HOW FINANCIAL CONFLICTS OF INTEREST ENDANGER OUR PROFESSION
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HOW FINANCIAL CONFLICTS OF INTEREST ENDANGER OUR PROFESSION JEROME P. KASSIRER, M.D. DISTINGUISHED PROFESSOR, TUFTS UNIVERSITY SCHOOL OF MEDICINE VISITING PROFESSOR, STANFORD UNIVERSITY EDITOR-IN-CHIEF EMERITUS, NEW ENGLAND JOURNAL OF MEDICINE. MY CONFLICT OF INTEREST Oxford University Press

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  • RHETORICAL QUIZ:

  • WHAT’S YOUR CHOLESTEROL? YOUR LDL? ARE YOU TRYING TO LOWER IT?


  • RHETORICAL QUIZ:

  • WHAT’S YOUR CHOLESTEROL? YOUR LDL? ARE YOU TRYING TO LOWER IT?

  • ARE YOU TAKING STATINS?


  • RHETORICAL QUIZ:

  • WHAT’S YOUR CHOLESTEROL? YOUR LDL? ARE YOU TRYING TO LOWER IT?

  • ARE YOU TAKING STATINS?

  • DO YOU KEEP TRACK OF NCEP GUIDELINES?


  • RHETORICAL QUIZ:

  • WHAT’S YOUR CHOLESTEROL? YOUR LDL? ARE YOU TRYING TO LOWER IT?

  • ARE YOU TAKING STATINS?

  • DO YOU KEEP TRACK OF NCEP GUIDELINES?

  • ARE YOU USING THEM?


  • RHETORICAL QUIZ:

  • WHAT’S YOUR CHOLESTEROL? YOUR LDL? ARE YOU TRYING TO LOWER IT?

  • ARE YOU TAKING STATINS?

  • DO YOU KEEP TRACK OF NCEP GUIDELINES?

  • ARE YOU USING THEM?

  • DO YOU KNOW WHO DEVELOPED THE GUIDELINES?


  • RHETORICAL QUIZ:

  • WHAT’S YOUR CHOLESTEROL? YOUR LDL? ARE YOU TRYING TO LOWER IT?

  • ARE YOU TAKING STATINS?

  • DO YOU KEEP TRACK OF NCEP GUIDELINES?

  • ARE YOU USING THEM?

  • DO YOU KNOW WHO DEVELOPED THE GUIDELINES?

  • DO YOU TRUST THEIR ADVICE?



  • THE EXPERT NCEP PANEL

  • S. Scott Grundy Director, Center Human Nutrition, Southwestern

  • Brairey Merz, Director Preventive/Rehab. Cardiac Center, Cedars-Sinai

  • H. Bryan Brewer, Chief, Molecular Disease Branch, NHLBI

  • Luther T. Clark, Chief, Division Cardiology, SUNY at Brooklyn

  • Donald Hunninghake, Professor of Pharmacol. and Medicine, U. Minnesota

  • Richard Pasternak, Director of Preventative Cardiol. And Cardiac Rehabilitation, MGH

  • Sidney Smith, Director of Center for Cardiovasc. Science, UNC; former AHA President

  • Neil Stone, Professor of Cardiology, Northwestern

  • James Cleeman, Coordinator, NCEP (NIH)


  • NEW NCEP GUIDELINES JULY ’04

  • Recommendation:

  • Aggressive LDL lowering for high risk patients with lifestyle changes (diet, exercise) and statins

  • (Primary prevention)



  • THERAPEUTICS INITIATIVE U.B.C.

  • (No industry support)

  • Conclusion:

  • Statins have not been shown to provide an overall health benefit in primary prevention trials


  • NCEP PANEL’S FINANCIAL CONFLICTS

  • (PERSONAL INCOME – HONORARIA, CONSULTING FEES

  • FROM ALL 5STATIN COMPANIES)

  • Grundy 5 Hunninghake 4

  • Pasternak 5 Merz 3

  • Stone 5 Smith 0

  • Brewer 4 Cleeman 0

  • Clark 4


  • FOLLOW-UP

  • OCTOBER 2006

  • 2004 NCEP GUIDELINES QUESTIONED

  • EVIDENCE BASE FOR ORIGINAL RECOMMENDATIONS WAS WEAK AND BASED ON SECONDARY PREVENTION

  • SOME ORIGINAL AUTHORS BACK OFF (NYT)

  • (Ann. Intern. Med 2006;145:520-530; Lancet 2007;369:168-169)


  • DRUG INDUSTRY MARKETING*

  • (billions)

  • Samples 15.9

  • Detailing 20.4

  • Direct to consumer 4.0

  • Meetings 2.0

  • Journal ads 0.5

  • Misc. 14.7

  • TOTAL 57.5 BILLION DOLLARS!

  • (APPROX. 90% DIRECTED AT PHYSICIANS)

  • *2004

  • Gagnon, Lexchin, PLoS Med 2008; 5(1):e1


1662 random physicians:

83% took gifts, 16-18% paid consulting

or speaking

459 Department chairs:

>25% paid consulting or speaking or both.

>66% said arrangements had no effect on

professional activities

JAMA (2007) 298:1779-1786

NEJM (2007) 356:1742-1750



  • SELF-DECEPTION?

  • HOUSE OFFICERS AT UCSF:

  • CAN YOU BE INFLUENCED?

  • CAN YOUR COLLEAGUES BE INFLUENCED?


  • SELF-DECEPTION?

  • HOUSE OFFICERS AT UCSF:

  • CAN YOU BE INFLUENCED?

  • 39% YES

  • CAN YOUR COLLEAGUES BE INFLUENCED?


  • SELF-DECEPTION?

  • HOUSE OFFICERS AT UCSF:

  • CAN YOU BE INFLUENCED?

  • 39% YES

  • CAN YOUR COLLEAGUES BE INFLUENCED?

  • 84% YES









  • Not all incentives are financial…

  • Nina Easton, a reporter for Fortune Magazine, was asked how she can be objective when discussing John McCain’s presidential candidacy on Fox News given that her husband is McCain’s media advisor. She replied,

  • “Disclosure is the great disinfectant.”

  • ( NPR, April 1st 2007)


  • ACADEMIC-INDUSTRY RELATIONS:

  • BENEFITS TO SOCIETY

  • Research collaboration

  • Drug development

  • Device development and modification

  • Consultations on scientific issues

  • Who do all other industry-paid activities benefit?

  • (Balanced view by Bernie Lo NEJM Feb 25, 2010)


Assumption:

  • EVEN SMALL GIFTS INFLUENCE BEHAVIOR

    Principles:

  • FINANCIAL CONSIDERATIONS NEVER COMPROMISE MD DECISION-MAKING

  • MEDICAL INFORMATION FREE OF BIAS FROM FINANCIAL INDUCEMENTS

  • PROFESSION ACCOUNTABLE FOR INORDINATELY HIGH COST OF CARE

  • ALL FINANCIAL ARRANGEMENTS OPEN AND TRANSPARENT




  • INTERPRETATION OF CHEST X-RAYS

  • 492 abnormal chest X-rays, according to 30 plaintiff-hired “B” readers (hirees).

  • Films re-read by 6 blinded “B” readers (independents).

  • (“B” readers are certified by NIOSH; all used standard DHSS form OMB No. 0920-0020)

  • Gitlin et al Acad. Radiol 2004;11:843-856


  • RESULTS

  • (%)

  • hirees independents

  • ------- ----------------

  • Parench. abn. 96 5

  • Pneumocon. 97 6

  • Pleural abn 26 8

  • Film normal 0 38


  • Off-label

  • drug use.

  • What’s

  • the real

  • motive?


  • GELSINGER CASE, 1999

  • Phase I gene therapy trial

  • 17-year old subject died

  • Several lapses in implementation of research protocol, including consent forms

  • U Penn, Dr. James Wilson (PI) both had equity in Genovo, Inc.

  • Was the research pressed forward for financial reasons?


  • SCREENING FOR LUNG CANCER

  • Oct. ’06 NEJM lung cancer study “IELCAP” 10 yr. survival >90%! PIs Henschke and Yalkelewitz (Cornell)

  • PIs and “Lung Cancer Alliance” urged CT screening for smokers, payment for screening, called double blind NIH screening trial (NLST) “unethical,” complained to Zerhouni, and convinced Congressional committee to investigate PIs of NLST.

  • No other medical organization agrees screening is justified

  • NEJM study is seriously flawed*

  • Cancer Letter (Jan 18, 2008) discovers that Cornell PI’s have 27 undisclosed patents on CT screening; other authors would stand to gain enormously.

  • (*H.G. Welch et al. Arch Intern Med Nov. 26, 2007)


  • KDOQI GUIDELINES ON EPO USE, 2006

  • CHAIR AND VICE CHAIR OF STEERING COMMITTEE, CO-CHAIRS OF WORK GROUP WERE CONSULTANTS FOR AMGEN OR ORTHO-BIOTECH, OR BOTH

  • 11/15 MEMBERS OF WORK GROUP HAD SIMILAR FINANCIAL CONFLICTS

  • AMGEN WAS THE FOUNDER AND PRINCIPAL SPONSOR OF THE GUIDELINE DEVELOPMENT

  • CONFLICTS OF THE 40 ADVISORY BOARD MEMBERS AND NKF OFFICERS NOT REVEALED


  • “WHEN THE LEADERS OF THE NATIONAL KIDNEY FOUNDATION APPOINTED THE HEAVILY CONFLICTED 2006 KDOQI ANEMIA WORK GROUP ON THE USE OF ERYTHROPOEITIN STIMULATING PROTEIN, WERE THEY OBLIVIOUS TO THE POSSIBILITY THAT ANY RECOMMENDATION OF THE PANEL WOULD BE CONSIDERED SUSPECT?”

  • (KASSIRER JP. STACKING THE DECK. CLIN J AM SOC NEPHROL 2007;2:212)


  • STACKING THE DECK APPOINTED THE HEAVILY CONFLICTED 2006 KDOQI ANEMIA WORK GROUP ON THE USE OF ERYTHROPOEITIN STIMULATING PROTEIN, WERE THEY OBLIVIOUS TO THE POSSIBILITY THAT

  • "The evidence indicates that Iraq is reconstituting its nuclear weapons program. Saddam Hussein has held numerous meetings with Iraqi nuclear scientists, a group he calls his ‘nuclear mujahideen’-- his nuclear holy warriors. Satellite photographs reveal that Iraq is rebuilding facilities at sites that have been part of its nuclear program in the past. Iraq has attempted to purchase high-strength aluminum tubes and other equipment needed for gas centrifuges, which are used to enrich uranium for nuclear weapons."


  • ARE THE EPO GUIDELINES BIASED? APPOINTED THE HEAVILY CONFLICTED 2006 KDOQI ANEMIA WORK GROUP ON THE USE OF ERYTHROPOEITIN STIMULATING PROTEIN, WERE THEY OBLIVIOUS TO THE POSSIBILITY THAT


  • ARE THE EPO GUIDELINES BIASED? APPOINTED THE HEAVILY CONFLICTED 2006 KDOQI ANEMIA WORK GROUP ON THE USE OF ERYTHROPOEITIN STIMULATING PROTEIN, WERE THEY OBLIVIOUS TO THE POSSIBILITY THAT

  • WHO KNOWS?


  • ARE THE EPO GUIDELINES BIASED? APPOINTED THE HEAVILY CONFLICTED 2006 KDOQI ANEMIA WORK GROUP ON THE USE OF ERYTHROPOEITIN STIMULATING PROTEIN, WERE THEY OBLIVIOUS TO THE POSSIBILITY THAT

  • WHO KNOWS?

  • FUNDING BY A COMPANY AND PARTICIPATION BY CONFLICTED INDIVIDUALS RAISES SUSPICION THAT THE GUIDELINES ARE BIASED.

  • IT DOES NOT PROVE THAT THEY ARE BIASED.


  • NATIONAL KIDNEY FOUNDATION APPOINTED THE HEAVILY CONFLICTED 2006 KDOQI ANEMIA WORK GROUP ON THE USE OF ERYTHROPOEITIN STIMULATING PROTEIN, WERE THEY OBLIVIOUS TO THE POSSIBILITY THAT

  • CONFLICT OF INTEREST POLICY

  • DISCLOSURES ANNUALLY BY ALL VOLUNTEERS, REVIEWED BY NKF AUDIT COMMITTEE

  • DISCLOSURES TO INCLUDE DOLLAR AMOUNTS (>$10,000)

  • CONFLICTS OVERSEEN BY NKF COMPLIANCE OFFICER

  • “SIGNIFICANT” CONFLICTS TO BE “MANAGED”

  • DISCLOSURE DATA OPENLY REVIEWED AT EACH KDOQI WORK GROUP MEETING

  • DISCLOSURES PUBLISHED WITH GUIDELINES

  • TOTAL SEPARATION OF FUNDING AND CONTENT

  • MULTIPLE SPONSORS FOR ALL GUIDELINES

  • (http://www.kidney.org/professionals/KDOQI/guidelinesCOI.cfm. Accessed 9/19/07)


  • NATIONAL KIDNEY FOUNDATION APPOINTED THE HEAVILY CONFLICTED 2006 KDOQI ANEMIA WORK GROUP ON THE USE OF ERYTHROPOEITIN STIMULATING PROTEIN, WERE THEY OBLIVIOUS TO THE POSSIBILITY THAT

  • CONFLICT OF INTEREST POLICY

  • DISCLOSURES ANNUALLY BY ALL VOLUNTEERS, REVIEWED BY NKF AUDIT COMMITTEE

  • DISCLOSURES TO INCLUDE DOLLAR AMOUNTS (>$10,000)

  • CONFLICTS OVERSEEN BY NKF COMPLIANCE OFFICER

  • “SIGNIFICANT” CONFLICTS TO BE “MANAGED”

  • DISCLOSURE DATA OPENLY REVIEWED AT EACH KDOQI WORK GROUP MEETING

  • DISCLOSURES PUBLISHED WITH GUIDELINES

  • TOTAL SEPARATION OF FUNDING AND CONTENT

  • MULTIPLE SPONSORS FOR ALL GUIDELINES

  • (http://www.kidney.org/professionals/KDOQI/guidelinesCOI.cfm. Accessed 9/19/07)


  • NATIONAL KIDNEY FOUNDATION APPOINTED THE HEAVILY CONFLICTED 2006 KDOQI ANEMIA WORK GROUP ON THE USE OF ERYTHROPOEITIN STIMULATING PROTEIN, WERE THEY OBLIVIOUS TO THE POSSIBILITY THAT

  • CONFLICT OF INTEREST POLICY

  • DISCLOSURES

  • DISCLOSURES

  • DISCLOSURE

  • DISCLOSURES

  • (http://www.kidney.org/professionals/KDOQI/guidelinesCOI.cfm. Accessed 9/19/07)


  • “MANAGING” CONFLICTS OF INTEREST APPOINTED THE HEAVILY CONFLICTED 2006 KDOQI ANEMIA WORK GROUP ON THE USE OF ERYTHROPOEITIN STIMULATING PROTEIN, WERE THEY OBLIVIOUS TO THE POSSIBILITY THAT

  • DISCLOSURE IS WIDELY CONSIDERED

  • “THE GREAT DISINFECTANT”

  • BUT IS IT?


The limits of full APPOINTED THE HEAVILY CONFLICTED 2006 KDOQI ANEMIA WORK GROUP ON THE USE OF ERYTHROPOEITIN STIMULATING PROTEIN, WERE THEY OBLIVIOUS TO THE POSSIBILITY THAT

disclosure


  • DISCLOSURE OF COMPANY TIES IS NOT A SOLUTION APPOINTED THE HEAVILY CONFLICTED 2006 KDOQI ANEMIA WORK GROUP ON THE USE OF ERYTHROPOEITIN STIMULATING PROTEIN, WERE THEY OBLIVIOUS TO THE POSSIBILITY THAT

  • REQUIRES ASSESSING SOMEONE’S MOTIVES

  • DIFFICULT TO DETECT BIAS EVEN WHEN CONFLICT OF INTEREST IS KNOWN

  • NAMING A COMPANY MAY NOT IDENTIFY DRUG UNDER DISCUSSION

  • ONCE DISCLOSED, ANYTHING GOES.


  • A MISGUIDED BROUHAHA OVER LACK OF DISCLOSURE APPOINTED THE HEAVILY CONFLICTED 2006 KDOQI ANEMIA WORK GROUP ON THE USE OF ERYTHROPOEITIN STIMULATING PROTEIN, WERE THEY OBLIVIOUS TO THE POSSIBILITY THAT

  • 2003 NEJM, ANNALS, JAMA

  • 2005 DEVICES AT CLEVELAND CLINIC

  • 2006 JAMA 3 INSTANCES

  • 2006 EDITOR OF NEUROPSYCHOPARMACOLOGY

  • 2007 PHS GUIDELINE ON DRUGS FOR SMOKING CESSATION


  • WHY MISGUIDED? APPOINTED THE HEAVILY CONFLICTED 2006 KDOQI ANEMIA WORK GROUP ON THE USE OF ERYTHROPOEITIN STIMULATING PROTEIN, WERE THEY OBLIVIOUS TO THE POSSIBILITY THAT

  • DISCLOSURE IS A NECESSARY, BUT NOT A SUFFICIENT SOLUTION TO CONFLICT OF INTEREST.

  • THE CONFLICT IS THE REAL PROBLEM, NOT WHETHER OR NOT IT IS DISCLOSED.


  • DISCLOSURE’S FLAWS APPOINTED THE HEAVILY CONFLICTED 2006 KDOQI ANEMIA WORK GROUP ON THE USE OF ERYTHROPOEITIN STIMULATING PROTEIN, WERE THEY OBLIVIOUS TO THE POSSIBILITY THAT

  • “IT HAS BECOME A TRUISM ON

  • WALL STREET THAT CONFLICTS OF

  • INTEREST ARE UNAVOIDABLE.

  • IN FACT, MOST OF THEM ONLY

  • SEEM SO, BECAUSE AVOIDING

  • THEM MAKES IT HARDER TO GET

  • RICH. THAT’S WHY FULL

  • DISCLOSURE IS SO POPULAR:

  • IT REQUIRES NO SUBSTANTIVE

  • CHANGE.”

  • SUROWIECKI J.

  • THE TALKING CURE.

  • THE NEW YORKER

  • DEC. 9, 2002


  • SOME SOLUTIONS APPOINTED THE HEAVILY CONFLICTED 2006 KDOQI ANEMIA WORK GROUP ON THE USE OF ERYTHROPOEITIN STIMULATING PROTEIN, WERE THEY OBLIVIOUS TO THE POSSIBILITY THAT

  • AT A MINIMUM, OPEN DISCLOSURE OF ALL CONFLICTS

  • SOCIETY OFFICERS AND JOURNAL EDITORS SHOULD HAVE NO FINANCIAL CONFLICTS

  • RESTORE PROFESSIONAL DECORUM OF MEDICAL MEETINGS

  • MINIMIZE FINANCIAL SUPPORT FROM INDUSTRY

  • DISCLOSURE OF ALL INDUSTRY SUPPORT OF SOCIETY

  • ADOPT STRINGENT POLICY ON CLINICAL GUIDELINE PANELS


  • A POLICY FOR GUIDELINES PANELS APPOINTED THE HEAVILY CONFLICTED 2006 KDOQI ANEMIA WORK GROUP ON THE USE OF ERYTHROPOEITIN STIMULATING PROTEIN, WERE THEY OBLIVIOUS TO THE POSSIBILITY THAT

  • NO CONFLICTED PANELISTS IF POSSIBLE

  • OTHERWISE, MINIMIZE NUMBER OF CONFLICTED PANELISTS

  • CONFLICTED EXPERTS CAN TESTIFY BUT NOT VOTE

  • INDEPENDENT EXPERTS

  • DIVERSITY IN PANELISTS

  • EXPERTISE IN DATA ANALYSIS

  • CONFLICTED ADVOCATES ON BOTH SIDES (??)



“CONSUMERS ALREADY SUSPECT THE SYSTEM IS RIGGED AGAINST THEM.

IN A SERIES OF FOCUS GROUPS WE CONDUCTED OVER THE PAST SUMMER…

PARTICIPANTS TOLD US THEY BELIEVED THE SYSTEM WAS DESIGNED TO

MAKE MONEY FOR DOCTORS, HOSPITALS, AND DRUG COMPANIES

RATHER THAN PROVIDE HIGH QUALITY CARE”

(Consumer Reports November 2007, page 13)


  • CONSUMER REPORTS TELEPHONE SURVEY, AUGUST 2010 THEM.

  • Influence of Pharmaceutical Companies (Base: Currently Take Rx)

  • 􀁏 Nearly 9 in 10 consumers expressed some kind of misgiving about the prescribing habits of doctors.

  • 􀁏 Many consumers said that pharmaceutical companies have excessive influence on the medicines that doctors

  • choose to prescribe.

  • 􀀖 More than two-thirds (69%) agreed completely or somewhat that pharmaceutical companies have too

  • much influence on the drugs that doctors prescribe.

  • 􀀖 Half (50%) agreed that doctors are too eager to prescribe a drug rather than consider alternate methods of

  • managing a condition.

  • 􀀖 Nearly half (47%) agreed that the drugs that doctors prescribe are influenced by gifts from pharmaceutical

  • companies.

  • 􀀖 Four in 10 (41%) agreed that doctors tend to prescribe the newer, more expensive drugs.

  • 􀁏 In addition:

  • 􀀖 Half (51%) agreed that doctors don't consider a patient's ability to pay when they prescribe a drug.

  • 􀀖 One-third (32%) agreed that they cannot rely on the doctor's advice alone to choose the best medication.


  • NATIONAL ATTENTION THEM.

  • TO CONFLICT OF INTEREST

  • Ongoing coverage By the media

  • Strong Reports by AAMC, IOM, IOM on CME

  • Action by states (VT, MA, MN)

  • Some medical school departments being investigated

  • Many medical schools revising their policies; given interest in Congress, question whether they will be considered sufficient.

  • April 21, 2010 New CMSS guidelines

  • Sunshine Act of 2010


  • SUNSHINE ACT OF 2010 THEM.

  • Companies must report payments greater than $10 to individual physicians

  • Covers cash, gifts, food, fees, stock ownership, honoraria, education funds, research funds

  • DHSS posts on searchable website

  • Starts January 2013

  • Penalties for non-compliance


  • THE THEM.

  • SLIPPERY

  • SLOPE

  • REPRINTS FROM THE REPS

  • PENS AND COFFEE CUPS

  • TEXTBOOKS AND STETHOSCOPES

  • LUNCHES AND PIZZA

  • DINNERS AND TRAVEL

  • CONTINUING MED. EDUCATION

  • SPEAKER’S BUREAUS

  • STOCK AND OPTIONS

  • CONSULTANCIES/MARKETING

  • CONSULTANCIES/SCIENCE

  • JOINT RESEARCH


  • THE THEM.

  • SLIPPERY

  • SLOPE

  • REPRINTS FROM THE REPS

  • PENS AND COFFEE CUPS

  • TEXTBOOKS AND STETHOSCOPES

  • LUNCHES AND PIZZA

  • DINNERS AND TRAVEL

  • CONTINUING MED. EDUCATION

  • SPEAKER’S BUREAUS

  • STOCK AND OPTIONS

  • CONSULTANCIES/MARKETING

  • CONSULTANCIES/SCIENCE

  • JOINT RESEARCH


  • THE THEM.

  • SLIPPERY

  • SLOPE

  • REPRINTS FROM THE REPS

  • PENS AND COFFEE CUPS

  • TEXTBOOKS AND STETHOSCOPES

  • LUNCHES AND PIZZA

  • DINNERS AND TRAVEL

  • CONTINUING MED. EDUCATION

  • SPEAKER’S BUREAUS

  • STOCK AND OPTIONS

  • CONSULTANCIES/MARKETING

  • CONSULTANCIES/SCIENCE

  • JOINT RESEARCH


  • THE THEM.

  • SLIPPERY

  • SLOPE

  • REPRINTS FROM THE REPS

  • PENS AND COFFEE CUPS

  • TEXTBOOKS AND STETHOSCOPES

  • LUNCHES AND PIZZA

  • DINNERS AND TRAVEL

  • CONTINUING MED. EDUCATION

  • SPEAKER’S BUREAUS

  • STOCK AND OPTIONS

  • CONSULTANCIES/MARKETING

  • CONSULTANCIES/SCIENCE

  • JOINT RESEARCH


  • THE THEM.

  • SLIPPERY

  • SLOPE

  • REPRINTS FROM THE REPS

  • PENS AND COFFEE CUPS

  • TEXTBOOKS AND STETHOSCOPES

  • LUNCHES AND PIZZA

  • DINNERS AND TRAVEL

  • CONTINUING MED. EDUCATION

  • SPEAKER’S BUREAUS

  • STOCK AND OPTIONS

  • CONSULTANCIES/MARKETING

  • CONSULTANCIES/SCIENCE

  • JOINT RESEARCH


  • THE THEM.

  • SLIPPERY

  • SLOPE

  • REPRINTS FROM THE REPS

  • PENS AND COFFEE CUPS

  • TEXTBOOKS AND STETHOSCOPES

  • LUNCHES AND PIZZA

  • DINNERS AND TRAVEL

  • CONTINUING MED. EDUCATION

  • SPEAKER’S BUREAUS

  • STOCK AND OPTIONS

  • CONSULTANCIES/MARKETING

  • CONSULTANCIES/SCIENCE

  • JOINT RESEARCH


  • THE THEM.

  • SLIPPERY

  • SLOPE

  • REPRINTS FROM THE REPS

  • PENS AND COFFEE CUPS

  • TEXTBOOKS AND STETHOSCOPES

  • LUNCHES AND PIZZA

  • DINNERS AND TRAVEL

  • CONTINUING MED. EDUCATION

  • SPEAKER’S BUREAUS

  • STOCK AND OPTIONS

  • CONSULTANCIES/MARKETING

  • CONSULTANCIES/SCIENCE

  • JOINT RESEARCH


  • THE THEM.

  • SLIPPERY

  • SLOPE

  • REPRINTS FROM THE REPS

  • PENS AND COFFEE CUPS

  • TEXTBOOKS AND STETHOSCOPES

  • LUNCHES AND PIZZA

  • DINNERS AND TRAVEL

  • CONTINUING MED. EDUCATION

  • SPEAKER’S BUREAUS

  • STOCK AND OPTIONS

  • CONSULTANCIES/MARKETING

  • CONSULTANCIES/SCIENCE

  • JOINT RESEARCH


  • THE THEM.

  • SLIPPERY

  • SLOPE

  • REPRINTS FROM THE REPS

  • PENS AND COFFEE CUPS

  • TEXTBOOKS AND STETHOSCOPES

  • LUNCHES AND PIZZA

  • DINNERS AND TRAVEL

  • CONTINUING MED. EDUCATION

  • SPEAKER’S BUREAUS

  • STOCK AND OPTIONS

  • CONSULTANCIES/MARKETING

  • CONSULTANCIES/SCIENCE

  • JOINT RESEARCH


  • THE THEM.

  • SLIPPERY

  • SLOPE

  • REPRINTS FROM THE REPS

  • PENS AND COFFEE CUPS

  • TEXTBOOKS AND STETHOSCOPES

  • LUNCHES AND PIZZA

  • DINNERS AND TRAVEL

  • CONTINUING MED. EDUCATION

  • SPEAKER’S BUREAUS

  • STOCK AND OPTIONS

  • CONSULTANCIES/MARKETING

  • CONSULTANCIES/SCIENCE

  • JOINT RESEARCH


  • THE THEM.

  • SLIPPERY

  • SLOPE

  • REPRINTS FROM THE REPS

  • PENS AND COFFEE CUPS

  • TEXTBOOKS AND STETHOSCOPES

  • LUNCHES AND PIZZA

  • DINNERS AND TRAVEL

  • CONTINUING MED. EDUCATION

  • SPEAKER’S BUREAUS

  • STOCK AND OPTIONS

  • CONSULTANCIES/MARKETING

  • CONSULTANCIES/SCIENCE

  • JOINT RESEARCH


  • THE THEM.

  • SLIPPERY

  • SLOPE

  • REPRINTS FROM THE REPS

  • PENS AND COFFEE CUPS

  • TEXTBOOKS AND STETHOSCOPES

  • LUNCHES AND PIZZA

  • DINNERS AND TRAVEL

  • CONTINUING MED. EDUCATION

  • SPEAKER’S BUREAUS

  • STOCK AND OPTIONS

  • CONSULTANCIES/MARKETING

  • CONSULTANCIES/SCIENCE

  • JOINT RESEARCH


  • ACADEMIC LEADERS ON INDUSTRY BOARDS THEM.

  • Can be valuable (new drug development, companies learn about new areas of research, academics learn to organize research teams)

  • Should Chairs and Deans serve as officers? As consultants? Is there a difference?

  • If they do serve, should they recuse themselves in the event of a conflict?

  • How much money is it appropriate for them to retain?

  • Is there effective oversight at the AMC? By whom?


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