Disclosures
For the 30 years up to the middle of 2008, I was employed by the University of California San Franciscso at the Institute for Health Policy Studies (IHPS) and since then I have been Director of the Palo Alto Medical Foundation Research Institute (PAMFRI). Both research units are parts of much larger organizations that provide medical care and would be affected by fundamental reforms to the health care system. Although the ideas incorporated in the SecureChoice plan have been shaped by observations of what works well (and poorly) in various health care organizations, neither organization even saw, let alone had to approve, the work presented here.
Consultation can serve many useful purposes, both to inform other organizations and government and in doing so, it helps the faculty member understand real-world issues and do better research. Therefore, an outright prohibition does not make sense. When I was Director of IHPS, we implemented a policy under which faculty members could do independent consulting—either to for-profit or not-for-profit organizations, or for the government. In no case, however, could they personally retain consulting fees. All payment had to be turned over to the University. It is the nature of consultations that most are not worth publishing, and some involve confidential material that cannot be published without agreement of the "client," whether the client is private or public. The requirement that fees be turned over to our organization, however, reduces the risk that one's research is influenced by financial conflicts. At PAMFRI we abide by similar policies.
As editor-in-chief of the journal Health Services Research I implemented disclosure policies that even go beyond the typical disclosures required by medical journals. I also helped draft a set of ethical guidelines for health services research. Adequate disclosure of involvements, whether compensated or not, can help the reader approporiately assess how much crediblity to attach to a particular research result or policy recommendation.
My own research is typically funded by a mixture of grants from private foundations such as the Robert Wood Johnson Foundation (whose Investigator Awards in Health Policy Research program provided a grant that funded the SecureChoice work), the Commonwealth Fund, and the California Healthcare Foundation as well as federal grants and contracts. To date, I have not been a formal advisor on health reform proposals to any political effort or the government, although I am offering my assistance on understanding and potentially applying the concepts I am putting forth here.