Med School Dean proposes softer reform

University of Minnesota Medical School Dean Dr. Deborah Powell is moving the institution toward weaker ethics reform than her own task force previously recommended, an unreleased draft report obtained by The Minnesota Daily indicates.
Incorporating some, but not all, aspects of what many viewed as hard-line and progressive recommendations by the school’s conflicts of interest task force, Powell’s draft moves the long-coming policy reform in a much softer direction than expected, sources close to the reform said.
From the 13-page report filed by the task force in August, Powell has solicited comments from faculty and consolidated the recommendations into a two-page draft, which will be the basis for a final report to the Board of Regents in April, said Academic Health Center spokeswoman Molly Portz.
Powell's report is just one part of an in-depth look at the need for reform at the school, which includes community focus groups, an independent review of current policies and input from faculty.
That information will go to a separate, higher-level committee, which includes Powell, before any recommendations are brought to the Regents, Dr. Frank Cerra, senior vice president for health sciences, told the Daily last month.
But critics of Powell’s report point to a disconnect between the task force’s recommendations and the draft, saying the dean has eliminated some of the strongest and boldest recommendations with little to no explanation.
Despite a recent announcement from University President Bob Bruininks that she will leave the dean’s post July 1, Powell will remain at the helm of the ethics reform as planned, after that it will be the responsibility of Cerra as senior vice president and dean of the school, Portz said.
Still, the controversy from Powell’s latest reform proposal is just the most recent example of a tenure at the school that has been recently mired in questions over her position on the board of directors for Pepsi Co. and conflicts of interest concerns.
Even the Medical School task force’s co-chairman, Dr. Leo Furcht, a Powell appointee, was disciplined for severe violations of the University’s conflict of interest policy in 2004 — a fact that was not disclosed to other members of the task force until reported by the Star Tribune late last year.
An inquiry panel then stated Furcht “at a minimum should not be allowed to perform the conflict of interest responsibilities of a department head.”
A signed letter from Powell accompanied the panel’s findings, according to a copy provided to The Daily.

‘They gutted it’

Key elements of the task force’s recommendations, believed by some to be among the most needed changes, are notably absent from Powell’s draft, among them a recommendation to sever financial ties between industry and continuing medical education programs.
“They gutted it,” said Center for Bioethics professor Carl Elliott. “They haven’t fixed the problems with the original draft.”
According to a Medical School statement provided by Portz, “there is no source of replacement funding identified” for the education programs, but the school will “certainly strive to get that in place.”
If the school severed those financial ties, that “would’ve put Minnesota on the map,” task force member and University journalism professor Gary Schwitzer said.
Powell also rejected the task force’s recommendation to eliminate the level at which Medical School faculty and staff would be required to disclose financial relationships with industry.
Powell recommended lowering the school’s current $10,000 threshold to $500, while the task force sought to do away with it all together.
But “faculty felt that no threshold would be impossible to enforce and comply with,” according to the Medical School.
The lower threshold was chosen to be used more broadly and still meet “the requirements for which it was intended,” according to the statement.
But disclosure isn’t a solution to the problem of exorbitant consulting fees, Elliott said.
“This is transparency, but transparency is not the problem,” he said. “The problem with the money is the money, not the secrecy.”
The task force recommended that faculty fully disclose the source of research funding as well, particularly those with clinical trials funded by industry, something Powell did not include in her recommendations.
But faculty comments collected by Powell indicate, “The faculty feels the sources of funding for research are well defined,” according to the Medical School.

A semi-closed process

Although the task force filed its recommendations to AHC leadership last summer, some members of the task force and faculty at the school contacted by The Daily were unaware the new draft existed.
Schwitzer said he felt in the dark, and news of Powell’s draft report “totally blindsided” him.
Powell’s draft, dated January 2009, has been circulating through the Medical School at the discretion of the department heads who received it.
Dr. Aaron Friedman, head of the pediatrics department, sent the draft to his entire department.
“I wanted them to review this most recent draft and offer any comments, concerns or questions,” Friedman said in a statement provided by Portz. Faculty in his department had previously been given the opportunity to comment on earlier drafts of the proposed policy changes.
All of the department heads, including basic science departments received the draft, Portz confirmed.

‘These are certainly weaker’

Powell’s recommendations are weaker in many ways compared to those from the conflict of interest task force, Gabriel Silverman, American Medical Student Association Scorecard director, said.
Still, even Powell’s recommendations are an improvement from the current conflict of interest policies, which earned a ‘D’ from the AMSA Scorecard in June of last year.
In an interview with The Daily last month, Silverman said AMSA would commend the school if it enacted the task force’s recommendations. Now he’s not so sure.
“It’s certainly not as strong as the initial recommendations,” he said. “Whether I would call it a strong policy overall I’m not sure.”
They’re “borderline,” he added.
Silverman also pointed to the loss of the provision separating industry ties to continuing medical education at the school as a concern with Powell’s recommendations.
The education program is the best way for doctors to stay current on medical advancements, he said, calling it “irresponsible” to allow that relationship to continue.
“If a doctor in the community can't go to a prestigious public university like Minnesota for continuing education programs that are free from industry sponsorship, then where can she go?” he asked.

— Emma L. Carew is a senior staff reporter. Jake Grovum is the Projects Editor at the Daily.