The school was one of the first to stop sales representatives from roaming its halls in 2006. It cut off the flow of free lunches and trinkets emblazoned with drug names. And last year, in a blow to its physicians' wallets, Stanford banned them from giving paid promotional talks for pharmaceutical companies.
One thing it didn't do was make sure its faculty followed that rule.
A ProPublica investigation found that more than a dozen of the school's doctors were paid speakers in apparent violation of its policy—two of them earning six figures since last year.
Dr. 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."
He was not the only school official caught off-guard.
Faculty at a half-dozen other institutions—including division chiefs—also lectured for drug firms in the last two years, ProPublica found, despite restrictions on such behavior. The University of Pennsylvania, the University of Pittsburgh and the University of Colorado Denver, among others, have launched reviews.
Conflict-of-interest policies have become increasingly important as academic medical centers worry that promotional talks undermine the credibility of not only the physicians giving them, but also of the institutions they represent.
Yet when it comes to enforcing the policies, universities have allowed permissive interpretations and relied on the honor system. ProPublica's review shows that approach isn't working: Many physicians are in apparent violation, and ignorance or confusion about the rules is widespread.
As a result, some faculty physicians stay on the industry lecture circuit, where they can net tens of thousands in additional income.
Critics of the practice say delivering talks for drug companies is incompatible with 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 Dr. Bernard Lo, a medical professor at University of California, San Francisco who chaired anational 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 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 the majority of the more than 70 drug companies in the United States don't report such payments, the review provides only a glimpse of possible lapses at schools. As more companies make their speaker fees public, additional faculty will likely show up, several 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 — they need to enforce it. Absent that, others will police their staffs for them 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?"
Most universities were unwilling to confirm whether individual faculty members flagged by ProPublica had erred, making it difficult to tally all offenders.
At Stanford, officials said some faculty members provided proof that they had not violated the policy because they used their own lecture materials or stopped speaking as soon as it took effect.
But others conceded they were in the wrong.
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