Thursday, January 29, 2009

UI Health Care conflict of interest policy: A long time comin'

We’re glad that University of Iowa Health Care has caught up with so many other institutions in developing a comprehensive policy for reducing conflicts of interest between its employees and health care companies. Given the huge number of university staff and physicians covered in this policy — everyone in the medical college and the hospital as well as in dozens of university departments — the drafting process for the committee must have been onerous and time consuming.

The very size of the committee — 40 members — demonstrates:

* How seriously UI Health Care officials take the issue and

* Just how much money is at stake if the policy is either too stringent or too lenient.

Now that the heavy lifting for the policy is done, we hope UI Health Care officials work to create a less onerous process by which the policy can be updated on a regular basis. That way, UI Health Care can live up to its slogan — “Changing medicine. Changing lives.” It can become a leader in the efforts to anticipate the conflicts that could arise in today’s rapidly changing medical landscape.

The new restrictions — which will be implemented by June — come after a UI-requested audit showed that administration needed a better way of monitoring potential conflicts. The audit, performed by the Iowa state Board of Regents audit committee and released in May of 2008, made a number of eyebrow-raising discoveries, including:

* Some UI doctors were paid for private consulting while on the clock for the university;

* Some UI staff had purchased equipment directly from companies with which they had financial ties; and

* Nine doctors out of more than 800 failed to file required reports in 2006 disclosing their potential conflicts of interest.

In response to those and earlier conflicts, the new policy prohibits employees and student trainees from:

* Accepting gifts, even those below the state's $3 gift limit;

* Accepting any free food;

* Distributing free drug samples or vouchers for free samples to clinical care patients; and

* Using free samples for themselves or their family members.

The policy also would:

* Prohibit sales representatives from being in patient-care areas (with some exceptions for training), and

* Require employees who consult for a private enterprise to complete a contract stating what tasks they will perform for the company and what their compensation will be.

Cynics might say, “If it takes an audit for UI to come around to something this obvious, we wonder what else is going on.” But the university itself initiated the audit as a means of increasing transparency in the relationships between researchers and industry.

“Not all of these relationships are ‘bad,’ if that’s even the right word,” said pathology professor Michael Cohen, who co-chaired the 40-person committee. “But they need to be managed. You can only do that if you have this sort of transparency in place.”

The current policy — if updated regularly — will help to mark when a relationship between a physician and manufacturer stops being in the best interest of patients. It will improve the likelihood that, when UI Health Care is purchasing a multi-million-dollar piece of medical equipment, it’s because the equipment meets the hospital’s needs and not because a UI researcher had such a good time with a sales rep at dinner.

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