We Must Separate Doctors from Industry
This summer, Harvard Medical School announced new restrictions on the relationships between its faculty and the pharmaceutical and medical-device industries. The policy prohibits faculty from accepting gifts and meals, limits their consulting income, and requires public reporting of any payments received. The stated goal is to eliminate a perception of undue commercial influence in medical education. This is the right decision by Harvard. It is now time that all other medical schools and teaching hospitals follow suit.
The medical/pharmaceutical industry influence on academic medicine is ubiquitous. In 2007, a survey of academic department chairs published in the Journal of the American Medical Assoc. revealed that 60% reported some form of personal relationship with industry, including as a consultant, paid speaker, officer, founder, or member of a board.
While many of these relationships are appropriate, an increasing number go off-track. Later that same year, the Department of Justice filed criminal complaints against four of the five medical-device manufacturers in New Jersey, alleging that the companies used consulting agreements with orthopedic surgeons as inducements to use a particular company’s products. According to Justice, the investigation revealed it was common practice that surgeons “were paid tens to hundreds of thousands of dollars per year for consulting contracts and were often lavished with trips and other expensive perquisites.”
More recently, Sen. Charles Grassley of Iowa has investigated research conflicts of interests at numerous teaching hospitals and academic medical centers, including Harvard Medical School. In October 2008, an article in the the New York Times noted that Grassley’s findings “suggest that universities are all but incapable of policing their faculty’s conflicts of interest.” Eric Campbell, a health policy researcher at Mass General and Harvard Medical School, called these consulting arrangements “one of the great wink-winks of all time.”
Things must change. Medical schools and teaching hospitals have nothing to fear by establishing more appropriate restrictions governing their relationships with industry. The experience of our hospital system is one case in point.
Several years ago, clinical leaders at our system, UMass Memorial Health Care, became concerned about the problem created by these relationships. As a result, we launched a comprehensive process that resulted in the adoption, in 2007, of one of the strictest vendor-relations policies in the nation. Among other things, we prohibit gifts, meals, and entertainment, eliminate industry influence in medical education, restrict consulting to true scientific (not marketing) issues, and restrict access by sales and marketing representatives at our facility.
At first, there was skepticism. Some physicians resented the suggestion that accepting a mug or a free lunch somehow taints their medical judgment. Others worried that we would lose industry support for medical education and they would not be able to stay current on the latest drug and device developments. But almost three years later, there has been nary a whimper. No grieving at the loss of free lunches or dinners, and very few complaints about the loss of any educational opportunities. Indeed, most physicians are happier with the more limited, and more appropriate, interactions with industry. And they don’t mind writing with generic pens.
Recently, we conducted a survey of our physicians and residents to determine the level of support for our policy. While there remains some skepticism, almost two-thirds of respondents said they wanted UMass Memorial to continue to play a leading role among academic medical centers in promoting a strict policy. One resident said the policy made him so proud that, as he leaves his training, he asks all his potential employers about their policy.
This is not about demonizing pharmaceutical and medical-device companies. Our policy continues to allow significant contact with industry. These companies are vital to medical research and our continued ability to discover new and improved ways of caring for patients. But when we allow the good parts of those relationships to be sullied by the bad, we undermine the integrity of the entire interaction.
All of academic medicine needs to now acknowledge that the goals of a profit-driven industry, while laudable, do not always align with the goals of independent scientific research, teaching, and the delivery of high-quality patient care. Harvard is not the first to go down this road, but it may be the most influential. It should not be the last.
Douglas S. Brown is senior vice president and general counsel, and Stephen Tosi is chief medical officer, of UMass Memorial Health Care in Worcester.