Association of Clinical Researchers and Educators: Misguided Students and Frightened Competition

The misguided voices of students on college campuses are a part of American culture we are too frequently reminded. Although many positive accomplishments can come from a free flow of ideas, and academic freedom, student organizations tend to be drastically overdramatic, and illogical. Such is the case of the American Medical Student Association (AMSA).

Recently, AMSA issued a press release to announce that they reject the objectives of the Association of Clinical Researchers and Educators (ACRE), a newly formed organization that seeks to limit conflict of interest regulations, and since its young existence, has only had one formal meeting.

Instead of allowing the voice of reason into their organization, and to hear from students and physicians on all sides of the spectrum, AMSA chose to be radical at a time that seems all too convenient for them: healthcare overhaul.

Is there a sense from the medical student body that more spots could be opening up in medical schools? Is there a chance that more money could be given for residencies, fellowships, loan forgiveness, and primary care? Those chances might be more likely for present medical students if they support the current government pushed initiatives. Consequently, what these ‘physicians-in-training’ have yet to realize in their course of education—or have intentionally been prevented from learning—is that industry enhances the outcomes for patients, and makes science and technology more effective with devices and medicines.

Interestingly, instead of objectively looking at the benefits from an organization like ACRE, AMSA has gone to the same extreme politicians have with healthcare reform, and look how far Congress has gotten with that. I guess most of the AMSA students were not paying attention to ACRE’s first meeting last week when the Dean of Harvard Medical School encouraged the organization to create a healthy debate regarding the role of industry and academia in medicine and research.

AMSA was more focused on asking the medical profession to continue to reduce the influence of both the pharmaceutical and medical device industries regarding promotional activities. What they will soon realize after leaving medical school is that the same ‘influence’ of industry they complain about as students, will be their savior when patients are in need, and training or extra funding is sought.

Moreover, while AMSA National President, Lauren Hughes, M.D., M.PH., believes that “ACRE is truly behind the times,” with regard to reforming conflict of interest policies, but she must not be familiar with recent legislation and laws that essentially ban industry from research and academia. Do we need to remind Dr. Hughes that not all conflicts are conflicts of interest?

As a leader, Dr. Hughes should be advocating for a balance in medical education and for students to see the benefits—which are indisputable—of using industry to fund and support new advances in medicine, clinical trials, continuing medical education, and devices.

Nitin Roper, a fourth year medical student at the University of Connecticut said he “was disappointed to find that the majority of the speakers failed to acknowledge that conflicts of interest even exist.”

Comments like these underlie the real problem: students and physicians who advocate a strong anti-collaboration stance do not even look at the issue neutrally.

Students assume that problems exist from what they are told as students and residents, not as business owners, corporations, researchers, or when they are supporting a family.

With the decreasing reimbursement rates for doctors, the uninsured, and skyrocketing healthcare costs, these students should be considering the support from industry as a blessing, before they take their business elsewhere and these ‘business people-in-training’ spending all their time figuring out how to collect fees.

AMSA seems dead set on stopping all involvement with industry, last year they made a big deal even stating at a Senate hearing last month giving this example:

A group of such students in their first year at Harvard sat in class one day last spring, listening to a faculty member lecture about treatment options for a rare and deadly form of cancer. When this faculty member advocated for the use of a new, less-researched, and expensive drug to be the first-line of treatment for this cancer over well-studied, effective, and cheaper alternatives, the students wondered why. They googled him and discovered he was a paid consultant for the drug company that makes the expensive new drug, yet the faculty member had not disclosed this fact during his presentation. After negotiations with the administration, a large group of students rallied to call for increased transparency of industry-medicine interactions and an end to conflicts-of-interest in their medical education.

What the AMSA students failed to disclose themselves is that for the 40 year old cancer therapy they referred to, life expectancy is up to 3 years less than those treated with the newer drug. Well conducted randomized studies have been performed such that at this point it is considered no longer a standard of care to prescribe the older therapy for newly diagnosed patients with this disease.

Moreover, the context of the incident was also incorrectly presented – both temporally and otherwise. The meeting was in the fall of last year, the faculty member was discussing the case of his patient who was actually sitting with him and with the students, and not in a traditional lecture format. There was no requirement for disclosure at the time, a point not made in the description to the Senate, and arguably I would suggest doing such a thing in front of the patient could, at best, be described as insensitive.

In my opinion, it is unethical for AMSA to continue their quest against industry and ignore facts to the contrary that new drugs are better and increased competition (including “me too” drugs) actually bring down and do not increase the cost of drugs (this is the point that I advocate for – that economics classes be added to the Medical School curriculum). It is also wholly inappropriate for an organization such as AMSA to misrepresent facts to anybody, let alone the United States Senate.

Other blogs also seem to be attacking ACRE. The Carlat Psychiatry Blog noted that the first ACRE meeting “made clear at the outset that the goal of ACRE is not to repeal the recent gift ban and disclosure law passed by the Massachusetts Legislature. Rather, ACRE will act as a forum for preventing further restrictions on industry academic interactions,” which are detrimental to medical research and treatment.

The Prescription Project devoted space on the bi-monthly blog postings to the meeting and included a quote from J. Michael Gonzalez-Campoy M.D. “Nobody is holding the press accountable for the harm they have done.” “My patients are being harmed by biased reporting,” he said. Overall the Prescription Project attempted to portray ACRE as anti-disclosure which from the outset the group has endorsed disclosure, and at the meeting just brought up instances where there were negative side effects to that practice.

Ultimately, Dr. Carlat’s attacks on ACRE are at best, misguided. The success of the first ACRE meeting was in establishing a purpose and principles to guide their goals and should be applauded not only by industry and physicians, but by patients who will gain access to more effective and efficient treatments.