When Harvard Medical School decided to change its policy last month regarding the interactions staff and faculty can have with commercial entities and industry, the conflict of interest (COI) movement asserted that these changes set an example for other academic medical centers (AMCs) to follow.
In fact, Douglas S. Brown, senior vice president and general counsel, and Stephen Tosi, chief medical officer, of UMass Memorial Health Care in Worcester, even went as far as asserting that the policy’s goal to “separate doctors from industry,” was the “right decision by Harvard.”
The problem with their perspective however, is that the authors are biased towards industry-academic relationships because in 2007, their own hospital established a similar policy. One they admit in a recent article in the Boston Globe, is the “strictest vendor relations policies in the nation” because it prohibits gifts, meals, and entertainment, eliminate industry influence in medical education, restrict consulting to true scientific (not marketing) issues, and restrict access by sales and marketing representatives at our facility. As a result, it should come as no surprise that they agree with Harvard’s policy, instead of fairly acknowledging the weaknesses and addressing the negative consequences that it can and will cause.
The article and authors also make the same mistakes that most media coverage commit by citing only the supposedly “negative” consequences that academic-industry partnerships are said to create. For example, they assert that “the medical/pharmaceutical industry influence on academic medicine is ubiquitous,” based on a 2007 survey of academic department chairs published in the Journal of the American Medical Association, which revealed that 60 percent reported some form of personal relationship with industry, including as a consultant, paid speaker, officer, founder, or member of a board.
Instead of trying to explain the potential reasons why such a large percentage of academic department chairs have such relationships, the authors conveniently conclude, without any evidence of harm to patients, that such relationships were wrong. Moreover, without even considering the positive impact those partnerships had on clinical care, research funding, education and training, and most importantly the freedom it allows physicians, the Globe takes the easy road and asserts that “things must change.”
Making the claim that industry-academic relationships need to change however, is confusing because the authors themselves acknowledge that “many of these relationships are appropriate.” Conveniently, by diverting their attention away from the “many” relationships that are appropriate, the authors decide to focus only on a few (and rare) cases that have recently been investigated by either the Department of Justice or Senator Charles Grassley (R-IA).
They also choose to bolster their claim that relationships between industry and academia are wrong by citing Eric Campbell, from Harvard, whose own views on academic-industry relationships are biased as well. In fact, by referring to consulting arrangements as “one of the great wink-winks of all time,’’ Campbell completely ignored the significant impact and breakthroughs such partnerships have created over the past fifty years, such as prolonged life and better health.
What the authors also do not address in their article, is that similar to policies being implemented at other AMC’s the Harvard policy lacks grounding in patient-level evidence regarding the risks and benefits of physician collaboration with companies that innovate. Moreover, such policies are constructed solely to address the “perception” of influence and the political fall-out associated with isolated and historic incidents.
Another problem with these policies is that many of the activities that garner the most ire, such as physicians being “lavished with trips and other expensive perquisites,” ended almost a decade ago yet continue to be sensationalized.
Industry-Academic Relationships Help Patients
Policies like Harvard’s forget the fact that before there were Federal statutes that provided incentive to collaborate and move discoveries from the bench to patients, few physicians collaborated with industry and medicine was undeniably inferior. For instance, before industry-academic collaboration, standard treatment for heart attack was observation because routine medicines such as Statins didn’t exist. For statins, it was industry that extended the government-funded work of Vagelos and of Brown and Goldstein, and developed these medications that we today take for granted.
Same for so many other drugs and vaccines – ACE inhibitors and ARBs; targeted cancer treatments; virtually all modern antibiotics; HPV and rotavirus vaccines; insulin analogs, etc. The numerous examples of the beneficial products that America has reaped from the growth in collaboration between academic physicians and industry directly mirrors the growth in discovery and delivery of new life-saving treatments to patients.
As a result, these new therapies and medical devices have dramatically lowered the death rate from heart attacks and strokes, practically eliminated debilitating diseases such as polio, and extended and improved the quality of life for patients suffering from HIV. Even generic medicines, which we have come to rely on as the low-cost alternative, were once brand-name medicines that were likely discovered through collaborative efforts between academia and industry.
Consequently, it is these advancements that we all benefit from today that would not have been possible without extraordinary research contributions from both academic physicians and industry. Yet they would have done little for patients had the innovation cycle – discovery, development and adoption – been broken by policies such as those adopted by UMass and Harvard.
Despite the authors’ claim of broad support for their policies, few physicians beyond the administrative and policymaking spheres agree that these policies enhance or support their research or patient care, which a recent analysis by an MIT student confirmed.
Even physicians from within their system have expressed significant concerns over the policies and the impact they have on access to information, research collaboration, and continuing medical education resources and opportunities.
To the contrary, faculty at academic medical centers from California to Wisconsin and beyond are realizing that patients not politics should be the benchmark against which all policies are measured and are taking a stand against these policies that have the potential for grave harm to patients today and tomorrow.
In addition, those who believe that the goals of a profit-driven industry do not always align with the goals of independent scientific research, teaching, and the delivery of high quality patient care are misguided. Every company involved in the research, development, education, training and implementation of technological and innovative breakthroughs in health care share the same goal: making people live longer, healthier lives. There can be no dispute with that fact.
What COI critics focus too much on is the fact that it’s not always cheap to provide the services that result from these breakthroughs to patients. But to exclude the chance for physicians to engage in these relationships would result in higher healthcare costs, not lower, because physicians would be less informed about new breakthroughs and treatments, and gaps in care would continue to grow. Techniques and training would also suffer because device makers would not have the ability to work closely with physicians to get the frequent input they need to make changes to their products.
Conclusion
In the end, if having policy’s like Harvard’s and UMass “is not about demonizing pharmaceutical and medical device companies,” then why are they so strict? Why do critics like Eric Campbell and the authors of the Boston Globe article feel the need to tell other universities to adopt policies that restrict the freedom of faculty and staff from hearing truthful and valuable information?
As the authors themselves acknowledge, “companies are vital to medical research and our continued ability to discover new and improved ways of caring for patients.” Since that is the case, we cannot let a few bad relationships “undermine the integrity of the entire interaction” by creating policies that will hinder collaboration and progress in medicine.
Excluding the opportunities for physicians and those in training to hear valuable information from all sources, and instead choosing what they can hear, is problematic on many levels. And even if COI policies like these still “allow significant contact with industry,” will physicians still be willing to participate in these relationships when so much negativity is associated with them?
As with all industries, occupations, and human interactions, there are instances of misunderstanding or mischief, or even blatant misconduct that cannot be defended. However, broadly curtailing opportunities for productive collaboration between academia and industry is rarely the correct solution, and in this instance, directly contradicts the central mission of organizations adopting the policies: To improve patient health.
Accordingly, it’s time to take a closer look at the evidence supporting these policies while putting the focus squarely back on patients not politics.