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Doctors' contracts in focus

Johns Hopkins revisits policy on advising investors

NEW YORK -- The Johns Hopkins University School of Medicine, the biggest recipient of funding from the National Institutes of Health, may tighten rules for faculty who consult for Wall Street firms on drug research.

Concern that doctors may give investors an unfair edge by violating drug-trial confidentiality has grown since cardiologist Eric Topol wrote about consulting agreements in the June 1 edition of the Journal of the American Medical Association. Large numbers of doctors are paid to advise hedge funds, venture capitalists, and investment banks, he wrote. US lawmakers this month called for a federal probe of possible insider trading.

Baltimore-based Johns Hopkins may ''tighten up on certain wording" in its conflict-of-interest rules in the next six to 12 months, said Julie Gottlieb, assistant dean of policy coordination. She declined to identify possible changes. This year, the Cleveland Clinic, where Topol works, required doctors to seek clearance on contracts with investors.

''If you exchange business ethics for medical ethics, this is the result," said Arthur Caplan, a bioethics professor at the University of Pennsylvania in Philadelphia, in an Aug. 16 telephone interview. ''One prosecution for insider trading will have more deterrent effect than all the seminars, media reports, and policy reforms combined."

Topol wrote the JAMA commentary with David Blumenthal, director of the Institute for Health Care Policy at Massachusetts General Hospital. The article focused on ''matchmakers," consulting companies such as Gerson Lehrman Group in New York that link doctors with analysts and investors.

The number of US doctors who make themselves available for consulting through matchmakers has soared 75-fold to 75,000, or almost 1 in 10 physicians, in the past eight years, the article said. Investors pay doctors rates ranging from $200 to more than $1,000 an hour, the authors wrote.

''Even without investing or having an interest in an investment entity, physicians face the potential for inadvertent breach of confidentiality or for supply of insider information," they wrote.

This month, the Seattle Times published a series articles saying information about some studies might have leaked in advance of the official release of study results, affecting stock prices.

Gerson has about 48,000 doctors in a database of consultants available to investors, Jonathan Glick, the company's research director, said in a telephone interview Friday. Of them, 10 percent to 15 percent each year receive work from clients at fees averaging $230 an hour, he said.

The doctors list their specialties with the company and sign a contract agreeing not to violate other legal agreements, Glick said.

''The issues raised regarding physician consulting are very important," Mark Gerson, 32, chief executive officer of Gerson Lehrman, said in a statement released Aug. 18. ''Indeed, our compliance systems have been designed and implemented with precisely those concerns in mind."

Alan Meisel, director of the Center for Bioethics and Health Law at the University of Pittsburgh, said it would be difficult for institutions to rein in physicians, who are often independent contractors.

''There could be a serious battle between doctors and the healthcare institutions," he said in an Aug. 16 telephone interview. ''It will be tough for the institutions to hold much sway."

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