Editor's Comment: Welcome to your medical system, where teaching hospital doctors receive millions of dollars to deliver speeches written by drug companies. The bottom line for the US medical industry? Just like everything else in American culture, it's about making money off other people, not health.
As medical schools wrestle with how to keep drug companies from corrupting their faculties, Stanford University is often lauded for its tough stance.
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 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 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.
Among them was Dr. Alan Yeung , vice chairman of Stanford's department of medicine and chief of cardiovascular medicine who earned $53,000  from Eli Lilly & Co. in 2009 and the first half of 2010. 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."
Child psychiatrist Hans Steiner  was paid $109,000  by Lilly to deliver talks about a drug for attention deficit hyperactivity disorder. In an e-mail, Steiner said he spoke in "very rural and other impoverished settings which only have limited access to experts like me."
He said he wrongly assumed Stanford's policy didn't apply to him once he became an emeritus professor last year, but now, "I fully intend to comply."
Pizzo, Stanford's dean, said physicians who appear to have violated the policy will be investigated and referred for discipline if necessary. He compared some of their explanations to what a cop 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. I looked and didn't harm anyone," he said. "The reality is, it's still a stop sign."