http://www.nytimes.com/2009/03/03/business/03medschool.html?ref=business
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?”
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). You are my near priest, the one who should have been except than I and all the others who learned from you would never have met you. But you would have been an excellent priest in a Church that needed folks like you with integrity and compassion and wisdom and always faith. 
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Alas, Comments Again
April 20, 2009 — hymesI expect some spam to get through the excellent spam filter Word Press provides for free and do not mind taking care of it. However, lately there has been an increase in what I would politely call “hostile” comments on my blog. So just so you know, all comments to this blog are moderated and have been for some time since the last influx of nastygrams/comments some time ago. I do not approve hate speech, I do not approve personal attacks on myself or others, I do not approve screeds and off-topic rants, I do not approve comments that don’t make sense. In fact this is a case of my blog, my rules. Luckily for anyone who wants to spend their time writing hate filled screeds, there are many free blogging platforms and unless somebody reports you for hate speech, you can go at it to your audience of one to your heart’s delight. But not on my blog.