A recent article in Harvard’s Crimson examined the newly announced changes in Partners’ Conflict of Interest Policy, and how some doctors are concerned about the policy’s reach. We previously wrote that one physician has already resigned because of the new policy.
The article mentioned Harvard Medical School assistant professor Paul M. Copeland gives industry-sponsored talks each year, and heads the endocrinology division at Partners Healthcare-affiliate North Shore Medical Center. He specifically stated that he does not do such talks for the money.
He told the Crimson that “these information sessions—or “talks for docs”—improve patient care, and all the material he presents has been approved by the Food and Drug Administration.” Unfortunately for Copeland, he can no longer register for the 2010 speaking cycle because of Partners new policy.
As we have previously explained, the revised policy puts restrictions on Partners employees, “including bans on speaking at industry-sponsored events and receiving stock options from pharmaceutical companies. Outside pay for senior officials sitting on boards of drug or medical device-making companies has been capped as well.” The policy considerations began in the fall of 2007, when “Partners Healthcare embarked on a conflict of interest review to better define the relationship between industry and medicine as well as strengthen oversight of physician activity with drug companies.”
Regarded as one of the strictest policies in the nations, “some Partners employees caution that the new restrictions may be too broad and could ultimately stifle essential physician activity.” Specifically, Dr. Copeland asserted that continuing medical education (CME) talks sponsored by drug companies “provide doctors with the latest information on treatments, address patient care issues, and educate physicians about the proper role of medications.” Under the new policy, doctors will be losing this valuable information, and will be forced to receive information elsewhere (where and from who?), and sometimes at a great inconvenience.
He further noted that at CME programs “he regularly fields an hour’s worth of questions from doctors who attend his talks about case studies and alternative treatments.” As a result, Dr. Copeland believes the new policy is so “disheartening” because “Patients and doctors benefit from these talks, and the policy will “have detrimental effects on physicians’ activities, such as continuing medical education.”
The article also cited Medical School professor David B. Acker, who is also chief of obstetrics at Brigham and Women’s, who supports the new policy and believed it came late. In addition, Medical School professor Charles N. Serhan, who served on the committee that issued the policy recommendations, also applauded the policy’s aims to rein in conflicts of interest issues, but he “cautioned that its expansive reach does not come without costs.”
As a member of the committee who issued the recommendations, he told the Crimson that as a result of the policy, “the pendulum is a little too far in one direction in that our rules are now too tight and could actually stifle innovation.” Consequently, Dr. Serhan asserted that “with time, the policy has to come back to some equilibrium.” Such comments are problematic as a member of the committee itself admits the new policy to be extreme.
Mass. General’s chief surgeon Andrew L. Warshaw also noted his concerns with the new policy in regards to “certain initiatives such as surgical fellowships, which are generally dependent on industry funding. He noted that although he understood the goals of the policy, the impact may cause these fellowships to “suffer from the crackdown on outside funding.” He further gave the example of a general surgeon who wanted to learn minimally invasive techniques, a scenario that is commonly funded by outside interests, and asked: “Is it a bad thing when someone gets training that they wouldn’t normally get and helps patients?”
Another clinical professor at the Medical School, Barry W. Levine, who has worked at Mass. General for four decades, “says he is still figuring out how the new policy will impact his profession.” Dr. Levine’s experience consists of 18 years of speaking about lung disease on behalf of drug companies like AstraZeneca and GlaxoSmithKline. He told the Crimson that “he does not plan to take on any more speaking engagements until the implications of the policy become clearer.”
Like Dr. Copeland, Dr. Levine believes “the new regulations stymie critical education about asthma and emphysema for doctors in underprivileged communities.” For example, “he routinely meets physicians who do not have access to pulmonary function machines, which are critical for diagnosing these diseases.” Dr. Levine firmly believes that such meetings are not promoting a drug. He also added that “the drug companies sponsoring the talks he participates in have no power to censor what materials physicians present, as long as the information has been approved by the FDA.”
As other physicians and institutions consider the effect of this policy and alternatives, committees should consider answering the following question presented by Dr. Copeland: “Is it a bad thing when someone gets training that they wouldn’t normally get and helps patients?” In answering that question, committees should recognize that regardless of the source of funding, the training will help patients.
Ultimately, the growing concern among doctors at Harvard and at Partners regarding the new conflict policies will have to resolve the difficult question of maintaining the necessary relationship between industry and medicine without distorting physician incentives. As is evident from the doctors cited above, the current policy places restrictions that “may be too broad and could ultimately stifle essential physician activity.” Moreover, as one of the committee members who created the policy himself stated, bringing the policy back to “equilibrium” now is critical before it stifles innovation.