The Daily Telegraph, Australia.

A drug company is offering doctors who prescribe its medicines a 10-day Mediterranean cruise in a move that could breach a code of conduct.

And taxpayers will help subsidise the cruise – described as “the perfect mix of education and relaxation” – because doctors are being told they can claim it as a professional development program.

The cruise raises questions about drug company ethics and the Australian Medical Association and the peak pharmaceutical industry group have warned the offer could lead to the perception of a conflict of interest for doctors who take it up.

Sigma, a generic drug manufacturer and the third-biggest pharmaceutical company in the country, wants to take general practitioners on a luxury cruise visiting Italy, Malta, Corsica and Monte Carlo in October…

Yes, word’s getting around. This is from the University of Iowa.

…from Science Magazine. Excerpts:

… The end result [of Senator Charles Grassley’s investigation and proposed legislation] is expected to vastly expand the information that faculty — both basic and clinical — must report to their institutions and to NIH. And it will likely ask for more details on how institutions follow up on conflicts.

… The issue exploded in the media a year ago thanks to Grassley, the ranking member of the Senate Finance Committee. The 75-year-old Midwesterner, a longtime fraud buster, started out investigating defense contracts. In recent years, Grassley, citing his committee’s oversight of Medicare and Medicaid, began probing conflicts of interest involving the approval of drugs such as Paxil and Vioxx.

In 2007, these probes led Grassley’s investigators to conflicts of interest at biomedical research institutions. Using a strategy that had worked well in an inquiry by the House of Representatives, they asked both companies and institutions about payments to a faculty member and looked for discrepancies. Grassley says they got leads from media reports and “whistleblowers” such as critical faculty members.

Grassley’s team made its first big splash with a front-page story in The New York Times last June. They alleged that three Harvard child psychiatrists had failed to report hundreds of thousands of dollars in income they received over several years from drug companies. Other psychiatrists and surgeons have since been accused of hiding similar payments, and some have been disciplined…

… No rule is universally obeyed, of course, and scientists could still hide their income. Many of those Grassley has probed allegedly were not following existing rules. The remedy for that, many observers say, is a public database of payments reported by companies — such as one that would be created by the bill introduced by Grassley and Senator Herbert Kohl (D–WI), potentially by October 2011. University officials could use the database to audit their faculty members, say AAMC and AAU, which support the bill…

A professor runs a research unit of some sort that gets grants.

At some point it occurs to the professor that he or she could start a business and steer grants the business gets to the university research unit.

This is classic conflict of interest, and there’s a case of it now at the University of Missouri.

An internal audit of MU’s Research Animal Diagnostic Laboratory, known as RADIL, prompted the lab’s director, Lela Riley, to step down because of a conflict of interest.

According to a statement issued by the university, a conflict of interest arose because Riley was both the head of the research lab and the head of a “private venture company” called Impact Bio Labs LLC. The company and the lab do business together, and MU felt that management changes were necessary to absolve the conflict.

Make that resolve the conflict. Conflicts don’t need absolution.

Another article about this conflict explained it this way:

In 2005, Riley and seven RADIL faculty members formed a private venture company known as Impact Bio Labs LLC. As a private company, Impact Bio Labs has been able to secure federal grant funding for private companies and unavailable to public universities.

Again, the idea is to steer grant money that the university can’t get directly to the university because, as owner of the private business, you now control the grant and can move it around. And you’re gonna move it around to your lab, of course. Conflict of interest means you’ve really got things sewn up. You’ve got them coming and going.

From the Canadian Jewish News:

… In his keynote address [at a Yeshiva event in Montreal recently], [Richard] Joel, who has been YU president since 2003, made an appeal for greater financial support from Montrealers, as well as for them to send more of their children to YU.

He said the university spends about $2.5 to $3 million a year educating those Montrealers, but receives only about $750,000 to $850,000 in revenue in any given year from Montreal.

“The economy is awful, and we are operating in a major deficit,” he added.

Joel did not refer to the $14.5 million YU has said it lost in the fraud allegedly perpetrated by Bernard Madoff, who was a member of its board of trustees…

UD takes this typically dull sentence from a book written by committee and full of dull sentences.

Unfortunately, the book is extremely important, making the case, as it does, that conflict of interest in academic and non-academic medicine is an immense national scandal.

This being University Diaries, UD pays attention only to that small part of the scandal that involves universities with medical schools. But there’s so much more, and this book covers it all. Dully.

Conflict of Interest in Medical Research, Education, and Practice (note titillating title), published by National Academies Press, may be bought, downloaded, skimmed online … mainlined via hypodermic… what I mean is, there are many, many ways to read this book. Is what I’m trying to get across.

An option that doesn’t exist is reading its important and even dramatic material in a way that doesn’t make you bitter about how old you’re getting. (Though this might just be me.)

The University of Florida medical school can’t even find and retain forms it’s been sent to complete on conflict of interest.

Because of this pathetic failure, the American Medical Student Association gave the school an F grade on its widely publicized national measurement of how well universities are handling conflict of interest in their med schools. The university had to plead with AMSA to change its grade to in progress,which AMSA graciously allowed.

And now a blowhard UF dean, interviewed by the student newspaper, comes out with this:

“[AMSA] is the least knowledgeable [in conflicts of interest policies],” Flynn said, referring to the fact that AMSA is an organization made up of medical students. “[No offense to them, but] they’re not even in the profession yet. We’re doing this because we feel it’s the right thing to do, not because of them.”

Yes, the wee babes of AMSA! We big boys who’ve been at the conflict of interest game for decades know how it’s played. These innocents, these hyper-moral fools, these fanatics, waltz in with their little questionnaires and think we have to notice! No offense, but they don’t know shit. We threw their presumptuous little form in the trash the minute we saw it… Now it turns out people actually pay attention to the fuckers…. We had four secretaries scrounging through garbage to find the thing! But no go. We’ve had to kiss up to the assholes…

As we await Madoff’s sentencing today, we revisit unapologetically ill-run Yeshiva University.

[Many institutions connected to Madoff] not only need to more formally organize their investing and giving along more official corporate governance lines — Yeshiva University in particular has been cited for this type of needed reform. [T]hey may need to address their own unwitting complicity in the dissipation of the assets of Mr. Madoff’s victims.

Madoff, recall, was Yeshiva’s treasurer, Ezra Merkin an influential trustee. There’s been no public reckoning with this history on that campus, and conflict of interest remains the all-male board of trustees’ middle name.

Sure, Yeshiva lost money through Madoff. It also made plenty of money – for itself, and for its trustees. Yeshiva has said nothing by way of acknowledgement of the depth of its misdeeds.

**********************

Update: It’s also a good day to remember this letter, written last year to the president of Yeshiva from one of its law school graduates, Andrew Sole. Here are its closing paragraphs:

[H]arm has come to this distinguished University, both in financial loss and worse, in reputation. It is my view that the harm today is directly attributable to the failed performance of our trustees. As fiduciaries they lost sight of their primary mission, to safeguard the long-term interests of Yeshiva University. Whether their activities were merely negligent, or worse, that judgment is best left for others.

In my view it will take a generation to repair the damage inflicted upon Yeshiva. And that is very sad. But what would be even sadder, and which would also give grave concerns to Yeshiva’s many supporters, would be for the University to continue to allow the current Board of Trustees to serve as fiduciaries going forward.

The honorable course (and we have seen virtually no honorable behavior in American corporate boardrooms, nor in our public servants, in 2008) would be for the University’s President, and its legal counsel, Sullivan and Cromwell, to demand the immediate resignation of the entire Board of Trustees. The University’s counsel, government regulators, and law enforcement will conduct their proper investigations, but the proud students, graduates, and supporters of Yeshiva University should not have to wait that long for credible and therapeutic action to be taken by this University.

Yeshiva has the opportunity to begin the healing process today by installing new fiduciaries that are untainted by scandal and embarrassment. I hope you will take this letter to heart and I wish the University the best during these incredibly trying times.

Yeshiva responded to Sole with a form letter brush-off.

And all of those men, those hands-in-each-others’-pockets men, those Madoff and Merkin men, remain on the Yeshiva University board of trustees.

… reminds us of the two biggest Larry Summers scandals at Harvard.  The blogger reminds us of this because he doesn’t think Summers should be considered for head of the Federal Reserve.  He doubts Summers could even make it through a Senate confirmation.

…He … was criticized for shielding his protégé Andrei Shleifer from accusations of conflict of interest when Shleifer sought lucrative commercial deals for himself as he headed a government-sponsored Harvard team to advise Russia on privatization. The university paid $26.5 million to the U.S. government to settle a lawsuit that Shleifer’s activities violated its contract.

This controversy, too, would resurface in any hearings on Summers’ fitness for the Fed job. Coupled with his own dubious fees from various Wall Street firms who wildly overpaid him for “advice” while he was aiding candidate Obama, the Shleifer affair would raise questions about Summers’ judgment in these matters. …

Both of these sleazy tales have been extensively covered on University Diaries.

Mississippi State University bioethicist Barton Moffatt predicts doctors who allow their names to be put on ghostwritten articles may one day find themselves being fired over the practice, adding that many in academia now see the practice as plagiarism.

[Trudo] Lemmens [a professor of medical law at the University of Toronto] says he would fail any student who handed in a ghostwritten article, adding that universities cracking down on student plagiarism need to pay closer attention to faculty, as well.

“It is clearly false representation, which is academic misconduct. If we don’t do something about it (ghostwriting), it’s hard to tell the students it is wrong.”

You do begin to wonder… I mean, what are universities afraid of? The medical faculty will poison their sherry? You’ve got all these really highly paid professors, quite a number of whom do a raft of illegal, unethical, embarrassing things… The whole conflict of interest, ghost-writing, Continuing Medical Vacation shebang…

From the same article:

To test the integrity of a [corporate-ghosted] publication called The Open Information Science Journal, Cornell University student Philip Davis and Kent Anderson of the New England Journal of Medicine, submitted a fake manuscript – generated by a computer program to be purposely nonsensical – at the end of January. The “open information” journal offered to publish the article if the pair agreed to pay an $800 publishing fee. The editor later resigned.

… release of its report on  Reggie Bush.

Medical school professors at the University of Minnesota are just as eager to lose money on their personal promotion of pills and devices, and on the sale of their university affiliation for use on corporate-generated research papers, as the University of Southern California is to admit guilt in the Bush recruiting scandal.   

Thrilled at the prospect of losing football games, incurring financial and win-record penalties, and telling professors accustomed to $500,000 base salaries plus up to a million dollars a year in corporate supplements that they’ll have to make due on the $500,000, committees at both schools are working with brisk efficiency on sanctions and rule changes. 

Here’s an update on the work of the University of Minnesota conflict of interest committee:

After a year and a half of work, the University of Minnesota still does not have a new conflict of interest policy in place for its 450 faculty, 990 residents and 920 medical students.

… [S]ome are frustrated with the pace of the process, and say the university has missed an opportunity to draft a tough policy that protects patients.

Josh Lackner and two dozen others in the University of Minnesota medical community came up with 14 pages of recommendations to prevent conflict of interest at the U of M’s medical school last fall.

Lackner, a recent med school graduate, doesn’t see many of those suggestions in a draft document being used by med school leaders to create a new conflict of interest policy.

… Allan Coukel, director of the Pew Prescription Project, a Boston-based group that monitors conflict of interest policies at the nation’s medical schools, has followed the U’s effort to rewrite its policy. Coukel thought early on the U was headed in the right direction.

“It looks like at one stage they were considering policies that really would have put them in the first rank nationally,” Coukel said. “And now they’re circulating a document that we can say is a modest advance, but they’ve squandered a chance to be a national leader.”

… Some say it’s simply taken too long for the med school’s leadership to come up with a new document. At one point, the document was expected to be ready by April.

Professors at the University of Wisconsin medical school are appalled at the voyeuristic ways of Charles Grassley.

Some of the orthopedic surgeons [who make enormous outside sums pushing medical devices] also were among the most vocal opponents to the university’s new disclosure requirements, referring to the more stringent disclosure requirements as voyeuristic.

In the past, they and other doctors who earned large sums working as consultants, speakers or from royalties could merely state that they received more than $20,000 without having to tell their patients or the university the actual amount.

It’s only appropriate that we not tell you the actual amount. Only a sicko would want to see the actual amount.

… [I protest the] feigned or real naiveté on the part of [medical] professionals who claim they are above being influenced [by industry money and gifts]. Physicians owe their patients much more than naiveté. The degree to which policy rather than personal ethics is necessary to bring an end to obvious marketing schemes is a reproach to my profession.

… Almost two-thirds [of medical school department chairs] have a personal relationship with industry as consultant, board member, paid speaker or the like. It is not unusual to see papers in major medical journals where authors disclose relationships with many, many industrial organizations.

Is anyone reassured by all this disclosing? I am not. To the contrary, I look askance at the discloser and at the substance that is being put forth. I am not surprised when paper after paper documents that when the study of a drug or device is industry supported, the result is far more likely to be positive than when the study of the same drug or device is government supported.

… My queasiness peaks when I know that the “CEO” of a large state-supported academic health center is also on the board of a certain major pharmaceutical benefits manager — which just happens to be the pharmaceutical benefits manager for that state’s employee health plan.

… Very seldom, anymore, are the trials necessary for licensing drugs or devices carried out by the manufacturer. There is an industry devoted to providing that service, the Contract Research Organizations (CROs). I have long railed against this relationship as I consider it inherently conflictual. Science is the exercise of disproving any hypothesis. The CRO is contracted in the hopes it will prove the hypothesis that a particular drug or device is an important contribution. There is no joy in Mudville when the study is negative (see the discussion above about industry-supported vs. government-supported science of this nature). CROs can be very lucrative. Many academic health centers have their own CRO, and many others wish they did. Furthermore, many an “academic physician” is employed for “translational research,” which is a euphemism for recruiting patients into trials run by CROs…

Norton Hadler, ABC News.

But here it is, in South Dakota. Bravo.

Austin Kaus, The Daily Republic:

A state senator says that if the Board of Regents doesn’t take care of a potential conflict of interest involving the president of South Dakota State University, the Legislature will.

Sen. Frank Kloucek, DScotland, a family farmer, said he is concerned about SDSU President David Chicoine’s appointment to the board of directors of the Monsanto Company, which produces crop seeds, herbicides and pesticides. For his role on the board, Kloucek said Chicoine will receive nearly $400,000, an amount that surpasses Chicoine’s salary as SDSU president by $80,000.

Kloucek said he wouldn’t object to Chicoine’s dual roles if the money from Monsanto went to the university. Chicoine’s private acceptance of the money, however, “leaves a foul taste in the mouth.”

“It’s just totally inappropriate to give that money to an individual rather than to the university for research,” Kloucek said. “It appears pretty clear-cut that they’re trying to buy influence at the university by buying influence with the president.”

In a letter that appears on Page 4 of today’s Daily Republic, Kloucek calls upon the state Board of Regents to resolve the issue.

“If the board does not act,” Kloucek wrote, “this issue will be presented to the South Dakota Legislature for a more permanent solution that will address it fairly and reasonably.”

In a telephone interview Thursday, Kloucek clarified, saying he and other legislators already are at work drafting potential legislation to deal with the issue.

“There will be at least one bill,” Kloucek said. “I just think it’s better … to make it clear the we’re not in that kind of game at South Dakota.”

The appointment of Chicoine to the Monsanto board negatively affects the credibility of the university, Kloucek said, since crop research reports from SDSU could easily be assumed as skewed.

“This research must not be tainted in any way, shape or form and this certainly taints that research,” Kloucek said. “It … jeopardizes the integrity because it makes it look like we’re in the hip pocket of Monsanto.”

Until the session begins, Kloucek said he’ll be taking input from other South Dakota residents on potential solutions to a problem that he said “smacks very hard of … conflict of interest.”

“It’s a tough issue, but I just think it’s wrong and I’m going to do everything I can to make sure to correct it in one shape, way or form,” Kloucek said.

We’re not in that kind of game at South Dakota.

Kiss the man.

… And… uh… where’s the response from the president? This story has been kicking around for weeks. If there’s no problem with what he’s doing, why isn’t he defending himself?

The University of Florida medical school received an F … on a scorecard designed to measure ethical policies on professors’ relationship with the pharmaceutical industry, the Pew Prescription Project announced Tuesday.

… The Gainesville school flunked because it refused to provide information, according to the 2009 American Medical Student Association PharmFree Scorecard. UF spokeswoman Melanie Fridl Ross said Tuesday, “We aren’t sure what happened with respect to the AMSA survey, but . . . shortly after being named interim dean of the College of Medicine last June, Dr. Michael L. Good appointed a task force to review and update the existing policies . . . on industry conflicts of interest and industry-academic relations . . . “

They can’t even find the survey.