Officials at the University of Pennsylvania believed they had a strong tool to prevent pharmaceutical-company money from corrupting the medical faculty.
In 2006, they acted to keep drug marketers out of their hospital and clinics, to ensure that treatment decisions were made for the right reasons. In one of the country's first policies of its kind, Penn also told its physicians that they "should not participate in industry marketing activities."
Penn's chief medical officer, P.J. Brennan, said he thought the policy was clear: Company-paid lectures are forbidden. "It flies in the face of what a professional ought to be," he said.
But an investigation by ProPublica found that 20 of Penn's doctors have delivered such lectures since 2009. Five, including one who left Penn last month, were paid more than $40,000.
Told of the findings, Brennan said Penn needs to make its policy more explicit.
He was not the only school official caught off-guard. ProPublica checked on 12 medical schools and teaching hospitals and found that faculty at half also lectured for drug firms in the last two years, despite restrictions on such speeches. Among them, Stanford University, the University of Pittsburgh, and the University of Colorado Denver have initiated reviews.
Conflict-of-interest policies have become more important as academic medical centers worry that promotional talks undermine the credibility not only of the physicians giving them, but also of the institutions they represent.
Yet when it comes to enforcing the policies, schools have allowed permissive interpretations and relied on the honor system. ProPublica's review shows that approach isn't working: Many doctors are in apparent violation, and ignorance or confusion about the rules is widespread.
As a result, some faculty stay on the pharmaceutical lecture circuit, where they can net tens of thousands of dollars in extra income.
Critics of the practice say delivering talks for drug companies is incompatible with the job of teaching future generations of physicians. That's because drug firms typically pick the topic of the lecture, train the speakers, and require them to use company-provided presentation slides.
"You're giving someone else's messages, someone else's talk, someone else's judgments," said Bernard Lo, a medical professor at the University of California, San Francisco, who chaired a national panel examining conflicts of interest in medicine. "We don't allow our students to use someone else's work."
Reporters compared the names of faculty members at a dozen medical schools and teaching hospitals with ProPublica's Dollars for Docs database of payments to doctors publicly reported by seven drug companies. Lists of the physicians whose names matched were provided to the universities and hospitals for verification and comment.
Because most of the 70-plus drug firms in the United States do not report such payments, the review was limited. As more firms release their speaker fees, more faculty will likely show up, university officials said.
Those who study conflicts of interest in academia say the findings point to a significant problem for teaching hospitals. Schools should not only have a policy - many do not - but also need to enforce it. Absent that, others will expose their staffs' participation, using drug company payment websites.
"For God's sake, if the media can look at these websites, why can't we?" said David Rothman, president of the Institute on Medicine as a Profession at Columbia University. "Why trust if you can verify?"
Penn and some other universities would not confirm whether faculty members flagged by ProPublica had erred, making it difficult to tally how many physicians violated their policies.
At Penn, the top paid speaker, according to Dollars for Docs, was Corey Langer, director of thoracic oncology at Penn's Abramson Cancer Center. He made nearly $70,000 speaking for Eli Lilly & Co. in 2009 and the first half of 2010.
Langer also received unknown amounts from other firms, such as Genentech Inc., OSI Pharmaceuticals Inc., and Bristol-Myers Squibb Co., according to his disclosure for a medical education program this month.
By e-mail, Langer said he was "now fully aware" of Penn's policy and was "taking measures to curtail speaking for pharmaceutical companies."
In a statement, Penn Medicine chief of staff Susan Phillips said there was "a need for Penn Medicine to greater define our policies to assist physicians in determining the appropriate boundaries of their outside activities."
Richard Krugman, vice chancellor for health affairs at the University of Colorado Denver, thought his policy was working until his staff ran the medical school's roster through ProPublica's database and some on his faculty showed up.
Krugman said he had assumed "that professionals have integrity and will live by the rules." Now he's trying to figure out what happened.
The university's policy, adopted in 2008, bars faculty from speaking on behalf of companies if "the content of the lectures, slides, references, or educational handouts is subject to approval by industry representatives." Any contracts with drug companies must be preapproved by the university.
ProPublica found 13 UC Denver doctors reported by drug firms as paid speakers.
Michael McDermott, director of the endocrinology and diabetes practice at the University of Colorado Hospital, earned the most, nearly $117,000 from Lilly. While his talks involved a Lilly drug, McDermott said he used the company's slides in only a fraction of them.
"From my standpoint, the value of my programs is purely educational for the attendees," he wrote in an e-mail. Selling of the drug is left to company reps "to be done at a time that is different than when I give my talk."
Still, he said, "I am weighing my future participation."
UC Denver's experience was mirrored at other schools where officials discovered their policies were not working as expected.
The University of Pittsburgh's 2008 policy bans paid speaking in many cases, said Barbara Barnes, an associate vice chancellor in charge of industry relationships. Yet ProPublica found 22 Pitt doctors in its database.
At Stanford University, ProPublica found that more than 12 of the school's doctors were paid speakers, in apparent violation of its 2009 policy. Two had earned six figures since last year.
Philip Pizzo, the dean of Stanford's medical school, sent an e-mail to all medical school staff last week calling the conduct "unacceptable." Some doctors' excuses, he wrote, were "difficult if not impossible to reconcile with our policy."
Some Stanford doctors said they were in the wrong.
Among them was Alan Yeung, vice chairman of Stanford's department of medicine and chief of cardiovascular medicine, who has been paid $53,000 by Lilly since 2009. In an e-mail, Yeung said he quit speaking for the company this fall.
"I take full responsibility for this error," he said. "Even though I felt that these activities are worthwhile educational endeavors, the perceived monetary conflict may be too great."
Pizzo compared some doctors' explanations to what a police officer might hear after catching a motorist running a late-night stop sign.
"You can give 1,000 reasons: 'There was nobody around. It's safe,' " he said. "The reality is, it's still a stop sign."