Originally published in MedPage Today
by Kristina Fiore, MedPage Today Staff Writer
Earlier this year, Harvard’s Partners Healthcare put a cap on payments its physicians can receive for serving on corporate boards at $5,000 a day.
Although the cap primarily affects top researchers and executives, it is by far the stiffest limit imposed by any academic medical center, and drives deeper the wedge between business and academia put in place by increasing bans on gifts, meals, and other relations over the last few years.
“What [Partners] is doing is unique compared to all hospitals nationwide, but it is not that unique for academic medical centers where this issue has been highlighted more in recent years,” said Andy Thomas, MD, of Ohio State University Medical Center.
The practice of doing promotional speaking for drug companies is not new, but it has come under fire in recent years. In this MedPage Today/Journal Sentinel special report, we examine the forces behind the recent increase in the use of non-academic physicians on the “dinner speaker” tour and the impact of this type of promotion.
Most institutions, he said, “have a policy for transparency of outside income and then once it gets above a certain level, it is scrutinized more fully for conflicts on interest on the part of the individual.”
A review of academic medical centers’ conflict-of-interest policies by MedPage Today and the Milwaukee Journal Sentinel found that to be the case. Many of them set up conflict-of-interest committees following passage of the Objectivity in Research Act of 1995, which required that institutions disclose all potential conflicts among researchers who apply for federal grant money.
Because of these committees, most universities know the extent of their employees’ involvement in industry relationships, said Marianne Hockema, MA, an administrator in the Office of Conflict of Interest Review at the Mayo Clinic in Rochester, Minn.
For example, Mayo has historically required a three-way contract between the institution, its physicians, and industry regarding any relationships — although these are not typically disclosed to the public.
There are increasingly fewer universities without a ban on gifts from the pharmaceutical industry. After several adopted such policies — Mayo, Stanford, the University of Pennsylvania, and Yale among them — the Pharmaceutical Research and Manufacturers’ Association (PhRMA) responded in 2008 with rules that banned all gifts to physicians — including even small tokens like pens, pads, and mugs.
PhRMA didn’t, however, set limits on speaking and consulting arrangements, meals, or continuing medical education (CME) dinners.
But academia has been picking up that slack, with varying success and commitment.
For example, in 2006 Stanford University barred pharmaceutical industry representatives from unscheduled visits and from patient care areas. Two years later, the school made headlines in the trade press by stating that it would no longer accept industry support for specific CME programs.
But this January, Stanford announced a $3-million grant from Pfizer to develop continuing medical education programs in a number of therapeutic areas for which the university had identified a need. Those areas include diabetes, cardiovascular disease, smoking cessation, and infections — all areas in which Pfizer either has products or, as stated on the corporate Web site, is seeking partners to address “unmet medical needs.”
Johns Hopkins has updated its conflict-of-interest policies with a narrower focus — since July 2009 its policy bans medical faculty from serving on speakers’ bureaus unless the Hopkins doctor has total control over the content and it isn’t subject to review by industry.
Hockema said Mayo has forbidden researchers from participating on speakers’ bureaus for at least 10 years. While the institution doesn’t have any restrictions on physicians serving on boards of directors, Hockema said Mayo is “always considering improvements in our policy,” even though it is not actively reviewing it.
Several states have also passed laws to mitigate potential conflicts that can arise from physicians’ interactions with industry. Last year, Vermont and Massachusetts enacted laws banning all gifts, from mugs to travel expenses. Minnesota has had the longest-standing ban: a 1993 law requires drug companies to disclose gifts over $100.
The state now is the only one to make all such payments publicly available — on its board of pharmacy Web site. In July, Massachusetts will start requiring public disclosure of conflicts by industry on its department of public health Web site.
Sen. Chuck Grassley (R-Iowa), has long been a champion of greater disclosure, and wants a similar program in place at the federal level. Such proposals are in both the House and Senate version of healthcare reform bills.
Some pharmaceutical companies — specifically Cephalon, GlaxoSmithKline, Lilly, and Merck — have already begun disclosing lists of payments to physicians on company Web sites, with more companies said to be following suit. And some academic centers have taken similar approaches — Stanford and the Cleveland Clinic among them.
While many are in favor of increased disclosure, some fear that the current attention surrounding physician-industry ties could be detrimental to future research.
“I do think there is a risk to over-regulating,” said Julie Gottlieb, MA, associate dean for policy coordination at Johns Hopkins. “We do need to retain the ability for researchers to interact with industry. There have to be avenues to help move ideas from the lab into commercial development.”
“I hope we can get to a balance that is free of some of the excessive behaviors we’ve seen,” she added.
Hockema said that while some relationships were not “managed as prudently as they should have been,” leading to recent reactions from academia, industry partnerships are “for the most part, very beneficial.”
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