The long road to ethics reform

Ethics reform at the University of Minnesota Medical School âÄî once the charge of a single task force âÄî has since ballooned into an in-depth, far-reaching and lengthy affair. Those anxious for change should be ready to wait a bit longer. Final recommendations from a separate, high-level committee are likely still months away. That committee includes a virtual whoâÄôs-who of Medical School and Academic Health Center administrators. Senior Vice President for Health Sciences Dr. Frank Cerra, Vice President for Research Tim Mulcahy and Medical School Dean Dr. Deborah Powell are all members, among others. Medical schools across the country have tightened conflict of interest policies in the past two years. The American Medical Student Association âÄî the organization that gave the UniversityâÄôs Medical School a âÄòDâÄô last summer for its current policies âÄî gave six times more positive reviews in 2008 as it did the year before, AMSA Scorecard Director Gabe Silverman said. âÄúThis is definitely like a tidal wave of policy change that is happening across the country,âÄù he said. With about 25 schools improving their policies in a year, and the next AMSA scorecard due out in June, comparatively speaking, the UniversityâÄôs Medical School has been slow to act. Still, if the current recommendations were implemented, the Medical School would be âÄúsignificantly improvingâÄù its policies, Silverman said, although theyâÄôre not without faults. âÄúWe would commend the school if they were to implement a policy along these lines,âÄù he said. âÄúIn almost all categories theyâÄôve substantially improved.âÄù

A lengthy process

ItâÄôs been more than a year since Powell commissioned a task force to address the schoolâÄôs perceived shortcomings with conflict of interest policies. That task force has since made sweeping recommendations that would increase scrutiny of industry-professor relationships and implement a ban on gifts to doctors, among other changes, that were well-received, even by critics. The University, as an institution, has not yet taken a stance on the recommendations. The other committee will analyze the task forceâÄôs recommendations, along with an external review of current policies and community focus groups, before presenting recommendations likely in March or April of this year. There are positive things in the recommendations, Cerra said, but added there needs to be more dialogue to make sure revisions are done correctly.

Conflicts: the risk and the reward

Relationships, including sometimes incredibly lucrative consulting and speaking contracts between faculty and industry, and the collaboration that has led to many medical advances, have been the most public aspect of the ongoing ethics reform debate across the country. Officials at the Medical School have been balancing between what they call the benefits of relationships with industry and the need for ethics reform. To that end, Cerra said the higher-level committeeâÄôs intent is âÄúto make a very clear statement of the value that is gained from relationships between our faculty and industry, while at the same time saying there needs to be appropriate conflict of interest policies and procedures in place.âÄù Cerra lauded the disclosure aspect of the recommendations specifically. It would require all faculty to disclose financial relationships. âÄúConflicts of interest are like budgets to me, the more transparency the better,âÄù he said. âÄúI truly believe in a 100 percent transparency.âÄù Disclosure has been the word du jour for Medical School officials throughout the reform process, yet critics say bringing those relationships to light can make them more acceptable and even increase bias. The idea that disclosure alone will fix the problem is âÄújust misguided,âÄù Dr. Carl Elliott , a professor in the UniversityâÄôs Center for Bioethics, said. âÄúDisclosure is a non-solution,âÄù he said. âÄúThe money is still there. ItâÄôs still a conflict but itâÄôs just a transparent conflict.âÄù Aside from that aspect, Elliott said the recommendations donâÄôt address advisory and consulting relationships that tend to be the most lucrative for faculty. âÄúThey close up all the small things, the lunches for the residents and that sort of thing,âÄù he said, âÄúbut they leave the really big things in place.âÄù

Students push for reform

For everyday students at the UniversityâÄôs Medical School, the reform process has been generally a closed one. The original task forceâÄôs recommendations were circulated among school faculty, but not the general student body, although there were a few students on the task force. Had the recommendations not been leaked to the media, itâÄôs possible that medical students wouldnâÄôt have had a chance to comment, AMSAâÄôs Minnesota chapter President Hannah Shacter said, and thatâÄôs a problem. âÄúStudentsâÄô voices should be heard on this,âÄù she said. âÄúThatâÄôs the only way to change it.âÄù AMSA-MinnesotaâÄôs official response to Dean Powell regarding the recommendations was largely positive, although it did call for more conflict of interest training for students. âÄúOur conversations with our peers have revealed enormous ignorance on the implications of conflicts of interest in Medicine ,âÄù the response reads. That is of particular concern, students say, because by nature medical schools lay the groundwork for what kind of doctors the students will become. âÄúWeâÄôre the doctors of tomorrow,âÄù AMSA-MinnesotaâÄôs secretary Joy Brintnall said. Still, aside from concerns over the integrity of research and patient care, AMSA-MinnesotaâÄôs concerns have a much more practical aim. âÄúWhat we care about is the integrity of our education,âÄù Shacter said. âÄúIf theyâÄôre in a stance to benefit itâÄôs going to affect my knowledge, what my curriculum is going to be.âÄù