Fwd: Harvard-Partners Hospitals Curtail Industry--Doctor Perks

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ALLIANCE FOR HUMAN RESEARCH PROTECTION Promoting Openness, Full Disclosure, and Accountability http://www.ahrp.org and http://ahrp.blogspot.com FYIDr. Peter Slavin, president of Mass. General Hospital: "We don't want ourfaculty being on the road as hired guns."Harvard-Partners Healthcare, which includes Mass. General and Brigham andWomen's hospitals, announced the adoption of measures curtailing freebiesfrom drug companies--but those measures do NOT cut the major source ofindustry revenue.The Boston Globe quotes Dr. Peter Slavin, president of Mass. General and amember of the commission that developed the new policy, "We don't want ourfaculty being on the road as hired guns." He was referring to the decisionto prohibit speaker's bureaus. In March, Massachusetts passed a law banning pharmaceutical and medicaldevice companies from gift giving to physicians, and requiring companies topublicly disclose payments to doctors over $50 "for certain types ofconsulting and speaking engagements."http://www.boston.com/news/local/massachusetts/articles/2009/03/12/state_bans_drug_firm_gifts_to_doctorsThe measures adopted by Harvard-Partners were clearly intended to improvepublic perception about Harvard-affiliated doctors as having sold theirintegrity for cash.Indeed, Dr. Slavin said the group decided to prohibit physicians from eatingmeals on a company's tab, including lunches bought for doctors-in-trainingin the hospital, because it "doesn't promote a positive image of physiciansand increases health care costs."The move is an acknowledgment that the cozy, financially lucrativerelationships between Harvard faculty and drug companies is both ethicallyodious and results in increased cost for healthcare, a cost passed totaxpayers and the middle class.Whereas Memorial Sloan-Kettering Cancer Center in New York City bannedindustry support for CME courses altogether, and Stanford University Schoolof Medicine recently barred drug companies from paying for specificcontinuing medical education, Harvard-Partners placed some restrictions onmedical education funding, but continues to allow industry support.Continuing medical education (CME) in psychiatry at Mass General is notedfor its multi-million dollar industry sponsorship.See:http://carlatpsychiatry.blogspot.com/2008/02/new-mgh-psychiatry-academy-take-money.htmlThe MGH "Psychiatry Academy" website for CME proudly states:"the Psychiatry Department ranks #1 in US News & World Report's Survey ofAmerica's Best Hospitals for a 13th consecutive year."Indeed, MGH psychiatry CME faculty are noted as industry's most influential"thought leaders" who have been effective in persuading other doctors toexpand their use of powerful psychotropic drugs.  Most notably, they havehelped industry catapult the second generation antidepressants andantipsychotics into blockbuster sellers--despite evidence of their hazardouseffects.Of note, out of approximately 26 MGH-CME faculty in psychiatry, only Dr.Andrew Nierenberg, disclosed support that he and MGH CME receive from drugcompanies.Manufacturers' internal documents uncovered during legal proceedings confirmthat these drugs are linked to debilitating, even life-threatening risks,including: suicide, mania, akathisia, sexual dysfunction and birth defects(SSRIs); suicide, stroke, cardiac deaths, metabolic malfunction, diabetes,and an array of involuntary movement disorders.Despite lack of scientific evidence of their clinical efficacy--whencompared to placebo in controlled trials--and despite the serious risksposed by SSRI antidepressants--including evidence of birth defects--HarvardMedical School faculty, led by Dr. Lee Cohen, Director of the Perinatal andReproductive Psychiatry Clinic Research Program and director of Women'sMental Health at MGH, has promoted the use of SSRIs during pregnancy. [1]Despite lack of scientific evidence of their clinical efficacy beyond "proofin principle," despite the evidence of profound harm, prominent HarvardMedical School faculty, led by Dr. Joseph Biederman, Chief of the Clinicaland Research Programs in Pediatric Psychopharmacology and Adult ADHD at MGH,recommend the use of antipsychotic drugs for unapproved, off-label uses evenfor young children with ADHD. [2]Neither the Massachusetts law, nor the Harvard-Partners newly adopted policyaddress industry's undue and corrupting influence over medical research. Thebasic tenets of science are currently undermined by (1) corporate controlover research data; (2) denial of access to the data by independentscientists; (3) academic physician-researchers who are financiallyintertwined with drug / vaccine / medical device manufacturers; (4) industryinfluence over the content of medical journals; (5) opaque peer reviewfavors "positive" findings.All of the above stakeholders contribute toward skewing the scientificliterature with misleading reports that favor the latest, high priced drugs.So long as medical institutions are financially tied to industry,evidence-based medicine is but a sound bite. Contact: Vera Hassner Sharavveracare212-595-8974http://www.boston.com/news/health/blog/2009/04/partners_adopts.htmlTHE BOSTON GLOBEPartners adopts tougher limits on doctors' ties to industryApril 9, 2009 By Liz Kowalczyk, Globe StaffDoctors at Partners HealthCare no longer will be allowed to accept gifts andmeals from drug and device companies, or travel the country as paid membersof company "speakers bureaus,'' as the state's largest hospital andphysician network adopts tougher restrictions to counter industry'sinfluence over the drugs and treatments doctors prescribe.Partners, which includes the Harvard-affiliated Massachusetts General andBrigham and Women's hospitals in Boston, also is placing new limits on howphysicians interact with company sales representatives and increasingoversight of these relationships. Overall, the changes, which also apply tosenior Partners executives, go further than a new state law governingdoctors' conflicts of interest and generally will bring the organization inline with other major US teaching hospitals that have adopted tougherstandards.Many Mass. General and Brigham physicians are top researchers, making drugand device companies eager to collaborate with them on developing newtreatments for patients -- relationships Partners executives said they wantto preserve. But because of their status as "thought leaders," these doctorsalso are attractive targets for helping companies spread their marketingmessages through speakers bureaus and medical education."We don't want our faculty being on the road" as "hired guns," said Dr.Peter Slavin, president of Mass. General and a member of the commission thatdeveloped the new policy, referring to the decision to prohibit speakersbureaus. Slavin said the group decided to prohibit physicians from eatingmeals on a company's tab, including lunches bought for doctors-in-trainingin the hospital, because it "doesn't promote a positive image of physiciansand increases health care costs."Company salespeople are frequently seen in the hallways of Mass. General andthe Brigham, but the new rules make them less welcome. They won't be able tovisit doctors without an invitation from the physician, and the policyforbids company representatives from providing free drug samples directly todoctors, a practice that's been used by companies to encourage the use ofnewer and usually more expensive brand-name drugs. Instead, they will beable to donate samples only to hospital pharmacies or some other centralrepository.Partners' policy, which was disclosed to staff today and will be implementedby October 1, goes further than a state law passed last year to restrictdoctors' relationships with industry. The law allows companies to pay forcertain meals and to distribute drug samples directly to doctors.The rules also go further than some other teaching hospitals', by banningall gifts and meals and forbidding speakers bureau participation and ghostwriting -- when researchers allow themselves to be listed as authors onpapers written by others, often by drug company staff.But in other respects, Partners did not go as far as Stanford UniversitySchool of Medicine, which recently barred drug companies from paying forspecific continuing medical education courses for doctors, or as MemorialSloan-Kettering Cancer Center in New York City, which banned industrysupport for the courses altogether. Partners placed further restrictions onmedical education funding, but still will allow industry support, as long asat least two companies pay for a specific course and it is approved by anewly-created Educational Review Board.Stanford and the Cleveland Clinic plan to disclose on their websites whichdoctors receive consulting payments from industry -- and the newMassachusetts law will require public disclosure of some of theserelationships as well, starting in July 2010. Partners' new policy does notaddress public disclosure, but Slavin, who will oversee implementation ofthe policy, said the hospitals will develop a plan for disclosure topatients.The changes come as Mass. General and several of its psychiatrists are underscrutiny from Congressional investigators over their relationships withpharmaceutical companies.US Senator Charles E. Grassley, Republican of Iowa, has accused Mass.General child psychiatrist Dr. Joseph Biederman of failing to tell HarvardMedical School until last March about most of the more than $1.5 millionthat the pharmaceutical industry paid him in consulting and speaking feesbetween 2000 and 2007. Biederman has said in statements and letters to theGlobe that he has been conscientious about disclosure requirements.Last month, federal prosecutors alleged that another Mass. Generalpsychiatrist, Dr. Jeffrey Bostic, became a "star spokesman" for NewYork-based Forest Laboratories Inc., which paid him more than $750,000between 2000 and 2006 for his presentations on treating depressed children.Bostic has not been charged with any crime and, through hospital lawyers,denied that he promoted the company's drugs.Partners must work out details of the ban on speakers bureaus; one or twopresentations by a doctor a year at a company-sponsored meeting might beallowed, but repeated talks paid for by a company will not be. Doctors stillwill be allowed to act as paid consultants for companies, but hospitaloversight of these activities will be more rigorous.Grassley and several groups advocating for tougher conflict-of-interestrules praised the new policy."It's good that the hospitals associated with Harvard are responding tothese concerns," Grassley said in a written statement. "I'm especially gladthat these hospitals are taking a national lead on issues such asghostwriting and speakers' bureau fees. ... I'll follow the progressclosely."Partners executives said they did not adopt the stricter policy because ofGrassley's investigation; the commission began its work in late 2007. ButDr. Eugene Braunwald, who chaired the group, said Grassley's inquiry was a"confirmation that people are watching us. If the public, as represented inSenator Grassley, doesn't trust us, we need to remedy that."Not everyone applauded all aspects of the new rules.Dr. Arnold Relman, a Harvard Medical School professor and former editor ofthe New England Journal of Medicine, said the medical education provisionsdon't go far enough. "There should be no, zero, industry funding for anyparticular educational program," he said. "If you know your CME program isdependent on money from a company, it's impossible not to be influenced bythat fact."Dr. Thomas Stossel, a physician at Brigham and Women's who was an advisor toMerck several years ago, said that growing restrictions on the interactionsbetween doctors and industry could end up hurting patient care. "We have allthese tools now (for caring for patients) and those tools have come fromphysicians working with industry," he said. He likened the currentatmosphere to a "witch hunt."But Dr. William Hoffman, a critical care physician at Mass. General, saidstricter rules are needed. He said he usually tells drug representatives to"stop by when they're in the building," and if he has time, he sees them. Hesaid he's unlikely to go to the trouble of issuing invitations."On the surface, most people here will say this policy is needed to rein inthe influence of companies," he said. "But there are people I'm sure whosupplement their income substantially who are going to miss it."FAIR USE NOTICE: This may contain copyrighted (C ) material the use of whichhas not always been specifically authorized by the copyright owner. Suchmaterial is made available for educational purposes, to advanceunderstanding of human rights, democracy, scientific, moral, ethical, andsocial justice issues, etc. It is believed that this constitutes a 'fairuse' of any such copyrighted material as provided for in Title 17 U.S.C.section 107 of the US Copyright Law. This material is distributed withoutprofit. _____________Infomail1 mailing listto send a message to Infomail1-leave =====In accordance with Title 17 U.S.C. Section 107, this material is distributed without profit to those who have expressed a prior interest in receiving the included information for research and educational purposes.