FROM THE ADJUNCT CLINICAL FACULTY ASSOCIATION IN PSYCHIATRY
AND FROM MEMBERS OF THE ADJUNCT CLINICAL FACULTY IN PSYCHIATRY, SLEEP MEDICINE,
GENERAL INTERNAL MEDICINE, ENDOCRINOLOGY, CARDIOVASCULAR MEDICINE,
PULMONARY & CRITICAL CARE, IMMUNOLOGY & RHEUMATOLOGY, PEDIATRICS,
ANESTHESIA, PAIN MANAGEMENT AND OBSTETRICS & GYNECOLOGY
May 7, 2010
Philip A. Pizzo
Dean of the School of Medicine
291 Campus Drive
MC5216, LKC3CO2
Stanford, California 94305-5101
John L. Hennessy
President and Bing Presidential Professor
Stanford University, Bldg. #10
Stanford, California 94305-2061
David K Stevenson
Senior Associate Dean for Academic Affairs
750 WELCH RD. #315
Palo Alto, California 94304-5731
John W Etchemendy
Stanford University Provost
BLDG. 10
Stanford, California 94305-2061
Dear Dean Pizzo, Associate Dean Stevenson, President Hennessy and Provost Etchemendy:
This is a letter of deep concern from the Adjunct Clinical Faculty Association in
Psychiatry and from members of the ACF in Psychiatry, Sleep Medicine, General Internal
Medicine, Endocrinology, Cardiovascular Medicine, Immunology & Rheumatology, Pediatrics,
Anesthesia, Pain Management, and Obstetrics & Gynecology. It is a letter expressing opposition
to recent changes to the SIIP / Conflict of Interest Policy as it pertains to the Adjunct Clinical
Faculty. We acknowledge your interests and we do not seek confrontation but we cannot stand
silent. We ask you to enter into productive and collegial dialogue with us with the objective of
finding new language that addresses valid University and School of Medicine interests while
respecting our rights and our duty of beneficence which we owe non Stanford patients.
We do not agree with the recent changes regarding industry speakers’ bureaus and drug
samples in private practice because we believe they expand the contours of your organizational
conflict of interest policy and in so doing impair our rights and responsibilities as practicing
community clinicians. Divestiture of conflicting interests is not so simple when interests involve
the welfare of patients. Divestiture is certainly not the sole mechanism available to you. As
clinicians, we manage competing interests and duties every day. We do not simply divest.
Indeed, “divesting” may breach our duty to our patients. In clinical practice, disclosure and
consent are the usual first-line protections against conflicts of interest.
We are also concerned that the process which led to the these changes, viewed in the light
of the many other changes previously announced such as restriction of facility access and
rescission of emeriti benefits, suggests a downward trajectory in respect for the contributions of
Stanford’s community clinicians.
The adjunct clinical faculty in Psychiatry contributes 15,000 service hours yearly, which
is an economic “gift” to SOM worth in excess of $3,750,000. The overall contribution of the
650 members of the school-wide adjunct clinical faculty is worth in excess of $17,000,000 per
year. These are both conservative estimates because they do not include billings under our
names.
In a first series of actions, you changed our name, attempted to eliminate the rank of
assistant professor, demanded prior approval of published use of title, and eliminated our
lecturers. In a second series of actions, you restricted ACF benefits - including access to books
held in campus libraries - and rescinded most emeriti benefits. In your recent third series of
actions, you made industry speakers’ bureau membership and receipt of drug samples in private
practice grounds for termination from the ACF – whether or not the activity is lawful, ethical,
unrelated to Stanford in any way; and even when there is no disclosure of any Stanford
affiliation.
We acknowledge your concern that drug samples from industry have a marketing intent.
However, we are more concerned that your attitude towards industry intent is not outweighed by
your trust that we have the competence - and the intent - to exercise our judgment solely for the
benefit of our patients. We are even more concerned that you have chosen to cross a boundary
that impairs our private right of contract and our duty of beneficence to non Stanford patients.
The former is an economic intrusion. The latter is an ethical one because it impermissibly limits
our independent exercise of professional judgment in our private practices that in no way
interface with any appropriate Stanford interest.
You have said that all faculty, paid and unpaid, are bound by the same rules. In reality, of
course, we are not the same. Stanford pays the members of its other faculties. It does not pay the
members of the adjunct faculty, all of whom have non Stanford duties and responsibilities. The
ban on drug samples received into our non Stanford practices is particularly odious. Some of us
donate them to free clinics or give them to uninsured patients as “starter packs” before issuing
high-cost full prescriptions. Others give them to “pro bono” patients who cannot afford
medication any other way. These patients are too young for Medicare, too rich for Medicaid, and
too poor to buy private insurance. Ignoring their needs is tantamount to abandoning them.
Doing so hardly advances any organizational conflict of interest policy whose proper aim is the
prevention of corrupt practices. Clinicians are not tortfeasors-in-waiting or potential criminals.
We are bound first and foremost by the ethics of our profession and our duty to patients..
We also question your appreciation that some ACF work in non Stanford clinics and
other medical facilities where residents train and which allow use of drug samples in special
situations. Are you not concerned that punishing these ACF might jeopardize your affiliate
relations and invite harsh comment from some in the community and beyond who could construe
such behavior as self-serving, even contrary to the welfare of non Stanford patients? Have you
considered that your actions may interfere with agreements entered into between ACF and non
Stanford medical entities? Can the School of Medicine ignore the impact on clinical education
that would result from any wholesale terminations or defections of teachers from an adjunct
faculty already reduced from 1700 to less than 700?
The Adjunct Clinical Faculty is a dedicated group of voluntary clinical teachers. Many of
us have been with you well over 30 years. We believe our respective positions can be reconciled.
We agree with you that corrupt practices must be prevented. We acknowledge that ethical
practice is of utmost importance and that clear guidelines must be established. Such guidelines,
however, must be consistent not only with good business practices but with the legal rights and
the fiducial duties of community clinicians in everyday practice.
We acknowledge your desire to protect Stanford’s reputational interests. Your specific
actions, however, risk the very reputational damage to the Stanford “brand” that you seek to
avoid. We recognize the totality of your interests but we cannot support unreasonable actions
that we believe place good will – and more - at risk. We seek to achieve a reasoned and
reasonable middle ground of workable understandings. Towards this end, we stand ready to
work with you on new language that addresses your concerns while respecting our rights and our
clinical duties.
Sincerely,
Mali A. Mann, M.D.
Adjunct Clinical Associate Professor
Chair, Adjunct Clinical Faculty Association (Psychiatry)
550 Hamilton #329 - Palo Alto, CA 94301
Telephone: (650) 325-8762
Email: mannm@stanford.edu
ACF ASSOCIATION COUNCIL
Diana O. Adams, Ed.D.
Adjunct Clinical Assistant Professor
Robert H Landeen, M.D.
Adjunct Clinical Assistant Professor
Alan Brauer, M.D.
Emeritus Adjunct Clinical Associate
Professor
Mary Ann Norfleet, Ph.D.
Adjunct Clinical Professor
Harvey E Dondershine, M.D., J.D.
Adjunct Clinical Associate Professor
John Greene, M.D.
Adjunct Clinical Instructor
Brad Novak M.D.
Adjunct Clinical Instructor
Michael K. Smith, Ph.D.
Adjunct Clinical Instructor
Randall Weingarten, M.D.
Adjunct Clinical Professor
MEMBERS OF THE ACF IN PSYCHIATRY, SLEEP MEDICINE, GENERAL INTERNAL MEDICINE,
ENDOCRINOLOGY, CARDIOVASCULAR MEDICINE, IMMUNOLOGY & RHEUMATOLOGY,
PULMONARY & CRITICAL CARE, PEDIATRICS, ANESTHESIA, PAIN MANAGEMENT AND
OBSTETRICS & GYNECOLOGY
Rhett W. Atkinson, M.D.
Adjunct Clinical Associate Professor
Diana Douglass M.D., Ph.D.
Adjunct Clinical Instructor
Anthony E. Atwell, M.D.
Adjunct Clinical Associate Professor
Susan L. Edelman, M.D.
Adjunct Clinical Associate Professor
Samuel C. Ballon, M.D.
Adjunct Clinical Professor
Donald Ehrman, PhD
Emeritus Adjunct Clinical Professor
Hugh Baras, Ph.D.
Adjunct Clinical Assistant Professor
Steven Donald Feinberg, M.D.
Adjunct Clinical Professor
Peter Berman, Ph.D.
Emeritus Adjunct Clinical Professor
Stan Fischman, M.D., FAPA
Adjunct Clinical Associate Professor
Arthur M. Bobrove, M.D.
Adjunct Clinical Professor
Neil J. Friedman, M.D.
Adjunct Clinical Associate Professor
David D. Burns, M.D.
Emeritus Adjunct Clinical Professor
Thomas Gaston, M.D.
Adjunct Clinical Associate professor
Antonio Chan, M.D., MBA, FACC, FAHA
Adjunct Clinical Professor
John P Glathe, M.D.
Emeritus Adjunct Clinical Professor
Michael W. Champeau, M.D.
Adjunct Clinical Professor
LIse M. Grondahlm, M.D.
Adjunct Clinical Instructor
James Corby, M.D., Psy.D.
Emeritus Adjunct Clinical Associate
Professor
Jeffrey M. Guardino, M.D.
Adjunct Clinical Assistant Professor
Richard J. Corelli, M.D.
Adjunct Clinical Associate Professor
Jeffrey Croke, M.D.
Adjunct Clinical Associate Professor
Ruth Ann Crystal, MD
Adjunct Clinical Instructor
Susan A Harris, M.D.
Adjunct Clinical Assistant Professor
William T. Hart, M.D., FCCP, FAASM
Adjunct Assistant Clinical Professor
Elizabeth A. Herb, M.D.
Emerita Adjunct Clinical Associate
Professor
Stanley E. Hirschman, M.D.
Adjunct Clinical Associate Professor
Stewart Kiritz, Ph.D.
Emeritus Adjunct Clinical Assistant
Professor
Brian N. Kleis, M.D.
Adjunct Clinical Assistant Professor
Kerry D. Kravitz, M.D., Ph.D.
Adjunct Clinical Associate Professor
Ami Laws, M.D.
Adjunct Clinical Associate Professor
Jeffrey Lin M.D.
Adjunct Clinical Instructor
Kenneth Lin, M.D.
Adjunct Clinical Instructor
Randolph B. Linde, M.D.
Emeritus Adjunct Clinical Professor
Scott Lock, MD
Adjunct Clinical Assistant Professor
David Mark, M.D.
Adjunct Clinical Associate Professor
Nancy Mason, M.D.
Adjunct Clinical Assistant Professor
Matthew May, M.D.
Adjunct Clinical Instructor
Burt McDowell, MD
Emeritus Adjunct Clinical Professor
Kerry E. Mitchell, M.D.
Adjunct Clinical Assistant Professor
George J. Nakano, MD
Adjunct Clinical Associate Professor
Andrew Newman, M.D. F.C.C.P.
Adjunct Clinical Professor
Nicholas H. Ney, Ph.D.
Adjunct Clinical Assistant Professor
Thomas F. Nagy, Ph.D.
Adjunct Clinical Assistant Professor
Sharon C. Nash, Ph.D.
Adjunct Clinical Assistant Professor
Richard Novak, MD
Adjunct Clinical Associate Professor
Scott Oesterling, M.D.
Adjunct Clinical Associate Professor
Gerald W. Piaget, Ph.D.
Adjunct Clinical Associate Professor
Stephen H Richmond, MD, Psy.D.
Adjunct Clinical Assistant Professor
Elise M. Rossiter, Ph.D., A.B.P.P.
Adjunct Clinical Associate Professor
John Ruark M.D.
Adjunct Clinical Associate Professor
Ross W. McQuivey, M.D.
Adjunct Clinical Instructor
Saad A. Shakir, M.D., DFAPA
Emeritus Adjunct Clinical Associate
Professor
Steven C. Merlone, M.D.
Adjunct Clinical Associate Professor
Mark Singleton, M.D.
Adjunct Clinical Professor
Terry P Miller, M.D.
Adjunct Clinical Associate Professor
Alan D. Sklar, M.D.
Clinical Associate Professor of Psychiatry
Edward B. Solomon, M.D.
Emeritus Adjunct Clinical Professor
Former Members of the ACF
John Smolowe, M.D.
Emeritus Adjunct Clinical Associate
Professor
Susan Sorenson, M.D.
Deputy Chief of Medicine
Adjunct Clinical Associate Professor
(resigned)
Tanya W. Spirtos, M.D.
Adjunct Clinical Assistant Professor
Anthony Cozzolino, M.D.
Adjunct Clinical Instructor (resigned)
Judith Stewart, Ph.D. MPH
Adjunct Clinical Assistant Professor
Stanford Community Physicians
Michael Taymor, M.D.
Adjunct Clinical Associate Professor
Amanda Templeton, M.D.
Adjunct Clinical Instructor
Manoj V. Waikar, M.D.
Adjunct Clinical Instructor
Saul Wasserman, M.D.
Emeritus Adjunct Clinical Associate
Professor
Joellen Werne, M.D.
Emerita Adjunct Clinical Associate Professor
Kenneth Woodrow, M.D.
Adjunct Clinical Associate Professor
Kin M. Yuen, MD, MS, FAASM
Adjunct Clinical Instructor
Victoria Y. Zvonkina, M.D.
Adjunct Clinical Instructor
Kathryn Mercer, M.D.
Obstetrics & Gynecology