Principles and process in the development of the Mayo Clinic's individual and institutional conflict of interest policy.

In 1995, federal regulations required all academic medical centers to implement policies to manage individual financial conflict of interest. At the Mayo Clinic, all staff are salaried, and all medically related intellectual property from the staff belongs to the clinic. Hence, it was necessary to develop a policy for institutional conflict of interest to complement the policy for individual conflicts of interest. This article addresses the principles and process that led to the development of the Mayo Clinic's policies that guide the management of conflict of interest of individuals and of the institution. Empowered by the Bayh-Dole Act, the Mayo Clinic participates in technology transfer through its entity Mayo Medical Ventures. Individual conflicts of interest arising from such technology transfer are associated with Institutional conflicts because all individual intellectual property belongs to the institution, per clinic policy. This policy addresses conflicts of interest that arise in research, leadership, clinical practice, investments, and purchasing. Associated with the statutory annual disclosure on personal consulting and other relationships with Industry, which are guided by federal regulations, all research protocols or grant applications require financial disclosure on initial submission and in annual progress reports. The clinic's Conflict of Interest Review Board was established to review each disclosure and recommend management of individual and institutional conflicts of interest according to policy.

Joining the team: ethics consultation at the Cleveland Clinic.

In this paper, I describe the development of ethics consultation services and their operation at the Cleveland Clinic; my own educational experiences and background and how I came to see the importance of setting and collaboration for successfully doing clinical ethics; the unique culture of the Cleveland Clinic and its influence on the ethics consultation services provided there; and, finally, the place of personal commitments and values on the conduct of ethics consultations. I stress the point that although philosophers (and perhaps other bioethicists without health professions training) are socialized and educated to do solitary work, successfully conducting ethics consultations requires relatively high levels of collaboration and cooperation that have not been sufficiently discussed. Although this paper is more a description than an analysis of the influence of institutional setting on ethics consultation, I would claim that attention to setting, either as the local scene of the consultation or the institutional and social framework, deserves more attention by bioethicists intent on understanding ethics consultation.