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Med school introduces new ethics policy

The medical school recently amended its ethics policy, placing new restrictions on adjunct clinical faculty members. (ARNAV MOUDGIL/Staff photographer)

Correction: In an earlier version of this story, The Daily misspelled the name of  School of Medicine Dean Philip Pizzo.

The School of Medicine made an official extension to its ethics policy on March 15, prohibiting its 660 adjunct clinical faculty from delivering paid speeches prepared by drug companies and the makers of medical devices.

The new policy change is a modification to the Stanford Industry Interactions Policy (SIIP), which was first enacted in October 2006 to articulate ethical standards for how employees, staff and volunteers should interact with pharmaceutical and biotechnology companies and medical device manufacturers.

Volunteer teaching staff with Stanford titles, commonly called adjunct clinical faculty, were previously exempt from the policy to avoid interference with their private practices.

In order to continue using their Stanford titles, adjunct faculty now must comply with many of the same policies that apply to full-time faculty. Adjunct faculty are now prohibited from ghostwriting, engaging in speakers’ bureaus and accepting gifts or meals from industry partners. They will also be prohibited from accepting free drug samples starting Jan. 1, 2011.

According to School of Medicine Dean Philip Pizzo, the School of Medicine’s policies on conflict of interest and industry relations are “among if not the [sic] most comprehensive in the nation,” he wrote in an e-mail to The Daily.

“In the beginning we were trying not to intrude in that regard,” said David Stevenson, senior associate dean for academic affairs. “It became clear that that exception was not one that could be maintained.”

According to Stevenson, the policy change has been discussed for “many months” and was prompted by increasing concerns about how industry and financial incentives influenced physicians’ responsibility to prioritize patient care.

Pizzo explained that when the SIIP was formed in 2006, the School of Medicine excluded adjunct faculty from the ban on speakers’ bureaus because it didn’t envision problems arising with adjunct faculty in the future.

“In honesty, I for one [sic] did not think that any adjunct clinical faculty member would be members of Industry Speakers Bureaus or earning large sums of money based on these activities,” Pizzo said.

A key consideration in modifying the policy was the fact that adjunct faculty commonly identify themselves with Stanford on Web sites, business cards and other contexts outside of the University.

Harry Greenberg, senior associate dean of research and training, said that misunderstandings can occur when the public doesn’t differentiate between employed faculty of the School of Medicine and volunteer faculty who use their Stanford titles in external settings.

“The public and the press really don’t understand, when someone has a title that says ‘Stanford Professor of Medicine Adjunct,’ that that person is spending most of their time in private practice,” Greenberg said. “They are looked upon as Stanford faculty.”

Stevenson said that companies would not be putting money into speakers’ bureaus and gifts to physicians if it weren’t yielding a return in sales on drugs and devices.
“The slide sets prepared by companies are basically a marketing tool, which is different from presenting original work,” Stevenson said. “The role of speakers’ bureaus is to change the clinical habits of physicians. That isn’t consistent with policy at Stanford University.”

Stevenson emphasized that the physicians must prioritize what is in the best interest of their patients and not what would benefit the stockholders of a particular company or yield personal financial gain.

The School of Medicine felt an added pressure to revise its industrial relations policy after a New York Times article last year noted that Stanford adjunct Manoj Waikar earned almost $75,000 from the drug maker Eli Lilly in a six-month period through paid speaking engagements.

As Greenberg put it, the distinction between Waikar’s title and that of an employed Stanford professor “doesn’t make much sense to the outside world.”
The new policy is largely an effort to protect the reputation of the University.

“I do not make any value judgments about the activities that community physicians wish to pursue, nor do we want to regulate them,” Pizzo said. “However, if that community physician has a Stanford title, as an adjunct clinical professor, it is clear that we must protect the reputation of Stanford Medicine and the University.”
Pizzo, Stevenson and Greenberg all took care to assert that the University appreciates the time, knowledge and experience that volunteer staff bring to teaching students and that the policy extension is in no way meant to deter volunteers from assuming adjunct faculty roles.

“The adjunct clinical faculty are very important to us,” Greenberg said. “They donate their time and their efforts and they have lots to add to this institution. The purpose was not at all to diminish numbers of adjunct clinical faculty.”

Stevenson said although some adjunct faculty are “not happy,” the decision to assume that position is voluntary. If faculty do not wish to accept the new policy, they can opt out of their staff roles.

“I think that most [adjunct faculty] will find this to be not difficult at all,” Stevenson said.

Greenberg summarized the logic behind the policy change.

“We made a decision that faculty at Stanford are academics, and that means that their work is based on their own scholarship,” he said. “A Stanford title to promote the marketing efforts of a drug company just didn’t seem appropriate.”

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