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I've written several times about pharmaceutical companies paying doctors to shill for them. Speak-for-fee has gotten enough bad publicity recently that fewer doctors are accepting money from the drug companies to tout certain medications.

But, as a lengthy article at the ProPublica site details, medical schools are falling behind physicians in general in reining in this practice. Here are the opening paragraphs:

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.