July 23, 2016
Dear Chancellor Hawgood,
We write representing the Board of the UCSF Faculty Association about the recent San Francisco Chronicle story about Mark Laret’s service on the board of two private entities. We understand that his service was in accordance with university and campus policy and was approved by your office on an annual basis.
We request that the policy be changed to forbid such service.
We make this request on the basis of a consistent body of research, much conducted here at UCSF, that documents that relationships with private entities affect behavior even when the individual says otherwise and even when the amount of the compensation is extremely small. While Mr. Laret may recuse himself from decisions affecting the specific vendors with whom he has a fiduciary relationship, the literature indicates that there are effects on one’s colleagues who may make decisions and that they may also not be aware of the effect on their behavior. The intent of this change in policy is to increase the probability that decisions about products are made on the basis of medical evidence, perhaps even evidence of cost-effectiveness.
As a result of this body of research, most clinical departments at UCSF have stopped accepting meals and other perks from drug and device manufacturers both to decrease the possibility that clinical decisions are affected by relationships with industry and to transmit an ethos of neutrality to trainees. Most professional associations have also moved to sever the most egregious aspects of industry-association relationships, for example by putting educational activities at a physical remove from industry exhibits at conferences. At the very least, these changes are designed to reduce the appearance of a conflict of interest even if it is difficult, despite the healthcare literature cited above, to prove an actual conflict in an individual case.
We ask no more than that the CEO of the Medical Center adhere to the same ethical standards as have been developed in the medical provider community to ensure that an individual patient receives care unaffected by commercial bias known and unknown and developed by the private health insurance industry and public insurance programs including Medicare, Medicaid, and the VA System to ensure that coverage for broad groups of patients be governed by the same principles.
The Board of the UCSF Faculty Association
Member, Council of UC Faculty Associations