"A significant portion of the budget of some of the best centers in the country is from some sort of arrangement with the industry," Hadler said. "It's systemic and it is intolerable that the sanctity of the patient-doctor relationship, the trustworthy nature of it, is being buffeted not just by individual conflicts of interest but by institutional conflicts of interest."
One doctor said that one of the glaring failures of the full disclosure policies is that disclosures presently rely largely on physician self-reporting, and it is not clear whether or not any institutions actually check to see how completely and accurately their doctors disclose their financial relationships. In this sense, what is "fully disclosed" could easily be just the tip of the iceberg.
"Determination of conflict of interest is a bit more sophisticated than listing doctors and fees," said Dr. Alan Leff, professor of medicine at the University of Chicago Medical Center. "It requires that any fee paid to a physician as a consultant is not related to a quid-pro-quo agreement that he or she will use their equipment or perform the company's studies."
"However, I would say now that a major percentage of studies done in my field are done through private practice physicians, who are paid for each patient recruited and for each stage of completion of the study."
At least part of the push toward full disclosure is motivated by congressional pressures on many of the top medical centers. Sen. Charles Grassley, R-Iowa, has spearheaded investigations into undisclosed payments to physicians by pharmaceutical companies.
In July, Sen. Grassley wrote a letter to Stanford University which was published in the Congressional Record. In it, he contended that Dr. Alan Schatzberg, chairman of psychiatry at Stanford University, did not provide all of the documentation necessary for a full disclosure of his investments in a pharmaceutical company that he founded. Sen. Grassley's office said that Schatzberg reported that he had more than $100,000 worth of investments in the company, Corcept Therapeutics, though his investments actually totaled more than $6 million.
However, Stanford University subsequently released a public statement explaining that the University's disclosure forms only ask researchers to disclose whether they held over $100,000 worth of investments, which Schatzberg did. For this reason, the University maintains that Schatzberg fully disclosed his investments based on the University's and the National Institutes of Health's guidelines for disclosure.
"In response to Senator Grassley's letter, Stanford University said that Dr. Schatzberg had fully complied with all conflict of interest policies both those of the University and of the National Institute of Mental Health," said Paul Costello, executive director of the office of communication and public affairs at Stanford University. "Dr. Schatzberg did, in fact, disclose the actual value of his stock in Corcept Therapeutics to Stanford as required in his ad hoc disclosures."