healthy4u: Medicines Transparency Alliance

The advancement of modern scientific medicine depends on the search for and dissemination of truth. Academic medicine, like the rest of academia, ought to be based on openness, transparency, and academic freedom. The 1940 American Association of University Professors (AAUP)<a href="http://www.aaup.org/AAUP/pubsres/policydocs/contents/1940statement.htm"> Statement of Principles on Academic Freedom and Tenure</a> opened with: <blockquote>The common good depends upon the free search for truth and its free exposition. </blockquote>Yet we have written about dark clouds of secrecy spreading over medicine and health care. The increasingly powerful leaders of health care increasingly use opacity and secrecy to keep what they are doing out of the public eye. We have frequently discussed the <a href="http://hcrenewal.blogspot.com/search/label/anechoic%20effect">anechoic effect</a>, how it is just not done to discuss certain topics, particularly those related to the adverse effects of bad (ill-informed, incompetent, self-interested, conflicted, or corrupt) leadership and bad (opaque, unaccountable, mission-hostile, unethical) governance of health care organizations.  People may feel it is unseemly to speak badly of renowned institutions such as hospitals and universities.  People with conflicts of interest may not be inclined to criticize those who pay them.  Now people employed by contemporary health care organizations may have to pledge theri silence to keep their jobs. The latest story in this regard comes from Virginia Commonwealth University (VCU), which includes VCU Health Systems, and MCV Hospital and Physicians.  (Full disclosure: I was a VCU full-time faculty member from 1987-1994, and still am on the adjunct faculty.)  In 2008, the VCU President resigned after the university's secret research contract with a tobacco company, and the President's own position on the board of directors of another tobacco company were revealed (see blog post <a href="http://hcrenewal.blogspot.com/2008/08/after-controversy-over-tobacco-money.html">here</a> and others <a href="http://hcrenewal.blogspot.com/search/label/Virginia%20Commonwealth%20University">here</a>). Michael Rao, the President since 2008, is now under outside review after it was revealed that he required his staff to sign a secrecy pledge.  The <a href="http://www2.timesdispatch.com/news/local-news/2010/nov/17/vcuu17-ar-658103/">story</a> appeared in the Richmond Times-Dispatch: <blockquote>Virginia Commonwealth University President Michael Rao asks employees who work in his office to sign an unusual <a href="http://static.mgnetwork.com/rtd/pdfs/vcuu17.pdf">confidentiality agreement</a> that bars them from talking about what they observe about him or his family. The prohibition goes beyond the standard agreement that university employees sign acknowledging that they can't disclose personal or proprietary information. The agreement, a copy of which was obtained by the Richmond Times-Dispatch, covers interactions at Rao's office and at his residence. It bars disclosure not just to the news media, family or friends, but also to colleagues, 'clergy and attorneys, or to any other person not otherwise identified.' 'I agree that any such disclosure in violation of this nondisclosure agreement could result in irreparable damage and harm to VCU, President Rao, and/or his family'" the agreement states. 'Any such violation or anticipated violation' would entitle Rao to seek 'injunctive relief' in Richmond or Henrico County circuit courts. VCU spokeswoman Pam Lepley said she could not comment immediately yesterday. Several current or former employees of the president's office confirmed that they had been asked to sign the agreement, including Kimberley Busch, Rao's former scheduler. She described it as a 'what happens in the president's office stays in the president's office' agreement.</blockquote> The newly uncovered confidentiality clause provoked strong criticism: <blockquote>Raymond D. Cotton, a Washington attorney who specializes in higher-education governance, said such a confidentiality agreement is highly unusual and goes against the culture of openness and transparency in higher education. 'There is this concept of academic freedom that is broader than the First Amendment,' he said.</blockquote> In fact, since Virginia Commonwealth University is a state-supported institution, the confidentiality clause may be unconstitutional, as <a href="http://www.wtvr.com/news/wtvr-mark-on-vcu-president-111810,0,1379760.story">reported</a> by WTVR: <blockquote>Kent Willis with the Virginia American Civil Liberties Union said the agreement doesn't pass constitutional muster. 'A public employee, no matter where they are in the government, has a right to speak out on matters of public concern,' Willis said. 'That's a U.S. Supreme Court case, it's guaranteed to every public employee by the First Amendment to the Constitution.' Willis said there are numerous legal issues raised by the contract. But, he said, the bottom line problem with the contract 'is the attitude. This is a contract that says 'I'm not transparent. I don't want you to know what is going on. I'm running a closed shop.''</blockquote> Times-Dispatch columnist Michael Paul Williams <a href="http://www2.timesdispatch.com/news/2010/nov/19/mike19-ar-663326/">wrote</a>: <blockquote>VCU, we have a problem. This confidentiality agreement does not inspire confidence. The lack of transparency only gives the appearance that someone's hiding something.</blockquote> He also further quoted Kent Willis: <blockquote>Rao's contract 'fails to address this whistle-blower right and could create conflicts for employees, who are silenced by the employment contract,' yet have a constitutional right to speak out on some matters, Willis said. And as Willis points out, even if a person's constitutional right trumps the contract, how many employees are willing to take that risk? 'Particularly disturbing is the prohibition against talking to an attorney,' he said. 'If an employee believes something illegal is going on at work, an attorney is precisely the person he or she should be talking with.'</blockquote> We just <a href="http://hcrenewal.blogspot.com/2010/07/stifling-whistle-blowers-old-and-new.html">posted</a> about how a pharmaceutical company included a confidentiality clause in a consulting contract, suggesting the deliberate creation of a conflict of interest in order to prevent criticism of the company's products or practices.  However, in several ways, the present example is more insidious.  First, it involves a university, whose mission is to discover and disseminate the truth.  Thus, as noted above, the confidentiality agreement subverts the university's core mission.  Second, it was required of full-time employees who wanted to keep  their jobs, making choose between secrecy and unemployment.  Third, it was particularly harsh, addressing incipient as well as actual disclosure, and including injunctive relief as well as the threat of  termination.  Fourth, it protected not just the organization and its products, but personally protected the organization's leader and his family.  It was not just a contract, but an oath of fealty, as if the CEO were nobility, or even royalty. The good news is that this confidentiality agreement now sits in the glare of sunlight.  One does wonder, however, how many other such agreements are already in force so that the would be nobility who now run too much of health care to avoid any embarassing revelations about what their leadership really is about. We are a long way from the transparency that true health care reform requires.

A Confidentiality Clause or an Oath of Fealty?

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