By Katie Kerwin McCrimmon
The University of Colorado’s medical school failed to police potentially unethical financial relationships between its doctors and drug companies, allowing faculty members to scoop up hundreds of thousands of dollars to give thinly-veiled marketing talks, often using the pharmaceutical companies’ own promotional materials.
An internal review at CU found 46 full-time medical school faculty members had received money either to give drug talks or to consult for pharmaceutical companies. The university may force several of the faculty members to pay back cash they received or reveal tax information in the future to ensure they are not violating ethics policies.
During a meeting of the medical school’s Faculty Senate on Tuesday, Dr. Richard Krugman, CU Denver’s vice chancellor for health affairs, said the questionable payments that have surfaced are no doubt the tip of the iceberg.
Krugman said medical school leaders must act now. He called on the faculty to help craft a new tougher policy to govern pharmaceutical payments and said it must be approved within the next two months.
Some doctors have willfully violated CU’s 2008 policy, which sought to ban cozy relationships with doctors and pharmaceutical companies. Krugman said the new policy will have more teeth, including financial penalties and possible termination for doctors who fail to comply.
“We risk losing the public trust if we don’t take the high ground in this enterprise,” Krugman said. “It takes years to build a reputation and relationships of integrity and trust. It takes one nanosecond to blow it.
“All of the efforts (by some people) to play by the rules can be exploded by situations like this,” Krugman said. “There are inconsistent messages and we think there’s damage to the school.”
ProPublica, an independent journalism website in New York, broke the Dollars for Docs story nationally when reporters examined millions of dollars in payments to doctors that seven drug companies have begun listing on the web, in some cases under court orders. The Affordable Care Act will require significantly more disclosure about long-secret relationships between doctors and pharmaceutical companies.
Krugman said that Colorado doctors may have financial relationships with more than 1,000 pharmaceutical companies and medical device manufacturers. Some of the arrangements are legitimate while others are clearly unethical.
Among those that ProPublica identified as the highest dollar earners at CU were Dr. Michael McDermott, director of endocrinology and diabetes practice, who received $117,000 from Lilly. McDermott defended his talks to ProPublica, but said he’s weighing future participation.
Krugman said the internal review found that only four of 46 doctors had sought permission to do the talks, as the 2008 policy required. One PhD candidate, whom Krugman did not name on Tuesday, had received more than a quarter of a million dollars and failed to ever sign a “member of practice agreement” requiring him to comply with CU policies.
Krugman said that when the university established the 2008 policy, he did not expect to have to police doctors. He assumed that “professionals would behave professionally.” But, clearly violations have arisen.
“Some of them did it once. Others were in the six-figure range,” Krugman said. “There are either unintended or civilly disobedient violations of university, school (of medicine) and UPI (University Physicians, Inc.) policies.”
The medical school’s executive committee is recommending prohibiting participation in any pharmaceutical company speakers bureau programs.
“From the (drug) company’s perspective, they are all about marketing and sales, not about education. You, in essence, become part of their marketing department,’’ Krugman said. “That’s got to stop.”
Among the proposed elements of a new policy:
- Mandating that doctors report all compensation through the University Physicians, Inc., which handles billing and other business matters for the medical school’s practitioners
- Requiring physicians to seek permission for all paid talks. The only talks that would automatically be allowed would be academic lectures at CU or partner institutions such as Children’s Hospital and Denver Health
- Mandating reporting of all income generated from for-profit companies (although Krugman and others acknowledged that the drug companies are quickly creating nonprofit shell companies to potentially hide payments to doctors)
- Requiring doctors to reveal tax information if questions arise about potentially inappropriate payments
Among the faculty members who attended Tuesday’s meeting, a handful were defensive about receiving money for drug talks while others said patients get very angry when they learn physicians have been hiding relationships with pharmaceutical companies.
“No one wants to think that their doctor has been consulting with the pharmaceutical companies,” said Dr. Micol Rothman, an assistant professor.
Some warned of the danger of allowing doctors to “hide” money by funneling it through the physicians group (UPI), which would have prevented doctors from showing up on ProPublica’s list.
Several faculty members said doctors must be transparent about all payments they receive from drug companies and will have to defend their actions to the public.
“Faculty hopefully are intelligent beings who are able to use their best judgment and are not selling themselves to the devil,” said Dr. Alex Wiseman.
A faculty committee will seek data and input from fellow doctors and Krugman expects a new policy within “a month or two.”
“Doing nothing is no longer an option,” Krugman said.