Time Magazine - Is Drug-Company Money Tainting Medical Education?

[Guest guest]

http://www.time.com/time/health/article/0,8599,1883449,00.html

Is Drug-Company Money Tainting Medical Education?

By Kluger Friday, Mar. 06, 2009

Corbis

It's not often that a place like Harvard Medical School gets an F —

particularly when rivals Stanford, Columbia and the University of

Pennsylvania are pulling A's and B's. That's what happened recently,

however, when the members of the increasingly influential — and

increasingly noisy — American Medical Student Association (AMSA)

decided to grade 150 med schools on just how much money and gifts

they're collecting from drug companies. The more goodies the schools

are vacuuming up from industry, the worse their grade.

More Related

Teaching Doctors To Care

Who Does Your Doctor Really Work For?

Ruling " Bong Hits " Out of Bounds

There's always been reason to worry about the influence of Big Pharma

on the practice of medicine. When doctors are being lavished with

meals and speaking fees by the likes of Pfizer and Merck, can you

really trust them when they later write prescriptions for those

companies' drugs? Medical schools were long considered above such

vulgar stuff. Now, however, it turns out that many professors and

instructors are, legally, on the dole as well, and students are

beginning to worry that what they're being taught is just as one-sided

as what patients are being prescribed. Campaigns to curb the med

school cash are growing — on campus, in Congress and in local

governments — and Harvard, at the moment, is at the center of it. (See

pictures of the college dorm's evolution.)

The issue exploded this week, when The New York Times published a pair

of stories tracking Harvard's industry ties. The school might have

turned a whole new shade of crimson when its flunking grade from AMSA

was made public last summer, but things got even uglier in November,

when 40 med students rallied on campus to demand a clean break between

industry and academia. The facts, they argued, justify their outrage.

Of Harvard's 8,900 professors and lecturers, 1,600 admit that either

they or a family member has had some kind of business link to drug

companies — sometimes worth hundreds of thousands of dollars — that

could bias their teaching or research. Additionally, pharma

contributed over $11.5 million to the school last year for research

and continuing-education classes. TheTimes covered these details in

its stories and included the damning fact that during the November

demonstration, an employee of the Pfizer company was on campus,

photographing protesters with a cell-phone camera. Pfizer did not deny

the account but contended that the employee did nothing wrong. (See

the top 10 scandals of 2008.)

The tug-of-war between industry and research is longstanding. Major

medical journals require any doctors publishing work in their pages to

disclose board memberships or other moneymaking arrangements they have

with drug companies. Last summer, the Pharmaceutical Research and

Manufacturers Association forbade salespeople from treating doctors to

meals or golf excursions and even banned the ubiquitous company-

branded pens, mugs and notepads that clutter waiting rooms and

reception desks. Just this week, federal officials revealed a newly

aggressive plan to begin pursuing civil and criminal charges against

doctors who accept kickbacks or demand speaking and consultancy fees

for prescribing drugs or medical devices.

But medical schools are a new low. After the Times stories were

published, Sen. Grassley, an Iowa Republican and longtime

critic of drug company influence, fired off a letter to Pfizer

Chairman Kindler describing himself as " greatly disturbed " by

the reports, and accusing Pfizer of trying to " intimidate young

scholars. " Grassley cited the 149 Harvard professors or instructors

who have received payments or benefits from Pfizer specifically and

demanded a detailed accounting of all of them. He closed with a terse,

" I look forward to hearing from you by no later than March 10, 2009. "

Pfizer has pledged to cooperate. (Read " The Year in Medicine 2008:

From A to Z. " )

The outrage comes easy for Grassley and the students — and when it

comes to doctors and professors accepting what look like legal bribes,

or drug companies strong-arming protesters, it should. But there are

some gray areas. Medical school professors get their jobs in the first

place because they know their fields. Forbid such educated people from

consulting with the companies that develop new medicines and you cut

off a valuable source of knowledge. What's more, pharma's largesse

also flows to the schools themselves in the form of multimillion-

dollar endowments. Whether the companies are trying to curry favor or

not, they're also building labs and bankrolling scholarships —

something that becomes increasingly important as a deteriorating

economy causes philanthropic giving to dry up. No one disagrees that

isolating academia from industry may be ideal, but even many academics

concede that the cooperation yields more good than harm. And while

Harvard might be the highest-profile name that was posted on the

AMSA's grade list, it was hardly the only ones that flunked: 40 out of

the 150 schools surveyed received F's; only 22 got an A or B.

Washington is sure to keep an eye on the brouhaha, and the states may

wade in too — as Massachusetts Governor Deval did last August

when he signed a law banning certain types of gifts to doctors and

requiring industry to disclose any others over $50 in value. Harvard

has convened a 19-member committee made up of representatives of its

medical school, affiliated teaching hospitals and research institutes

and the student body to review its pharma policy, though the

university is hedging on whether it actually plans to change the way

it operates. " We cannot speculate on the outcomes of the review

process, " is all a spokesman is willing to say. And as of Wednesday,

Pfizer had apologized to Grassley for what it called the " unfortunate

incident " that has " overshadowed the importance of collaboration

between industry and leading academic medical institutions. " That may

be nothing more than a well-spun half-apology — but it doesn't mean

there's not some truth to it too.