April 3, 2009

Mardi Gras beads, fishing guides
and a whole lot of eating

Many academic physicians accept gifts from pharmaceutical companies, but they also receive invaluable financial support for their research. Is it an unhealthy relationship?

Noting that the pharmaceutical industry underwrites about $1.5 billion in research annually, Campbell said, “These relationships have benefits that are real and important and essential to the health of the American people. Great drugs exist because we have these close relationships.”

“Ubiquitous” is the word Eric G. Campbell kept using to describe the cozy relationships that exist between the pharmaceutical industry and academic medicine. But while he offered many staggering statistics and cringe-worthy examples of perks accepted by academic physicians, he said banning industry support is “not possible or advisable.”

Campbell, an associate professor of medicine (health policy) at Harvard Medical School, spoke on physician relationships with industry and the ethics of conflict of interest in scientific research at the latest Medical Student Council Perspectives on Medicine session.

These relationships involve everyone from third-year medical students to the “rock stars” of the profession, said Campbell, who drew his conclusions from data he collected through national surveys. He found that 53 percent of all faculty, one third of all institutional review board members, 60 percent of department chairs, 94 percent of practicing physicians and 100 percent of third-year medical students have gained from a relationship with industry.

These gains take many forms, including consulting jobs, equity ownership, speaking fees, free trips, tickets to sporting events, drug samples and free meals. “There’s a whole lot of eating going on in academic medicine,” Campbell said. (In 2006, Yale School of Medicine faculty adopted guidelines for physician interaction with the pharmaceutical industry that ban the acceptance of any form of gift or meal.)

Some of the more egregious examples Campbell cited include:

• A department chair who was treated several times to visits to Platinum Plus, an adult entertainment facility in Los Angeles
• Physicians who were paid to attend “consulting meetings” at the Olympic games
• An industry think tank whose “consultants” include fishing guides in Alaska.
• Doctors who were paid $25,000 to ride on Mardi Gras floats and another $15,000 to throw beads.

“It’s a long list, and there’s some real ugly stuff that goes on between physicians and drug companies,” Campbell said.

But that’s only half the story. Noting that the pharmaceutical industry underwrites about $1.5 billion in research annually, Campbell said, “These relationships have benefits that are real and important and essential to the health of the American people. Great drugs exist because we have these close relationships.”

Researchers who are industry supported have access to the most cutting-edge information, materials and resources. “On every measure of academic productivity,” Campbell said, “we can demonstrate that scientists who are funded by industry are significantly more productive than those who do not have such funds.”

So what’s the solution? Campbell recommends that medical schools establish institutional level review boards. “Managing conflicts of interest is a fundamental part of medical professionalism today,” he said. “We need to disclose these things and we need to manage them.”

Calling students the “moral soul” of universities, he urged them to take the lead as they did on issues like the Vietnam War and apartheid. “Demand that your school protect your educational environment from industry influences,” he said.

—Jennifer Kaylin

Photo by John Curtis

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