Healthy Skepticism Library item: 14003
Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.
Publication type: news
Relman AS.
Improper rewards of research
Boston Globe 2008 Jul 12
http://www.boston.com/bostonglobe/editorial_opinion/oped/articles/2008/07/12/improper_rewards_of_research/
Full text:
THREE prominent psychiatrists on the staff of Massachusetts General Hospital recently made headlines when Senator Charles Grassley of Iowa, ranking Republican on the Senate Finance Committee, announced that they had underreported income they had received from drug companies.
Why all the fuss? It is because the public is getting angry about revelations that doctors are being secretly paid by the companies that sell the expensive drugs these doctors prescribe. At the least, the public should know about such payments.
But this case involves more than nondisclosure. These psychiatrists are nationally known for advocating the “off-label” use of powerful antipsychotic drugs in the management of children believed to have childhood bipolar disorder, a new but controversial diagnosis that they themselves have done much to publicize. The Federal Drug Administration approved these drugs only for the treatment of adults, but physicians can prescribe approved drugs for any use, and the Harvard psychiatrists are recommending these antipsychotic drugs as safe and effective in children with cyclic mood swings they claim are “bipolar disorder.” Not surprisingly, some other psychiatrists are dubious.
Grassley’s report was not about this medical controversy. He was focusing on the money paid to the MGH psychiatrists by the manufacturers of these drugs. He wanted such payments fully disclosed to the medical schools and hospitals they work for, to conform with current federal and local institutional regulations. He and Democratic Senator Herb Kohl of Wisconsin have introduced a bill requiring drug and device manufacturers to report all payments to doctors in excess of $500 a year.
The problem cuts much deeper and broader than that. Academic physicians exert great influence through their writings and lectures over the way practitioners prescribe drugs. The public expects that this teaching will be unbiased and evidence-based, because they want their own doctors to be dispensing reliable advice. But when medical teachers take payments from drug manufacturers their recommendations must be questioned.
Defenders say that without financial rewards academic physicians would not be motivated to do clinical research or collaborate with companies in the pursuit of new and better treatments. They say that industry should reward faculty for their collaboration, so long as these rewards conform with institutional guidelines and are fully disclosed.
Medical research can certainly be advanced by collaboration between academic clinical investigators and industry, but that does not mean that industry’s payment for such collaboration should go directly to the investigators rather than to the medical schools and teaching hospitals that employ them.
These investigators should be well paid by their institutions, and they should have the time and resources needed to do their research, but they should not expect to be personally enriched beyond that.
Clinical researchers in academic institutions, like Harvard Medical School and the MGH, should be committed to serving the public interest first, not the commercial interests of pharmaceutical corporations. Rewards to researchers from these corporations weaken that commitment and contribute to the growing public distrust of all clinical research sponsored by industry.
If leading medical schools and teaching hospitals cannot meet their responsibilities by enforcing rigorous conflict of interest guidelines for their clinical faculty, then they must expect that government will do it for them.
