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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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slide1
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
slide2
MY CONFLICT OF INTEREST
  • Oxford University Press
  • October, 2004
slide3
RHETORICAL QUIZ:
  • WHAT’S YOUR CHOLESTEROL? YOUR LDL? ARE YOU TRYING TO LOWER IT?
slide4
RHETORICAL QUIZ:
  • WHAT’S YOUR CHOLESTEROL? YOUR LDL? ARE YOU TRYING TO LOWER IT?
  • ARE YOU TAKING STATINS?
slide5
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?
slide6
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?
slide7
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?
slide8
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?
slide9
NCEP GUIDELINES JULY ’04
  • (Sponsors: NIH, AHA, ACC)
  • Reviewed these studies:
  • PROSPER
  • ALLHAT-LLT
  • ASCOT-LLA
  • PROVE IT-TIMI 22
  • HPS
slide10
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)
slide11
NEW NCEP GUIDELINES JULY ’04
  • Recommendation:
  • Aggressive LDL lowering for high risk patients with lifestyle changes (diet, exercise) and statins
  • (Primary prevention)
slide12
THERAPEUTICS INITIATIVE U.B.C.
  • (No industry support)
  • Reviews these studies:
  • PROSPER
  • ALLHAT-LLT
  • ASCOT-LLA
  • AFCAPS
  • WOSOP
slide13
THERAPEUTICS INITIATIVE U.B.C.
  • (No industry support)
  • Conclusion:
  • Statins have not been shown to provide an overall health benefit in primary prevention trials
slide15
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
slide16
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)
slide17
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
slide18
“EPIDEMIOLOGY”

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

slide19
FERVENT BELIEFS OF OBJECTIVITY
  • TRAINED IN THE SCIENTIFIC METHOD
  • RELIGIOUS ADHERENCE TO EVIDENCE-BASED MEDICINE
slide20
SELF-DECEPTION?
  • HOUSE OFFICERS AT UCSF:
  • CAN YOU BE INFLUENCED?
  • CAN YOUR COLLEAGUES BE INFLUENCED?
slide21
SELF-DECEPTION?
  • HOUSE OFFICERS AT UCSF:
  • CAN YOU BE INFLUENCED?
  • 39% YES
  • CAN YOUR COLLEAGUES BE INFLUENCED?
slide22
SELF-DECEPTION?
  • HOUSE OFFICERS AT UCSF:
  • CAN YOU BE INFLUENCED?
  • 39% YES
  • CAN YOUR COLLEAGUES BE INFLUENCED?
  • 84% YES
slide23
THE CANDY EXPERIMENT AT CORNELL’S HOTEL SCHOOL
  • THE GIFTTHE TIP
  • NO CANDY
  • ONE PIECE
  • TWO PIECES
  • ONE PLUS ONE
slide24
THE CANDY EXPERIMENT AT CORNELL’S HOTEL SCHOOL
  • THE GIFTTHE TIP
  • NO CANDY 19.0%
  • ONE PIECE
  • TWO PIECES
  • ONE PLUS ONE
slide25
THE CANDY EXPERIMENT AT CORNELL’S HOTEL SCHOOL
  • THE GIFTTHE TIP
  • NO CANDY 19.0%
  • ONE PIECE 19.6%
  • TWO PIECES
  • ONE PLUS ONE
slide26
THE CANDY EXPERIMENT AT CORNELL’S HOTEL SCHOOL
  • THE GIFTTHE TIP
  • NO CANDY 19.0%
  • ONE PIECE 19.6%
  • TWO PIECES 21.6%
  • ONE PLUS ONE
slide27
THE CANDY EXPERIMENT AT CORNELL’S HOTEL SCHOOL
  • THE GIFTTHE TIP
  • NO CANDY 19.0%
  • ONE PIECE 19.6%
  • TWO PIECES 21.6%
  • ONE PLUS ONE 23.0%
slide28
“ I CAN RESIST ANYTHING BUT TEMPTATION”
  • (OSCAR WILDE, LADY WINDERMERE’S FAN, 1892, ACT 1)
slide30
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)
slide31
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)
slide32
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
slide35
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
slide36
RESULTS
  • (%)
  • hirees independents
  • ------- ----------------
  • Parench. abn. 96 5
  • Pneumocon. 97 6
  • Pleural abn 26 8
  • Film normal 0 38
slide37
Off-label
  • drug use.
  • What’s
  • the real
  • motive?
slide38
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?
slide39
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)
slide40
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
slide41
“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)
slide42
STACKING THE DECK
  • "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."
slide45
ARE THE EPO GUIDELINES BIASED?
  • 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.
slide46
NATIONAL KIDNEY FOUNDATION
  • 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)
slide47
NATIONAL KIDNEY FOUNDATION
  • 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)
slide48
NATIONAL KIDNEY FOUNDATION
  • CONFLICT OF INTEREST POLICY
  • DISCLOSURES
  • DISCLOSURES
  • DISCLOSURE
  • DISCLOSURES
  • (http://www.kidney.org/professionals/KDOQI/guidelinesCOI.cfm. Accessed 9/19/07)
slide49
“MANAGING” CONFLICTS OF INTEREST
  • DISCLOSURE IS WIDELY CONSIDERED
  • “THE GREAT DISINFECTANT”
  • BUT IS IT?
slide51
DISCLOSURE OF COMPANY TIES IS NOT A SOLUTION
  • 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.
slide52
A MISGUIDED BROUHAHA OVER LACK OF DISCLOSURE
  • 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
slide53
WHY MISGUIDED?
  • 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.
slide54
DISCLOSURE’S FLAWS
  • “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
slide55
SOME SOLUTIONS
  • 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
slide56
A POLICY FOR GUIDELINES PANELS
  • 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 (??)
slide57
“…GUIDELINES WOULD INSPIRE THE MOST CONFIDENCE IF INDEPENDENT EXPERTS DEVELOPED THEM WITHOUT FUNDING FROM INDUSTRY OR OTHERS WITH SELF INTEREST IN THE OUTCOME.”
  • (Robert Steinbrook. Guidance for Guidelines.
  • NEJM 356:331-332, 2007)
slide59
“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)

slide60
CONSUMER REPORTS TELEPHONE SURVEY, AUGUST 2010
  • 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.
slide62
NATIONAL ATTENTION
  • 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
slide63
SUNSHINE ACT OF 2010
  • 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
slide64
THE
  • 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
slide65
THE
  • 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
slide66
THE
  • 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
slide67
THE
  • 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
slide68
THE
  • 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
slide69
THE
  • 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
slide70
THE
  • 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
slide71
THE
  • 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
slide72
THE
  • 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
slide73
THE
  • 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
slide74
THE
  • 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
slide75
THE
  • 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
slide76
ACADEMIC LEADERS ON INDUSTRY BOARDS
  • 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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