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 had asked about side effects.
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 also a paid consultant to 10 drug companies, including five makers of cholesterol treatments.
‘‘I felt really violated,’’ Zerden, now a fourth-year student, 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.’’ Zerden’s minor stir four years ago has grown into a full-blown movement by more than 200 Harvard Medical School students and sympathetic faculty members, 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 be hurting its reputation and affecting its teaching.
The students argue, for example, that Harvard should be embarrassed by the ‘‘F,’’ or failing, grade it recently received from the American Medical Student Association, which rates how well medical schools monitor and control drug industry money. Harvard’s peers received much higher grades, including the top ‘‘A’’ for the University of Pennsylvania; ‘‘Bs’’ for Stanford University, Columbia University and New York University; and the ‘‘C’’ for Yale University.
Harvard has fallen behind, some faculty members 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’s board of directors; and because a crackdown could cost it money or faculty.
The dean, Jeffrey 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 Harvard students have already secured a requirement that all professors and lecturers disclose their industry ties in class—ablanket policy that has been adopted by no other leading medical school in the United States.
(One Harvard professor’s disclosure listed 47 company affiliations.) ‘‘Harvard needs to live up to its name,’’ said Kirsten Austad, 24, a firstyear 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.
Flier, the dean, says the faculty of Harvard Medical may lead those of others in the United States in receiving money from industry, as well as from government and charities, and he does not want to tighten the spigot.
‘‘One entirely appropriate source, if done properly, is industrial funds,’’ Flier said in an interview.
The payments, however, are drawing scrutiny even in Washington. On Tuesday, Senator Charles Grassley asked the drug maker Pfizer to provide details of its payments to at least 149 Harvard faculty members in the last two years.
The request expands Grassley’s investigation of industry payments to three Harvard psychiatrists who had promoted antipsychotic medicines for children. According to records Grassley obtained from drug companies, the professors were accused of not properly reporting at least $4.2 million in payments from 2000 to 2007. One of them has been suspended from conducting clinical trials.
The senator, an Iowa Republican, also asked for any Pfizer e-mail, faxes, letters or photos regarding Harvard medical students who have protested drug company influence.
At an October demonstration, which involved about 50 Harvard Medical students and was sponsored by the American Medical Student Association, some protesters saw a man photographing them with a cellphone. He later identified himself as a Pfizer representative but did not give his name.
A Pfizer spokesman said Tuesday that the company ‘‘will fully cooperate with Senator Grassley’s request.’’ The spokesman, Ray Kerins, said Pfizer regrets it if the photograph taken by the sales representative ‘‘was offensive to anyone involved’’ but believes the company has acted legally and ethically and that collaboration with medical schools is ‘‘a valuable source of innovation and scientific advancement.’’ Kerins said recently that the man had told him the photos were for personal use. Kerins said the man, whom he declined to name, had done nothing improper.
Harvard policy prohibits drug representatives from interacting with students on the medical campus but does not bar them from the campus or from taking photographs.
David Cameron, spokesman for Harvard Medical School, said in an e-mail message, ‘‘We are unable to provide comment on this matter.’’ With Harvard’s endowment having lost 22 percent of its value since last July and the recession causing philanthropic contributors to retrench, school officials maintain that corporate support for their faculty is all the more crucial.
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 they provided for continuing education.
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 family members 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 gifts to faculty—meals, trips or the like.
A smaller 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.
March 05, 2009
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