Summit on Biomedical Ethics Held at Cleveland Clinic

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Most of the 300 medical professionals and industry reps who came from around the country to attend the day-long conference agreed they're under the microscope over their increasingly close collaboration in the development of new medical innovations. Some fear the healthcare industry could become embroiled in the kind of corporate corruption scandals seen at Enron and WorldCom unless it creates its own rules for governing the balance between physician profits and patient protections. Former U.S. Attorney General Richard Thornburgh, himself a pharmaceutical company director, admits there's a lot at stake.

Richard Thornburgh: If important research, regulatory and clinical institutions begin to lose the public trust, we risk undermining our nation's capacity for experimentation, scientific innovation and ultimately, excellence in patient care.

Some institutions have begun to create their own codes of ethics. Last week, Stanford University announced that starting in October doctors and medical students may no longer accept any gifts from drug and medical company salesmen. Philip Pizzo, dean of Stanford's medical school, says the stringent new rules will ban things like coffee cups and notebooks adorned with logos from pharmaceutical companies can influence doctors.

Philip Pizzo: Pharma today invests over $20 billion in marketing, much of which is directed at physicians. To think that there is no suasion that happens because of small gifts is, I think, somewhat naive.

But while there's agreement that some individual conflicts can and should be eliminated, many believe other conflicts - particularly those within institutions - can be managed in way that's transparent enough to assure public trust. Pizzo admits Stanford's School of Medicine has accepted money from the medical industry to endow a residency. He says medical schools need money for residencies, scholarships, and other programs and in the face of waning academic support, they're turning to drug makers and device manufacturers to fund them. Roy Vagelos, former CEO of drug giant Merck, believes institutional gifts are less likely to be viewed as influence-peddling.

Roy Vagelos: That makes it impersonal and does not have undue influence, I don't think, on prescriptions in that institution. Whereas the pizza delivered by a sales rep does. But there's got to be a payback. No company is going to put money into a medical center and get nothing out of it.

One idea is to replace marketing reps with informational meetings between institutions and drug firms. But there are conflicting ideas over how to manage the relationship between researchers and the medical industry when they're working together to bring a new product to market. While some institutions, like the Cleveland Clinic, have created new guidelines for doctors to disclose their financial interests in industry-funded development of new drugs or medical devices, others, like Stanford, have placed caps on the amounts doctors can earn. Again, Stanford Dean Philip Pizzo.

Philip Pizzo: We want to work with industry in ways that promote the exchange of knowledge. Our mission at Stanford is to bring discoveries forward that can then be commercialized. There are literally some schools now that are aligning their faculty's achievement in getting patents. I think that's wrong.

Only one of the conference's speakers took issue with the idea that researchers are doing something wrong. Dr. Thomas Stossel, a professor of medicine at Harvard Medical School, argued that too much regulation could lead to a chill on new research that would ultimately hurt, not help patients.

Thomas Stossel: I see a harmony, not a conflict of interests. The accusations that they have compromised research are untrue.

But the general consensus of conference attendees seemed to be that self-regulation is preferable to having government or Congress step in. Members of the medical community say they'll continue to refine how they manage conflicts of interests. Karen Schaefer, 90.3.

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