfordmedicine.org/about/news.html.

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