Effect Measure

Pills, profits and medical schools

When I was in medical school it was common to get gifts from drug companies. Since many of us had very little money, the gifts were welcome. One company gave me a Littman stethoscope, at the time, the most advanced stethoscope around. The same model costs about $100 now. I was glad to get it, although I can’t tell you the name of the company. I forgot the names as quickly as I pocketed their gifts. We all got lots of free samples, too, and they were often things like tranquilizers sent through the mail and left in the magazine bin in my apartment house common mailbox area. Yes, these folks were trying to get me to prescribe their drugs but in those days (more than 40 years ago) they were doing it in a fairly ham handed and straightforward way. My father was a GP and he kept a huge rack of samples he gave free to his patients, many of whom couldn’t pay his $2 office visit bill, much less buy prescription drugs. That was then. In recent decades drug companies have gotten very, very sophisticated. Yesterday’s New York Times has a contemporary example from Harvard Medical School:

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 asked about side effects.

Mr. 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 a paid consultant to 10 drug companies, including five makers of cholesterol treatments.

?I felt really violated,? Mr. Zerden, now a fourth-year student, recently 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.?

Mr. Zerden?s minor stir four years ago has lately grown into a full-blown movement by more than 200 Harvard Medical School students and sympathetic faculty, 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. (Duff Wilson, New York Times)

Agitation by medical students on this issue is not new. There were vigorous movements in the 60s, 70s and 80s. Meanwhile Big Pharma and the biotech industry has busily infiltrated medical school faculties to the point where rooting them out will be a difficult job. In the current economic environment scientists look for support wherever they can find it. As a long time researcher with a successful funding record I don’t take any industry money, but I understand the impulse to do so and I have many colleagues who do, sometimes to save or advance a research program dear to their hearts and sometimes to save their jobs and sometimes because they are greedy bastards who want the money and often combinations of all of these reasons.

Harvard, like many prestigious universities, has avidly and whorishly accepted huge gifts from chemical companies like Monsanto to do research to cure the very cancers Monsanto’s products may have caused. I know many scientists who do science with Monsanto or Merck or Squibb or some other big company. Some of them are world class scientists who would never fudge data or alter findings to suit their paymaster. But Monsanto would never ask them to. That’s not how the game is played. Monsanto (or whoever) gets two important things out of their arrangement. They get advanced notice and first crack at important discoveries in basic and applied science, giving them what is often a crucial head start over competitors. And just as importantly for a company like Monsanto, by affecting the research agenda itself, they direct what is a scarce resource, productive scientists and their laboratories, toward science that benefits them and away from science that might hurt them.

As for individual faculty members, the situation at Harvard is completely out of control:

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 a family member 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 new Harvard Medical School Dean has his own history:

Dr. Flier, who became dean 17 months ago, previously received a $500,000 research grant from Bristol-Myers Squibb. He also consulted for three Cambridge biotechnology companies, but says that those relationships have ended and that he has accepted no new industry affiliations.

Compared to the previous Dean, though, he’s squeaky clean:

That is in contrast to his predecessor as dean, Dr. Joseph B. Martin. Harvard?s rules allowed Dr. Martin to sit on the board of the medical products company Baxter International for 5 of the 10 years he led the medical school, supplementing his university salary with up to $197,000 a year from Baxter, according to company filings.

Dr. Martin is still on the medical faculty and is founder and co-chairman of the Harvard NeuroDiscovery Center, which researches degenerative diseases, and actively solicits industry money to do so. Dr. Martin declined any comment.

Harvard will undoubtedly clean up some of its act. But the Big Pharma/biotech/chemical company cancer has metastasized very widely in American medical education and academic science. More government support of research and stricter conflict of interest rules will help but won’t cure the disease. Research supported by drug and chemical companies has done some real good, but also much damage and it is costly in many ways. The results are privatized, licensed and profits exorbitant.

And it’s not at all clear there is a net benefit.

Comments

  1. #1 floormaster squeeze
    March 4, 2009

    I think there are lots of insidious effects of money in medicine–a problem that few are really ready to confront. I will note several ironies with this though. About not being influenced by gifts or meetings or visits–this conceit has been exposed by some pretty good research. They tracked the prescription habits of doctors before and after a pharma funded talk and the prescribing habits changed dramatically (95% percent of those attending the talk changed their patterns). This is not the remarkable part (unless you are a drug company; when asked before, during and after 95% of the doctors said they would NOT change their behaviors. I think more pyschologists need to look at this cognitive dissonance.

    The other irony is that I am sure every doctor taking money and pimping for pharma/medicine in med schools would be outraged a the slightest hing of commercial influence in their child’s or grandchilds schools (Math Class: “If you have three Pepsis and drink one, how much more refreshed are you?”).

    It is pretty obvious that money blinds and deafens people. Its a public health crisis.

  2. #2 Paul (The Troll)
    March 4, 2009

    I agree with you that conflict of interest, and even the appearance of such, is demoralizing, can influence judgment, and even corrupt the truth. Just as in espionage, once you start taking money, that very fact helps push you down the slippery slope.

    I, too, remember those Littman stethoscopes and the real leather doctor’s bags with your name embossed with gold lettering, prematurely displaying the M.D., while still in medical school (they were never very practical – when I ended up making house calls, I used one of those fishing tackle boxes that had adquate space and organizing trays that perfectly prepared you for anything you might need in the field).

    There is, however, the innate problem of human behavior, which will never change – despite good men’s ideals and utopian goals. Government funded research, even when fruitful, is not always fully utilized or pursued for all its possible potential. And why? Because bureaucracy replaces the bottom line – a critical distinction when it comes to motivating all men, pace those who work more idealistically only for the scientific truth. And it is the very latter who may not be best equipped (because of the absence of avarice in their characters)to realize the full potential of their discoveries vis a vis those who are more driven to exploit that discovery to all profitable ends. But the reason those ends are profitable is because they are of benefit (in their final utilizable form) to the populace.

    A long description of the free market vs. centralized planning and funding. Perhaps the compromise solution is that adopted by peer reviewed journals: full disclosure. And woe to those professors who fail to do so. It is better to find compromise solutions that are amenable to basic human nature, a spectrum of amalgamations of the base and the ideal, than insist on an idealistically pure, but rigid solution, which forces human nature to find more insidious avenues to inexorably manifest itself. The latter only results in black markets and forces men into criminal acts, defined by unrealistic laws, as was so prevalent in the centrally planned economy of the former Soviet Union.

    I treated many Soviet immigrants when they came over in the early 80′s in that first wave when “dissident” Jews were allowed to emigrate. They gave me a first-hand education on how otherwise honest people would to have cheat and steal in order for them and their families to survive. The entire system worked on this principal, along with the ubiquitous bribe.

    I believe it was Lord Acton who cautioned that if you make laws that are impossible to implement or enforce, men will lose all respect for any law.

  3. #3 M.Randolph Kruger
    March 4, 2009

    What Revere? You are angry and surprised by all of this? Shit, if they can lobby Congress where there are lobbyist rules and get away with stuff didja think they couldnt do it with schools and doctors?

    I’ll give it to old son that you have ethics that you dont bend off of too much. Me too. I agree with you on this one… It ought to be illegal and that which isnt is always taken to an extreme. Natural propagation of a system that we all created. Cancer docs really dont make any money unless they are prescribing medications… pretty much how they get paid.

  4. #4 Rich
    March 4, 2009

    And yet the pharmaceutical companies like to cry poverty, despite getting access to taxpayer-paid basic science and getting tax breaks for R&D and write-offs for stuff that doesn’t work out, not to mention the last administrations gift to them in non-competitive pricing for Medicare.

  5. #5 Sue
    March 4, 2009

    Pharma companies spend more money on marketing than R&D because they know that 50% of the time a patient asks for a drug by name, they get it. I worked with a large NYC ad agency to help them walk into a pharma and show marketing all scripts written by geography by doctor by med by disease category. They could cross reference marketing programs and see the effects. They could add personal physician info like where he/she graduated, what conference he/she attended last and build a target list. The only cure for this incredible waste of money is to restrict sales access to doctors and ban ads on tv.

  6. #6 Paul The Troll
    March 5, 2009

    Ah, that filthy lucre! You’re right Randolph. The lobbying has gotten way out of hand. This democratic capitalism really has stink’n drawbacks…a lousy system, but as they say, the others are all even worse.

    Rich, ever looked at how many billions Pharma invests on the R&D of meds that never get to market. I don’t know of another category of enterprise that also doesn’t get to write off its losses. Medicare cannot invite competitive bids for pricing – it’s restricted from doing so by law. It was that way since 1965 when the program began; it wasn’t just with “this last administration.” The other side of that same coin prevented individual doctor from even discussing their office fees with one another in a hospital staff room, lest they be cited for breaking anti-trust laws – whether Medicare or private/3rd party payor patients. At least pharm reps could go into their local pharmacies to track the competition. As I alluded to above, Drs. found indirect ways to advise their younger colleagues what the going rates were in a small town, at least, without explicitly spewing price quotes. That damned human nature again, so hard to suppress!!

    And thanks for illustrating my point, Sue. It didn’t take you long to arrive at the same solutions applied by centrally planned dictatorships. Restrict access by salesmen of any medical products to their specific customers; that ought to stop all this insidious free market capitalism, which uses salesmen to bring to their customers what the companies they represent have to sell. And if you can show me any present-day industry or company that did not utilize targeted marketing to increase the efficiency of their marketing efforts (i.e., expenses), I’ll show you a dead industry/company. Taking your recommendation to its logical conclusion, pharma reps should just go door-do-door in every residential neighborhood to sell their wares, like the Hoover vacuum men used to do. Better to just take a map of America and hire a zillion salesmen to cover their randomly selected geographic territories. Forget those computers that use zip codes and other data (known as demographics, feasability studies, and other money-wasting boondoggles)that only increase marketing efficiencies.

    Oh yeah, and ban ads on TV – that’s a good one – I wonder why some of those other centrally planned dictatorships haven’t thought of censorship yet? And it should be obivous to these dumb companies that advertising is “a waste of money.” If we controlled the pharma, and all these other fat-cat industries, we’d restrict research and competition so that only the best (one) drug would be allowed to be distributed for reduced cost, or even for free. We’d have the noble R&D folks, who were no longer working for profit, and being paid by the state instead of greedy individual companies, to come up with the one drug that cured everything. And since people didn’t have to pay for any of this stuff, they’d be willing to wait in long lines, hoping the state drug store hadn’t run out before they got to the counter. Besides, if that happened, they could walk to the next state to try their luck there, since we’d banned the marketing of competing car companies, so there really weren’t so many of them either (except the few available to the apparatchiks who wisely do all the central planning and who know what works and what’s “just a waste of money.”)

    Aside from organic chemistry and the other “hard” sciences, did any of you folks ever happen to take a history or political science course during your educational careers. I know with all the scientific journals, you may not have much time to read too much in depth about the political landscape that’s evolved after a couple of World Wars. But scientists are pretty intelligent and good at what they do, and like Hollywood actors, being competent in their fields of endeavor, automatically conveys wisdom about other fields, such as socioeconomic systems that result from different models of government, and the dumb government shenanigans – especially those that inevitably crop up in those muddled democratic capitalistic (and parasitic) systems, reasons for war, conspiracies…and, oh yeah – the money wasted on marketing by greedy entreneurs who are ignoramuses compared to the brilliant and enlightened philosopher kings, who get to plan everyone’s Utopia, and also get the few cars that manage to get made, even if they don’t meet the reasonable emission standards y’all would have established.

  7. #7 paiwan
    March 5, 2009

    This is not an issue of the contrast between the conscientious students and the senior medical elites who have owned the political resources in influencing the audiences. It is a struggle between the truth and the falsehood.

    No, devils are not Pharmas, they are dwelling in people’s heart; especially for those who clings to stardom and prestigious positions. Luckily, a healthy community has provided the system which has been supported by ascending spirit to conquer the temptation.

    Now, Harvard Medical School rated “F” in monitor and control drug industry money. They announced the blanket policy and is forming a 19 people’s committee which recruits three students as representatives.

    We are glad that the new generation has grown more ethical which has reflected the tradition and teaching from the previous generations- also reflected the true democracy which treat individual with dignity and full respect-and it ignites the reform in every corner; education, politics and health care system ceaselessly.

    We human beings have a bit kicking off the political tyranny (many parts of the world are still struggling) and facing the impotency in dealing with economical tyranny- devils are in the heart and feeding people’s greed.

    We just have dialogued the lifestyle of taking care of our body, perhaps extending to mental; see how terrible of growing the population of dementia in developed countries. Not enough, it has covered our value system- the conquer of economical tyranny.

    When people’s lifestyle is not measuring an individual’s worth based on people’s economical status; say the professor in Harvard maybe not earning high salary, nevertheless he/she has immersed himself in devotion of medical research and teaching deeply-and he/she has been respected more than the guy engaging with fancy tie-up with commercial project. The students and faculty are able to tell, it will make the difference.

    Martin Buber is right; I and Thou. When we treat each other as Thou not It- it starts the turning. Hope that the recovery of true religious education arrives everywhere. :-)