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News
Harvard Medical School in Ethics Quandary
March 2, 2009
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?"
Source: http://www.nytimes.com/2009/03/03/business/03medschool.html?_r=1&hp
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