Monday, September 29, 2008

Regulating Doctors on the Dole at the University of Minnesota?


From MPR:

The University of Minnesota is considering a new plan to prevent conflict of interest at the University's Medical School. The plan would cover all of the medical schools 450 faculty, 990 residents and fellows, and 920 medical students.

The recommendations haven't been made public. The plan would not would stop the flow of money that has some concerned.

Most of the 25 people on the conflict of interest task force were University of Minnesota medical insiders - doctors, researchers and medical students. But at least one person came in with a different perspective. "I was probably the most outside outsider, maybe the only real outsider on this committee," said Gary Schwitzer.

Schwitzer isn't a medical doctor, he's a professor in the U of M's school of journalism.

In general, Schwitzer said most consumers have no idea what happens between doctors and pharmaceutical companies, whether it's in Minnesota or elsewhere in the country.

"If we went out on the street and told people some of what went on, they would be shocked," he said.

Schwitzer said. "This is a beginning...(it) may have raised more questions that it answered," he said. The recommendations are in draft form at this point and haven't been released publicly. Minnesota Public Radio news obtained a copy of the document.

The plan does contain bans on gifts to doctors, but it does not stop doctors from accepting paid positions as consultants for medical companies. Rather the recommendations focus on making those relationships transparent.

One recommendation would require university doctors to disclose all financial involvements they have with companies. Currently anything under $10,000 isn't considered a "significant financial interest", and doesn't have to be reported.

Another recommendation would require doctors inform patients what financial relationships they have with a drug company before they treat them with a product from the same company.

The plan would also order the the medical school to create a website to show the public how the University manages issues of conflict of interest.

"That would be useful, but it wouldn't be as useful as saying, 'The payments are not allowed'. That would be much more useful," said Dr. Carl Elliot, a professor in the University of Minnesota Department of Bioethics.

Elliott wasn't on the task force. But he's seen the recommendations and doesn't think they go to the root of the problem.

"If the problem is that you think getting all this money from a pharmaceutical company is a conflict of interest, than the solution is to eliminate the money," Elliot said. "The solution is not to say, 'Alright you can still take the money, but you have to report it to someone'. I can't see how that's going to fix anything."

Dr. Deborah Powell, dean of the university's medical school, declined to comment on the recommendations. She directed questions to task force co-chair Dr. Leo Furcht.

Furcht calls the recommendations a first step toward creating a more a transparent, open culture when it comes to financial deals between doctors and medical companies.

Furcht claims relationships between the medical school and medical companies is a necessary part of developing new treatments and devices.

He says ending those relationships outright is the not best option.

Furcht admits industry interests and medical education have become too intertwined.

"I think that what the field is calling for is revisiting this and essentially unwinding some of these relationships that are frankly unnecessary and put the relationship on a more higher plane and a more professional level," he said.

One place the university task force is attempting to unwind industry from medicine is in continuing medical education, or CME.

Last year at the University of Minnesota, medical industry money paid for half of the school's $2.3 million continuing medical education budget. The U of M task force has recommended that within five years, no industry funds be used for CME.

U of M bioethicist Dr. Carl Elliot applauds that move. It may be tough for some doctors to deal with, he said.

"They've come to see that as a perk of the job, that their expenses, their registration fees, their entertainment, their meals will all be subsidized by someone who's willing to buy their good will. It's a clear conflict of interest we should just do away with it," he said.

The U of M isn't the only medical school dealing with the issue of conflict of interest. Schools across the country are in the process of rewriting their polices. The impetus was a report in 2006 in the Journal of American Medical Association that called for colleges to revamp their conflict of interest policies to avoid any influence by pharmaceutical companies on patient care, education or research.

That was followed by a New York Times report in June 2007 that raised questions about four Minnesota psychiatrists who received payments from pharmaceutical companies even after they were disciplined by the state medical board. At least one had spent time teaching at the U of M.

A task force at the University of Pittsburgh's medical school recently rewrote that school's conflict of interest policy, and it's considered one of the best in the nation.

The new policy doesn't ban arrangements like consulting contracts between doctors and companies, but it requires prior approval from the university, said Dr. Barbara Barns, who's in charge of industry relationships at the school. "Those agreements are reviewed by the appropriate department chair or administrator and then by our legal counsel, who then render advice to the appropriateness of the relationship," Barns said.

The University of Pittsburgh medical center has also banned industry support of continuing medical education.

Fourth-year University of Minnesota medical student Josh Lackner, who served on the University of Minnestota task force, welcomes restrictions on the medical industry's involvement at the university. But Lackner doesn't want the effort to stop with the draft recommendations.

"I think there needs to be an ongoing evaluation of what's going on. And I think one committee's policy recommendations while good are not the final answer, it's needs to be the beginning and not the final word," Lackner said.

The recommendations have been emailed to members of the university's medical school community along with a request for input. University of Minnesota medical school leaders say they don't have a timeline to act on the recommendations, but would like to see some action taken in the next year.

Sunday, September 21, 2008

The following piece, in a slightly shorter form, has appeared in the Minnesota Daily:

Call For A Campus-Wide Discussion of our Top Three Goal

"The time has come," the Walrus said, "To talk of many things: Of shoes—and ships—and sealing-wax— And cabbages—and kings—“

Another great summer has passed. The campus was surprisingly alive with students - some taking classes, some doing research, and some being introduced to the U through various summer programs. The students certainly aren't the problem here.

The tail end of the summer was a little disheartening though. We were humilated in the new Forbes ratings (524th !), but showed slight improvement in the US News beauty contest (61st) – leaving us still last in our self-selected peer cohort and in the bottom half of the BigTen. We are now four years from the beginning of our campaign to greatness, in another year we should be half way there. Are we?

This is being written on the last Friday in August and I was away earlier in the week 'Up North in God's Country, aka the Norwegian Riviera, at Naniboujou above Grand Marais. There were no tvs, no newspapers, no email, no internet. This was a chance to think about where we are and where we'd like to be both personally and at the U.

Margaret Soltan, an English prof at George Washington, writes the premiere academic blog in the US, University Diaries (UD). One of her favorite targets is the excesses of football at the expense of academics, and we have become one of her favorite targets. It was on the UD site that I first learned of the latest troubles at the football factory. Evidently, we have made our academic standards even lower in our latest recruiting efforts.

I believe that our current football troubles and most of our other problems are directly linked to the top three goal. President Bruininks has touted ambitious aspirations in an embarrassingly titled document: "Serving Minnesota Through World-Class Greatness.”

"Starting in 2004...Under the leadership of Provost Sullivan, the University community articulated an ambitious aspiration for the University—to be one of the top three public research universities in the world [sic] within a decade."

Today's piece is not meant to be argumentative but to stimulate the initiation of a campus wide discussion of where we are as a university and where we would like to go as a community. I am very disappointed that the establishment of a blog for this purpose [“Conversations with the Provost”], promised last year by provost Sullivan, was dropped because of lack of time on his part. Certainly time spent on such a campus-wide discussion is worth more than that spent on yet another legal tome or further resume-building conferences?

Let all of us, students, faculty, staff, and administrators, work hard to make the U an institution of which we can be proud. People need to have input and they should have some tangible evidence that their input has been heard and acted upon and not just used as evidence that they have been consulted. The administration needs to stop calling people who disagree with them “doubters.” We have just as much at stake as they do, perhaps more.

In the words of Mark Yudof:

To the best of my recollection, no great scientific discoveries, no insightful social science tracts, and no novels have been produced in Morrill Hall. No classes are taught in Morrill Hall. No patients are made well in Morrill Hall. Help, or get out of the way! Without authority invested where the real work of this University is done, the light of excellence will only grow dimmer. University administrators have not yet cornered the market in acumen and foresight; a monologue will not suffice.
President Bruininks, Provost Sullivan, how about it?

I ask that you respond with a piece on the top three goal and that we continue a public dialog throughout this academic year so that communication about important issues does not continue to be a monologue.

Examples of other important topics include the money sink that is UMore Park, ethical behavior at the university, student debt upon graduation, relations with our outstanding coordinate campuses, and the land grant mission of the university. But the place to start discussion is the top three goal, because its pursuit precludes the solution of more important current problems.

I look forward to your response and the initiation of a true conversation this year.

Bill Gleason is a medical school faculty member and U of M alum (PhD, chemistry, 1973) who has taught at Carleton and St. Catherine. Prior to returning to the U in 1989 he worked nine years as a research chemist at 3M. He writes a blog entitled The Periodic Table, described as: "Periodic submissions related to chemistry, education, research, academic life at BigU, and anything else of interest to Mr. Bonzo (aka the Whining Dinosaur)."

Friday, September 12, 2008

Greed Is Good ?

From the Folks who Brought Us Jacko and Sainfort, we have...


"It's one thing if you're bringing in a criminal to speak. But if someone's under investigation, that's fair game," he [Parente] said.

Stephen Parente, director of the Medical Industry Leadership Institute in the Carlson School of Management at the University of Minnesota


Note: added 9/16

It's all a mistake, folks. Despite what you read below, latest word from the U is: "Word last week that he was being considered for "executive in residence" status at the Carlson School of Management was countered Monday by a denial from the university."

I wonder why the denial came from flack-catcher-in-chief, Dan Wolters, rather than OurLeader?

See: Hold that Thought - U Claims No Intent To Gown McGuire

So, I guess these events, described below, did not happen, Mr. Wolters?

Stephen Parente, director of the Medical Industry Leadership Institute in the Carlson School of Management, said the school had given him the go-ahead to explore the idea with McGuire, former chief executive of Minnetonka-based UnitedHealth Group.

There was some discussion within the school, Parente said, on whether it was appropriate to engage McGuire, given the lawsuits and investigations in which he was embroiled. The conclusion was that it was.


From the Strib:

U considering McGuire as a business school expert

By CHEN MAY YEE, Star Tribune

September 11, 2008

The University of Minnesota is courting William McGuire, the health insurance executive who lost his job in a stock options scandal, as "executive in residence" at its business school.
Stephen Parente, director of the Medical Industry Leadership Institute in the Carlson School of Management, said the school had given him the go-ahead to explore the idea with McGuire, former chief executive of Minnetonka-based UnitedHealth Group.

McGuire stepped down as chief executive of UnitedHealth Group in late 2006 after an internal investigation found that stock options at the company had likely been backdated.

This week, he agreed to pay a record $30 million to settle a class-action lawsuit led by the California Public Employees' Retirement System without admitting wrongdoing. He earlier paid a record $7 million fine to the Securities and Exchange Commission and relinquished a total of $618 million in options and other benefits obtained while running UnitedHealth.

Parente said his approach to McGuire was along the lines of: "We don't really care about the stock options. You know stuff. Tell us what you think."

In June, when Parente presented a paper titled "Is Consumerism at Odds with Prevention?" at the American Society of Health Economics at Duke University, he listed McGuire as one of six co-authors.

It would be pretty much negligent on my part not to attempt to engage him."

Some comments from Strib readers:

My Wife And I Will No Longer Support The U

My wife and I had a good year so we were going to gift $50,000 to my wife's alma mater, the U's pharmacy school. After learning that the U was even entertaining hiring someone who I still do not understand why the government has not indicted, we decided not to make the $50,000 gift. We will likely never gift anything to the U. The U's compass is broken. Education should include ethics and morality. If the U wants to be the class institution that it holds it self out to be, it should avoid hiring cheaters and certainly potential indictees.

U of M

Why isn't this surprising. They recruited two professors who lied to their other school and double dipped until they got caught. What a laugh, we need new leadership at the U of M, perhaps someone with ethics.

Medical Industry Leadership Institute

McGuire should fit in just fine at the institute. In fact the institute's director goes on record saying "It's one thing if you're bringing in a criminal to speak. But if someone's under investigation that's fair game." What an incredibly low moral bar he has for deciding whom to hire for a "leadership" institute. Such a sad statement for someone to make on behalf of a publicly funded university.

The Regents Should Put a Stop to This Poor Judgment

I can't even remotely consider how the University would approve adding McGuire to their staff, but I can tell you if Parente worked for my company he'd be out the door today. If McGuire does get added to the U's staff, my substantial annual donation to the University will be stopped. Somehow, some way, our society needs to say no to these types of situations and not back down for the sake of a dollar. I'll be glad to be the first to take that stand on this issue!

U Students Get the Message

The U has made it clear- not only with the McGuire situation, but with the case of attempts by the double-dipping husband wife team out of Georgia- that they will employ people of questionable ethics as long as the U benefits. I've always believed that you don't do business with people you can't trust, no matter what the potential "profits". Believe me, the kids are getting the message.

I just can't even believe this is real................. thing the U of M will do is hire Michael Vick for their Veterinary school. And I'm an alumni---I'm truly embarrassed.

Hmmmm . . .

Maybe they can get him to teach the "Ethics in Business" Class. I understand the "How to Backdate your way to Wealth" module is especially popular.



There are more depressing comments, but I had to quit reading. I kept thinking of a recent comment by OurLeader:

"I think we need to put ourselves in the position of acting according to the highest ethical principles. I believe our people do that now and I believe our people will be doing that in the future as well."
President Bruininks (Daily: 6-18-08)

Please, Bob, this has to stop.

Friday, September 5, 2008

Tuition Increase for Next Year At the University of Minnesota?

For a change the administration has put their cards on the table at the beginning of the academic year. I have some problems with this plan, but congratulate them for not waiting until the last minute to make public their target figure as they did last year.

More to come.

September 5, 2008

Tuition relief for students from middle-class families and increased pay for faculty and staff are the highlights of the legislative budget request that will be unveiled next week to the University of Minnesota Board of Regents.

University President Robert Bruininks is proposing a two-year request to the Legislature that would increase state spending by about $142 million.

If approved by the Legislature, the average tuition increase would be 4.5 percent per year across the university system in 2009-10 and 2010-11.

"It's a pretty modest request to the state relative to the requests we've made over the last 10 years," said Richard Pfutzenreuter, a university vice president and chief financial officer. "It's in recognition that the state has some budget problems."

The request represents a 9.8 percent increase over the previous biennium. The regents will hear Bruininks' budget plan when they meet on Friday.

The new program -- which would cost about $8 million annually -- will be need-based and for resident students from families making between $50,000 and $100,000. Pfutzenreuter said that a student from a family making $100,000 might receive only $500 in aid while a student from a family making $50,000 might receive $4,000.

About 65 percent of the school's undergraduates would be eligible for the awards that would average $1,700, Pfutzenreuter said.

After tuition on the Twin Cities campus went up 7.25 percent for the 2008-09 school year, the university is trying to limit increases over the next two years.

More than $95 million of the new money would be used to increase wages for faculty and staff at all of the university's campuses. The average raise would be 3 percent annually, but some employees would see larger or smaller increases.

The remaining funds would be used to enhance research and research infrastructure.