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The next time your treating physician recommends a new prescription medicine for your use, you might consider inquiring as to whether there is a financial relationship between the doctor and the manufacturer of the drug. Many Colorado doctors act as promoters for large drug companies, which creates an inherent conflict of interest when in private practice, prescribing prescription medicine for patients.

The University of Colorado School of Medicine, National Jewish and Denver Health are all reviewing and tightening ethics rules as dozens of doctors ignore reporting requirements for drug-company payments that can reach well into six figures.

The new scrutiny about relationships with multibillion-dollar drug companies arose from a database by the ProPublica journalism group. Using disclosures from the larger companies, many ordered by the courts, the database shows doctors at CU and Denver Health, as well as other doctors, are earning hundreds of thousands of dollars from drugmakers. The University of Colorado Denver’s School of Public Affairs website Solutions reported on a medical- school faculty meeting last week where the ethics issues resurfaced.

National Jewish, most of whose doctors have dual roles with CU, said it is conducting its own rules review after a preliminary CU report said doctors were testing ethical boundaries and ignoring or disobeying disclosure rules. The review comes in part as a response to concerns over pharmaceutical company spending. Children’s Hospital said its policies were under review as part of its regular two-year accreditation cycle.

CU’s department chairs have recommended banning the "speakers’ bureau" contracts with drug companies that pay doctors to give talks to other doctors based on their research and experience with a pharmaceutical. Many critics say those sessions amount to marketing pitches for the company’s drug.

Medical-school doctors have also been either ignoring or misunderstanding existing policy on reporting speaking fees and other arrangements with drug companies. Doctors on the CU faculty are often employed by other institutions or practice at other hospitals, including National Jewish, Denver Health, Children’s Hospital and more – requiring adherence to more than one set requirements.

By example, Dr. Ronald Balkissoon is a National Jewish pulmonologist and CU faculty member who earned at least $220,000 from the larger drug companies. National Jewish said he declined to talk about the arrangements. Other doctors affiliated with National Jewish have also taken large payments.

Many doctors contacted on the subject by The Denver Post did not return phone calls or e-mails.

And there is uncertainty as to how the faculty and school leadership will deal with doctors who fail to disclose speaking fees. Some have suggested past and future payments should be repaid if they aren’t approved or disclosed; others have mentioned an "amnesty period" to encourage more disclosure.

Reviews have found dozens of CU doctors on lists disclosed by the largest drug companies. And there are hundreds more makers of drugs and medical devices that also seek arrangements with doctors, but have not made public such information.

Colorado doctors are also required to report relationships worth more than $5,000 to a state database, kept by the Board of Medical Examiners, but comparison of that data base with the lists from drug companies demonstrates significant failure on the part of the doctors to self-report.

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