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The Cleveland Clinic Sets An Example For The University of Minnesota

From the New York Times:

Cleveland Clinic Discloses Doctors’ Industry Ties

Published: December 2, 2008

The Cleveland Clinic plans to announce this week it has begun publicly reporting the business relationships that any of its 1,800 staff doctors and scientists have with drug and device makers.

The clinic, one of the nation’s most prominent medical research centers, is making a complete disclosure of doctors’ and researchers’ financial ties available on its Web site, www.clevelandclinic.org.

The Cleveland Clinic’s Web postings are the most recent part of a conflict-of-interest effort at the clinic after some of its leading doctors came under fire several years ago when the news media disclosed some of their financial links.

“They are breaking a new path here,? said Dr. David J. Rothman, the president of the Institute on Medicine as a Profession, a nonprofit group based at Columbia University that studies potential conflicts of interest.

In American medicine, doctors’ links to industry are often hidden from public view. And critics argue that such relationships can taint the integrity of medical research and patient care. In one of the most recent controversies, a highly regarded and influential psychiatrist at Emory University, Dr. Charles B. Nemeroff, drew criticism in October for failing to disclose at least $1 million in consulting fees from drug makers.

Senator Charles E. Grassley, Republican of Iowa, has brought Congressional scrutiny to the issue and introduced legislation that would require drug and device makers to divulge the payments they make to doctors. In a statement, Senator Grassley praised the clinic’s move, citing it as evidence of change. “Patients deserve easy access to information about their doctors’ relationships with drug companies,? he said, “and the Cleveland Clinic is making that possible.?

Under the effort led by Dr. Chisolm, every scientist and doctor employed by the clinic must report any industry relationship to the clinic at least once a year. Members of the committee, which meets monthly, typically interview the doctors involved, often requiring documentation like letters to academic journals alerting editors to the industry relationships.

The clinic has been working for more than a year to set up the public listing on its Web site, where consulting payments of more than $5,000 a year, and all royalty and equity interests, will be disclosed.

“Disclosure is a minimum,? said Dr. Chisolm, who hopes to begin listing the actual dollar amounts involved in a doctor’s consulting arrangements next year. The current disclosure simply lists the companies for whom the consulting takes place. He said the group was planning to improve the clinic’s ability to audit the information it received from doctors, because the clinic must now rely on doctors’ self-reporting to find potential conflicts.

The committee does sometimes ask doctors to choose between their consulting and research roles. Dr. Richard Grimm, a cardiologist, was a consultant for the device maker Medtronic, receiving more than $10,000 a year, the limit above which a doctor or researcher must get special approval to continue related research. Last year, he was asked either to stop overseeing clinic research involving a Medtronic device or to do less consulting.

“I sincerely never felt that one was having any effect on the other,? recalled Dr. Grimm, but he chose to scale back his consulting. “One of the main reasons I’m at the clinic is to have involvement in teaching and research,? he said.

Among the most difficult potential conflicts to manage are those that involve the clinic’s own entrepreneurial activities. In one case, the clinic is undertaking research about a medical treatment after surgery developed by one of its own start-up companies. The committee, working with the clinic’s board, developed a management plan that barred any of the research being conducted by someone directly involved in the company. And it called for the possible review of the research findings by an independent party.

Dr. Cosgrove says the clinic’s efforts, like those of the country’s other medical centers, are still a work in progress.

“This is a moving target,? he said, “and it’s obviously moved a long ways in the last 20 years.?

And some institutions are moving faster than others...

Dave Durenberger (in his newsletter) notes of this development:

This week the Cleveland Clinic announced a complete disclosure of their 1,800 staff doctors and scientists relationships with drug and device makers. Over $5,000 a year plus royalty and equity interests. The information will be available on the clinic’s website. I’ve never met a doctor who would admit to being influenced by special favors, economic or otherwise, from product vendors. That includes Cleveland Clinic CEO Toby Cosgrove who publicly complains “you can’t get a coffee mug from a drug company.? But the rate at which American medicine seeks them (and Cosgrove himself has gone way beyond coffee mugs) and the ends to which so many well-paid professionals go to hang on to them, says otherwise. Senate Finance Committee ranking Republican Chuck Grassley of Iowa deserves a huge amount of credit for the pressure he is putting on these professionals to act like professionals so he doesn’t have to act like an outraged legislator.

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