Healthy Skepticism Library item: 18467

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Publication type: news

Kowalczyk L
Harvard puts tighter limits on medical faculty
The Boston Globe 2010 July 21
http://www.boston.com/news/education/higher/articles/2010/07/21/harvard_puts_tighter_limits_on_medical_faculty/

Abstract:

Restricts involvement with health care industry

Full text:

Harvard Medical School will prohibit its 11,000 faculty from giving promotional talks for drug and medical device makers and accepting personal gifts, travel, or meals, under a new policy intended partly to guard against companies’ use of Harvard’s prestige to market their products.

The conflict-of-interest rules also place stricter limits on the income faculty can earn from companies for consulting, joining boards, and other work; require public reporting of payments of at least $5,000 on a medical school website; and promise more robust internal reporting and monitoring of these relationships.

Harvard, which provides continuing medical education for tens of thousands of doctors worldwide, also will erect a more solid firewall between itself and health care companies during these courses. The greatest impact will be on Pri-Med, an annual conference for primary care doctors at a Boston convention center, which features Harvard-taught courses. Pharmaceutical companies pay for separate breakfast, lunch, and dinner lectures by non-Harvard specialists and even market products in restrooms. The industry program will be moved to a more separate location, and marketing signs will no longer be allowed in bathrooms.

The new rules, which will be phased in after Jan. 1, are designed to keep doctors from becoming – or being perceived as – marketing agents for industry, said Dr. Robert Mayer, cochairman of the committee that wrote the new policy. “We’re anxious to be viewed publicly as doing what’s in the best interest of our patients,’’ he said. The school wants to “ensure credibility even more than we do today.’’

The group attempted to strike a careful balance, said Mayer and Dr. Jeffrey Flier, the medical school dean, reducing problematic conflicts while protecting collaboration between faculty and companies on research, because these relationships lead to important and life-saving treatments. Faculty still will be allowed to conduct industry-funded research and work as paid members of company scientific advisory boards.

Harvard, like other top medical schools, has come under intense scrutiny in recent years over the ties between some of its faculty and pharmaceutical and device companies, particularly from Senator Charles Grassley, Republican of Iowa, who investigated several Harvard physicians accused of breaking medical school and federal conflict-of-interest rules.

Companies have long sought to tap the expertise of Harvard doctors and those at other top institutions for conducting clinical trials, consulting on new treatments, and speaking at conferences, but critics say the arrangements can serve as tacit endorsements and help companies promote their products to patients and other physicians.

Mayer, a cancer specialist at Dana-Farber Cancer Institute, said the scrutiny “has made all of us around the country take a second look at what we’re doing.’’

Harvard officials met with Grassley’s staff yesterday to describe the new rules. “Greater disclosure is a foundation for more accountability,’’ Grassley said in a statement afterward. Noting that his staff had found “significant discrepancies’’ in faculty reporting of payments from drug companies, he said the Harvard policy “will be effective if it is followed by timely implementation and meaningful enforcement.’’

Dr. Steven Nissen, head of cardiovascular medicine at Cleveland Clinic Foundation and an outspoken advocate of tougher restrictions on doctors’ relationships with industry, said the Harvard policy is similar to rules some other top medical schools and teaching hospitals are adopting. But because Harvard “is a closely watched institution,’’ he said, it “will influence others’’ to revise their rules.

Harvard’s decision to disclose most industry payments publicly on its website was made as the Massachusetts Legislature considers whether to repeal a similar disclosure law requiring companies to report payments to physicians. Hotel and restaurant owners have complained to lawmakers that the new state law, which also bans industry from providing meals to physicians, is hurting their business. Grassley pushed a national disclosure law that was approved as part of the new federal health overhaul.

Harvard’s policy closely aligns with rules approved last year by Partners HealthCare, which employs thousands of Harvard physicians at Massachusetts General and Brigham and Women’s hospitals. Boston University School of Medicine is revising its policy, while UMass Memorial Medical Center adopted a strict policy in 2007.

Harvard’s policy is stricter than conflict-of-interest rules at other top medical schools in some respects. For example, Harvard faculty members cannot earn more than $10,000 annually from a company whose product or technology they are investigating in clinical research, half the previous income limit. Few other medical schools have placed hard and fast limits on faculty earnings from industry.

On continuing medical education, however, Harvard has taken a more lenient approach than Stanford University School of Medicine and UMass Memorial, for instance, which prohibit companies from funding specific continuing medical education courses at all. Harvard’s new rules say that individual courses must be paid for by at least two companies; about 5 percent of the school’s continuing medical education offerings are now paid for by one company.

Medical school leaders said they will revamp Pri-Med, which draws 6,000 physicians to Boston every fall and is supported by tuition and industry funding.

“There has been a perception that there is a lot of commercial influence there,’’ said Dr. Sanjiv Chopra, faculty dean for continuing medical education. “We are addressing that.’’

Flier, the dean, requested an outside audit of the conference, and while the physician reviewers deemed the Harvard courses excellent, they also found “a blur as to where Harvard ended and pharma began,’’ Mayer said.

The Harvard courses and the industry symposium will be promoted to doctors separately. They also will probably be held on different floors, rather than in the same rooms.

Similar to Partners, the medical school is also banning faculty from participating in company speakers bureaus, which require physicians to use company-produced slides to talk to other doctors about medications. Flier said that he does not think the ban will affect large numbers of doctors, but that it “is unseemly’’ for faculty to be projected “as marketers for a company. We want our faculty to say what they think and feel. They are thought leaders.’’

Harvard administrators would not comment on whether the new rules, had they been in place, would have prevented the public run-in with Grassley. He has accused Dr. Joseph Biederman, a well-known Mass. General child psychiatrist and a leading advocate of diagnosing and treating bipolar disorder in children, of failing to make timely disclosures to Harvard of more than $1.5 million that drug companies paid him in consulting and speaking fees.

Biederman has said in statements and letters to the Globe that he complied with conflict-of-interest and disclosure rules. Harvard’s investigation into the matter is not completed, the school said. But Flier and Mayer said that there has been general confusion among faculty over what they must disclose, and this policy will help clarify what is expected. Faculty will have to complete online education courses on conflict-of-interest rules before filing their annual disclosure forms, and Harvard will conduct random internal audits.

“The devil is in the details and we had not specified the details,’’ Mayer said.