Partners Healthcare COI Policy and the Prescription Project (Who’s calling the shots)

According to Partners COI Policy (page 11), the Prescription Project was deeply involved in guiding the writing of the policy.

Substantial public attention has been paid to the pharmaceutical/medical device industry marketing practice of providing small gifts, meals, and drug samples to physicians, particularly since the publication of an article in The Journal of the American Medical Association (JAMA) in 2006, raising concerns about some aspects of these practices and urging stricter conflicts of interest (COI) policies at academic medical centers (AMCs).  (See Appendix E for a copy of this article.)  The Prescription Project was launched by Community Catalyst, a national non-profit advocacy organization, in partnership with the Institute on Medicine as a Profession (IMAP) and with funding by the Pew Charitable Trusts, to promote the recommendations espoused in the JAMA article (Brennan Paper).

In August, 2007, Partners was invited by Prescription Project leadership to attend a meeting of Massachusetts AMCs regarding COI policies, and has since participated in several such meetings.

A number of peer institutions, including Stanford University, Yale University, University of Pennsylvania, University of Pittsburgh Medical Center, and the Mayo Clinic have already taken steps to eliminate gifts and meals.

Locally, in collaboration with the Prescription Project, Boston University/Boston Medical Center, Tufts University/Tufts Medical Center, and University of Massachusetts/UMass Memorial Medical Center have instituted strict policies over the past year that limit interactions between physicians and industry representatives.

A later paragraph also outlines how closely the Prescription Project is working with universities to implement their strict COI policies:

Members of speakers’ bureaus deliver talks on behalf of the company at company-designated forums (often using slides provided by the company).  “Ghostwriting” refers to the practice of physicians allowing articles to be published under their names when these articles are, in fact, written by industry representatives or others who are not listed as authors, and where the physician does not make an appropriate level of contribution to the paper.  A number of high-profile media articles have recently detailed such arrangements, and there have been public efforts to curtail these activities.  The influential 2006 JAMA article, “Health Industry Practices that Create Conflicts of Interest,” by Brennan, et al., highlighted these practices, urging AMCs to prohibit them, and the Prescription Project has championed this cause.  More recently, the AAMC Task Force on Industry Funding of Medical Education recommended that AMCs should “strongly discourage participation” by their faculty in industry speakers’ bureaus and prohibit presentations of any kind to be ghostwritten.

The Prescription Project was the brain child of David Rothman, Ph.D., Co-Author of the Brennan Paper and Executive Director of the IMAP, which also funded the Brennan Paper.  The Prescription Project is a partnership between IMAP and Community Catalyst that was created to promote the belief systems and changes at AMCs proposed by the Brennan Paper.

The Partnership received a $6 million dollar grant in 2006 from the Pew Charitable Trusts to accomplish this. 

David Rothman wrote up this past fall in a JAMA article titled:  New Developments in Managing Physician Industry Relationships.

How did these changes (at Academic Medical Centers) come about? Immediately after the publication of the ABIM-IMAP recommendations,  (the Brennan Paper) the Pew Charitable Trusts contacted IMAP to explore strategies to promote their enactment. The discussions, joined by Community Catalyst, a national consumer advocacy organization, led to the establishment of the Pew-funded Prescription Project.

Under its auspice, and with additional funding to IMAP from the Attorney General Consumer and Prescriber Grant Program,  IMAP has been investigating the origins and consequences of the policy innovations and providing technical assistance to AMCs. Presuming that the AAMC recommendations will further stimulate change, in this Commentary we report on findings to date to help facilitate the process.

Change has come from the top down. The dean’s office has typically taken the lead in inspiring, formulating, and enacting new policies

But in the end, medical centers are hierarchical places, and at universities like Yale, Stanford, Pennsylvania, and Pittsburgh, it was the deans who appointed and charged the task force to draft new policies, and together they presented and defended the documents before the governing committees (the faculty practice group, the department chairs, the faculty council). With approvals forthcoming, the new policies were announced. In no case that we know of was a dean’s support for a rigorous policy derailed, voted down, or even substantially weakened.

The Prescription Project has since expanded their mission to include promoting strict COI policies for medical specialty societies, patient organizations, and promoting strong regulations around COI in state legislatures, including the recent Massachusetts law, and various anti-pharma marketing bills.  It is interesting to note that some members of the Advisory Board of the Prescription Project include:

Jerry Avorn, M.D., Chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital (Chief Proponent of Academic Detailing and Owner of Independent Drug Information Service);

Cathy DeAngelis, M.D., Editor-in-Chief of The Journal of the American Medical Association (Co-Author of the JAMA Paper on COI in Medical Societies);

Steven Nissen, M.D., Immediate Past President of the American College of Cardiology (Co-Author of the IMAP JAMA Paper on COI in Medical Societies); and

Phillip A. Pizzo, M.D., Dean of Stanford Medical School (the Dean that banned commercial support of CME except for pooled funding).

The Prescription Project is proud of its efforts, as outlined in its own press release in September 2007 and how The Prescription Project worked with BMC and BUSM during the development of these standards, and is now engaging a number of other AMCs across the country.

What stands out is how coordinated the effort has been to separate industry involvement from academia, and how successful a small group (the Prescription Project-IMAP) has been in coercing academic medical institutions into adopting the Prescription Project’s strict definition of COI.

The meetings with AMCs and the Prescription Project is just one example of how this organization is working to end all prescriber ties with industry.