U of M medical school's ethics plan a work in progress

After a year and a half of work, the University of Minnesota still does not have a new conflict of interest policy in place for its 450 faculty, 990 residents and 920 medical students.

The policy is being rewritten because of concern that gifts and payments, everything from pens from drug firms to well-paid positions on medical device company boards, may influence a doctor's patient care decisions.

It's a complicated issue and will take time to sort out, medical school officials said. But some are frustrated with the pace of the process, and say the university has missed an opportunity to draft a tough policy that protects patients.

Josh Lackner and two dozen others in the University of Minnesota medical community came up with 14 pages of recommendations to prevent conflict of interest at the U of M's medical school last fall.

Lackner, a recent med school graduate, doesn't see many of those suggestions in a draft document being used by med school leaders to create a new conflict of interest policy.

"There are two pages left," Lackner said. "And there are still some good things in it. But there are some notable problems I think."

Here are some of the problems Lackner sees.

The recommendation that within five years the university stop using industry money to fund continuing medical education, or CME, is absent. Doctors from across Minnesota attend CME classes in order to keep their licenses current. In 2007, medical industry money paid for half of the University of Minnesota's $2.3 million CME budget.

The suggestion that U doctors stop taking small gifts from pharmaceutical companies, like pens and coffee cups, isn't there, either. Some patient advocates worry even seemingly insignificant gifts can influence a doctor to prescribe a drug to patients.

One item being considered forces U medical school employees to report outside income above $500 from any one source. The current threshold is $10,000. The task force that looked into the issue recommended that all outside income regardless of amount be reported.

The U of M isn't the only medical school dealing with the issue of conflict of interest. Schools across the country are in the process of rewriting their polices.

Allan Coukell, director of the Pew Prescription Project, a Boston-based group that monitors conflict of interest policies at the nation's medical schools, has followed the U's effort to rewrite its policy. Coukell thought early on the U was headed in the right direction.

"It looks like at one stage they were considering policies that really would have put them in the first rank nationally," Coukell said. "And now they're circulating a document that we can say is a modest advance, but they've squandered a chance to be a national leader."

With help from Coukell's group, the American Medical Student Association recently published its annual report card rating the nation's medical schools conflict of interest policies. The report, noting the U of M has yet to complete its new policy, gave the school a provisional grade of 'C'. Last year the grade was a 'D'. The report card notes the U's current work "demonstrates progress toward a model policy".

At least one person involved with a task force in the early stages of the new conflict interest policy says the process should have been more open to public input.

"And that really throws me for a loop," said Gary Schwitzer, a professor in the U of M's school of journalism. Schwitzer has investigated conflict of interest issues in the medical field in his years as a health journalist.

"For this to have any legs, for it to gain any traction, for it to gain the public's trust, it has to involve public input," Schwitzer said.

Currently the final document is being considered by a team of deans and department heads in the medical school. A spokesperson for the school says there are plans to take public input on the final plan, but they are still looking into the best way to do that.

Some say it's simply taken too long for the med school's leadership to come up with a new document. At one point, the document was expected to be ready by April.

This is a complicated process that needs to move through multiple layers of medical school and University bureaucracy, said Dr. Frank Cerra, senior vice president for health sciences and dean of the U of M medical school.

"We have to kind of work our way through that and understand the consequences of that," Cerra said.

Simply ending drug and medical device maker relationships with doctors and researchers doesn't make good policy, according to Cerra.

"You don't want to stifle the innovation and creativity and what it means for the private sector and the business and the University," Cerra said.

Cerra and other medical school officials maintain that relationships between the medical school and medical companies are a necessary part of developing new treatments and devices.

Medical schools across the country scrambled to shore up their conflict of interest policies when, in 2006, the Journal of American Medical Association called for colleges to revamp their conflict of interest policies to avoid any influence by pharmaceutical companies on patient care, education or research.

That report was followed by a New York Times report in June 2007, that raised questions about four Minnesota psychiatrists who received payments from pharmaceutical companies even after they were disciplined by the state medical board. At least one had spent time teaching at the U of M.

Cerra said he hopes a new conflict of interest document is ready within a few months.

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Editor's note: Allan Coukell's name was misspelled in an earlier version of this story.

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