Medical, Biotech Leaders Discuss Ethics

Doctors must work with drug and medical-device makers to promote innovation but their collaboration should not allow a physician's financial interests to overtake patient needs, medical and health-industry leaders said Wednesday.

"We're certainly under a microscope with this issue," Norka Ruiz Bravo, deputy director of research sponsored by the National Institutes of Health at locations coast-to-coast, said at a Cleveland Clinic-hosted conference on biomedical conflicts of interest.

The issue of conflicts of interest has emerged increasingly in the health field amid the fast pace of medical innovation. The clinic announced plans for the conference after its CEO ran into ethics problems over his relationship with a medical-device company.

The conference attracted doctor-researchers, medical educators, biotech executives and health care ethics experts. The discussion ranged from whether doctor-inventors should be allowed to test their devices on patients to whether drug companies should provide free pizza to a physician while making a pharmaceutical sales pitch.

Dr. Philip A. Pizzo, medical dean at Stanford University, said conflicts of interest should be expected as doctor-researchers work with commercial ventures on new drugs or medical devices. The need is not to eliminate such conflicts, but to manage them with full disclosure, he said.

"We want them to be open with us," he said.

Last week officials at Palo Alto, Calif.-based Stanford announced that effective Oct. 1 it would ban physicians working at its two hospitals from accepting even the tiniest gifts from drug industry sales representatives to try to eliminate corporate influence from medical decisions.

Such gifts are meant to give drug makers access to doctors to promote pharmaceuticals, according to P. Roy Vagelos, who retired in 1994 as chairman of the drug maker Merck & Co.

"Companies have measured the impact of gifts or they wouldn't spend the money," Vagelos said.

Dr. Thomas P. Stossel, professor of medicine at Harvard University, took a different tack and said interactions between doctor-researchers and commercial ventures hadn't increased research biases or reduced public confidence.

"Let's just keep things in balance," Stossel said.

He said news media coverage of medical ethics lapses had raised awareness of the issue and made people sensitive to the matter.

Ethical lapses increasingly involve institutions like research hospitals instead of individual researchers, said Dr. Darrell G. Kirch, president of the Association of American Medical Colleges. He said tight money for medical education could lead to more hospital-corporate partnerships, posing more ethics conflicts.

The Cleveland Clinic had its share of ethics issues over the past year. In August, the hospital fired a noted cardiologist for failing to disclose royalties from a stroke-preventing device that he invented and promoted to fellow physicians. In December, a Wall Street Journal story detailed clinic CEO Dr. Toby Cosgrove's relationship with a medical-device company and the clinic's role in a venture capital firm that invested in it.

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Cleveland Clinic: http://www.clevelandclinic.org