Harvard Medical Students Rebel Against Pharma-Ties

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Harvard Medical Students Rebel Against Pharma-Ties

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Tuesday, 03 March 2009

 

 

200 Harvard Medical School STUDENTS are confronting the administration

demanding an end to pharmaceutical industry influence in the classroom.

A front page report in the Business section of the New York Times should

bestir some of Harvard Medical School alumni. 200 Harvard Medical School

STUDENTS are confronting the administration demanding an end to

pharmaceutical industry influence in the classroom.

 

" The students say they worry that pharmaceutical industry scandals in

recent years - including some criminal convictions, billions of dollars in

fines, proof of bias in research and publishing and false marketing claims -

have cast a bad light on the medical profession. And they criticize Harvard

as being less vigilant than other leading medical schools in monitoring

potential financial conflicts by faculty members. "

Harvard received the lowest grade--an F--from the American Medical Student

Association, a national group that rates how well medical schools monitor

and control drug industry money. Harvard Medical School's peers received

much higher grades, ranging from the A for the University of Pennsylvania, to

B's received by Stanford, Columbia and New York University, to the C for

Yale.

 

The revolt began when a first year medical student " grew wary " when a

professor promoted cholesterol drugs and " seemed to belittle a student who ask

ed about side effects. " He later discovered that the professor, a full-time

Harvard Medical faculty member, was a paid consultant to 10 drug companies,

including manufacturers of cholesterol drugs.

 

Another first year student said: " Before coming here, I had no idea how

much influence companies had on medical education. And it's something that's

purposely meant to be under the table, providing information under the

guise of education when that information is also presented for marketing

purposes. "

 

The fact is, no one is keeping track of faculty income from industry, or

covert marketing pitches infiltrating the classroom: " The school said it was

unable to provide annual measures of the money flow to its faculty.. " One

Harvard professor's disclosure in class listed 47 company affiliations.

 

On one side of the confrontation: the administration and most of the

faculty who admittedly loath to " tighten the spigot " of cash from industry:

 

" school officials see corporate support for their faculty as all the more

crucial, as the university endowment has lost 22 percent of its value since

last July and the recession has caused philanthropic contributors to

retrench. "

An outspoken supporter of ties between industry and academia--who served

on numerous pharmaceutical advisory boards, Professor Thomas Stossel who is

unconcerned about industry influence. He views industry support as " a huge

opportunity we ought to mine. " A smaller faction of students calls for

" continued interaction between medicine and industry at Harvard. " They are led

by Vijay Yanamadala, 22.

 

On the other side: students such as Kirsten Austad, 24, a first-year

Harvard Medical student who is one of the movement's leaders, who said:

" Harvard

needs to live up to its name. We are really being indoctrinated into a

field of medicine that is becoming more and more commercialized. "

 

The students are joined by Dr. Marcia Angell, a faculty member and former

editor in chief of the New England Journal of Medicine who has vigorously

advocated for an end to liaisons between academia and Big Pharma: " Too many

medical schools have struck a 'Faustian bargain' with pharmaceutical

companies. If a school like Harvard can't behave itself, who can? "

Posted by: Vera Hassner Sharav

_http://www.nytimes.com/2009/03/03/business/03medschool.html_

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THE NEW YORK TIMES

March 3, 2009

Harvard Medical School in Ethics Quandary

By DUFF WILSON

 

BOSTON - In a first-year pharmacology class at Harvard Medical School,

Matt Zerden grew wary as the professor promoted the benefits of cholesterol

drugs and seemed to belittle a student who asked about side effects. Mr.

Zerden later discovered something by searching online that he began sharing

with his classmates. The professor was not only a full-time member of the

Harvard Medical faculty, but a paid consultant to 10 drug companies, including

five makers of cholesterol treatments.

 

" I felt really violated, " Mr. Zerden, now a fourth-year student, recently

recalled. " Here we have 160 open minds trying to learn the basics in a

protected space, and the information he was giving wasn't as pure as I think it

should be. "

 

Mr. Zerden's minor stir four years ago has lately grown into a full-blown

movement by more than 200 Harvard Medical School students and sympathetic

faculty, intent on exposing and curtailing the industry influence in their

classrooms and laboratories, as well as in Harvard's 17 affiliated teaching

hospitals and institutes.

 

They say they are concerned that the same money that helped build the

school's world-class status may in fact be hurting its reputation and affecting

its teaching. The students argue, for example, that Harvard should be

embarrassed by the F grade it recently received from the American Medical

Student Association, a national group that rates how well medical schools

monitor and control drug industry money.

 

Harvard Medical School's peers received much higher grades, ranging from

the A for the University of Pennsylvania, to B's received by Stanford,

Columbia and New York University, to the C for Yale.

 

Harvard has fallen behind, some faculty and administrators say, because

its teaching hospitals are not owned by the university, complicating reform;

because the dean is fairly new and his predecessor was such an industry

booster that he served on a pharmaceutical company board; and because a

crackdown, simply put, could cost it money or faculty.

 

Further, the potential embarrassments - a Senate investigation of several

medical professors, the F grade, a new state law effective July 1 requiring

Massachusetts doctors to disclose corporate gifts over $50 - are only now

adding to pressure for change.

 

The dean, Dr. Jeffrey S. Flier, who says he wants Harvard to catch up with

the best practices at other leading medical schools, recently announced a

19-member committee to re-examine his school's conflict-of-interest

policies. The group, which includes three students, is to meet in private on

Thursday.

 

Advising the group will be Dr. David Korn, a former dean of the Stanford

Medical School who started work at Harvard about four months ago as vice

provost for research. Last year he helped the Association of American Medical

Colleges draft a model conflict-of-interest policy for medical schools.

 

The Harvard students have already secured a requirement that all

professors and lecturers disclose their industry ties in class - a blanket

policy

that has been adopted by no other leading medical school. (One Harvard

professor's disclosure in class listed 47 company affiliations.)

 

" Harvard needs to live up to its name, " said Kirsten Austad, 24, a

first-year Harvard Medical student who is one of the movement's leaders. " We

are

really being indoctrinated into a field of medicine that is becoming more

and more commercialized. "

 

David Tian, 24, a first-year Harvard Medical student, said: " Before coming

here, I had no idea how much influence companies had on medical education.

And it's something that's purposely meant to be under the table, providing

information under the guise of education when that information is also

presented for marketing purposes. "

 

The students say they worry that pharmaceutical industry scandals in

recent years - including some criminal convictions, billions of dollars in

fines, proof of bias in research and publishing and false marketing claims -

have cast a bad light on the medical profession. And they criticize Harvard as

being less vigilant than other leading medical schools in monitoring

potential financial conflicts by faculty members.

 

Dr. Flier says that the Harvard Medical faculty may lead the nation in

receiving money from industry, as well as government and charities, and he

does not want to tighten the spigot. " One entirely appropriate source, if done

properly, is industrial funds, " Dr. Flier said in an interview.

 

And school officials see corporate support for their faculty as all the

more crucial, as the university endowment has lost 22 percent of its value

since last July and the recession has caused philanthropic contributors to

retrench. The school said it was unable to provide annual measures of the

money flow to its faculty, beyond the $8.6 million that pharmaceutical

companies contributed last year for basic science research and the $3 million

for

continuing education classes on campus. Most of the money goes to

professors at the Harvard-affiliated teaching hospitals, and the dean's office

does

not keep track of the total.

 

But no one disputes that many individual Harvard Medical faculty members

receive tens or even hundreds of thousands of dollars a year through

industry consulting and speaking fees. Under the school's disclosure rules,

about

1,600 of 8,900 professors and lecturers have reported to the dean that they

or a family member had a financial interest in a business related to their

teaching, research or clinical care. The reports show 149 with financial

ties to Pfizer and 130 with Merck.

 

The rules, though, do not require them to report specific amounts received

for speaking or consulting, other than broad indications like " more than

$30,000. " Some faculty who conduct research have limits of $30,000 in stock

and $20,000 a year in fees. But there are no limits on companies' making

outright gifts to faculty - free meals, tickets, trips or the like.

 

Other blandishments include industry-endowed chairs like the three Harvard

created with $8 million from sleep research companies; faculty prizes like

the $50,000 award named after Bristol-Myers Squibb, and sponsorships like

Pfizer's $1 million annual subsidy for 20 new M.D.'s in a two-year program

to learn clinical investigation and pursue Harvard Master of Medical

Science degrees, including classes taught by Pfizer scientists.

 

Dr. Flier, who became dean 17 months ago, previously received a $500,000

research grant from Bristol-Myers Squibb. He also consulted for three

Cambridge biotechnology companies, but says that those relationships have ended

and that he has accepted no new industry affiliations.

 

That is in contrast to his predecessor as dean, Dr. Joseph B. Martin.

Harvard's rules allowed Dr. Martin to sit on the board of the medical

products company Baxter International for 5 of the 10 years he led the medical

school, supplementing his university salary with up to $197,000 a year

from Baxter, according to company filings.

 

Dr. Martin is still on the medical faculty and is founder and co-chairman

of the Harvard NeuroDiscovery Center, which researches degenerative

diseases, and actively solicits industry money to do so. Dr. Martin declined

any

comment.

 

A smaller rival faction among Harvard's 750 medical students has

circulated a petition signed by about 100 people that calls for " continued

interaction between medicine and industry at Harvard Medical School. "

 

A leader of the group, Vijay Yanamadala, 22, said, " To say that because

these industry sources are inherently biased, physicians should never listen

to them, is wrong. "

 

Encouraging them is Dr. Thomas P. Stossel, a Harvard Medical professor who

has served on advisory boards for Merck, Biogen Idec and Dyax, and has

written widely on academic-industry ties. " I think if you look at it with

intellectual honesty, you see industry interaction has produced far more good

than harm, " Dr. Stossel said. " Harvard absolutely could get more from

industry but I think they're very skittish. There's a huge opportunity we ought

to mine. "

 

Brian Fuchs, 26, a second-year student from Queens, credited drug

companies with great medical discoveries. " It's not a problem, " he said,

pointing

out a classroom window to a 12-story building nearby. " In fact, Merck is

right there. "

 

Merck built a corporate research center in 2004 across the street from

Harvard's own big new medical research and class building. And Merck

underwrites plenty of work on the Harvard campus, including the immunology lab

run

by Dr. Laurie H. Glimcher - a professor who also sits on the board of the

drug maker Bristol-Myers Squibb, which paid her nearly $270,000 in 2007.

 

Dr. Glimcher says industry money is not only appropriate but necessary.

" Without the support of the private sector, we would not have been able to

develop what I call our 'bone team' in our lab, " she said at a recent

student and faculty forum to discuss industry relationships. Merck is counting

on her team to help come up with a successor to Fosamax, the formerly $3

billion-a-year bone drug that went generic last year. But Dr.

Marcia Angell, a faculty member and former editor in chief of The New

England Journal of Medicine, is among the professors who argue that industry

profit motives do not correspond to the scientific aims of academic medicine

and that much of the financing needs to be not only disclosed, but banned.

Too many medical schools, she says, have struck a " Faustian bargain " with

pharmaceutical companies.

 

" If a school like Harvard can't behave itself, " Dr. Angell said, " who can? "

 

Copyright 2009 The New York Times Company