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.
They say they are concerned that the same money that helped build the
school’s world-class status may in fact be hurting its reputation and affecting
its teaching.
The students argue, for example, that Harvard should be embarrassed by
the F grade it recently received from the American Medical Student Association,
a national group that rates how well medical schools monitor and control drug industry money.
Harvard Medical School’s peers received much higher grades, ranging from
the A for theUniversity of Pennsylvania, to B’s received by Stanford, Columbia and New York University, to the C for Yale.
Harvard has fallen behind, some faculty and administrators say, because
its teaching hospitals are not owned by the university, complicating reform;
because the dean is fairly new and his predecessor was such an industry booster
that he served on a pharmaceutical company board; and because a crackdown,
simply put, could cost it money or faculty.
Further, the potential embarrassments — a Senate investigation of
several medical professors, the F grade, a new state law effective July 1
requiring Massachusetts doctors to disclose corporate gifts over $50 — are only
now adding to pressure for change.
The dean, Dr. Jeffrey S. Flier, who says he wants Harvard to catch up
with the best practices at other leading medical schools, recently announced a
19-member committee to re-examine his school’s conflict-of-interest policies.
The group, which includes three students, is to meet in private on Thursday.
Advising the group will be Dr. David Korn, a former dean of the Stanford
Medical School who started work at Harvard about four months ago as vice
provost for research. Last year he helped the Association of American Medical
Colleges draft a model conflict-of-interest policy for medical schools.
The Harvard students have already secured a requirement that all
professors and lecturers disclose their industry ties in class — a blanket
policy that has been adopted by no other leading medical school. (One Harvard
professor’s disclosure in class listed 47 company affiliations.)
“Harvard needs to live up to its name,” said Kirsten Austad, 24, a
first-year Harvard Medical student who is one of the movement’s leaders. “We
are really being indoctrinated into a field of medicine that is becoming more
and more commercialized.”
David Tian, 24, a first-year Harvard Medical student, said: “Before
coming here, I had no idea how much influence companies had on medical
education. And it’s something that’s purposely meant to be under the table,
providing information under the guise of education when that information is
also presented for marketing purposes.”
The students say they worry that pharmaceutical industry scandals in
recent years — including some criminal convictions, billions of dollars in
fines, proof of bias in research and publishing and false marketing claims —
have cast a bad light on the medical profession. And they criticize Harvard as
being less vigilant than other leading medical schools in monitoring potential
financial conflicts by faculty members.
Dr. Flier says that the Harvard Medical faculty may lead the nation in
receiving money from industry, as well as government and charities, and he does
not want to tighten the spigot. “One entirely appropriate source, if done
properly, is industrial funds,” Dr. Flier said in an interview.
And school officials see corporate support for their faculty as all the
more crucial, as the university endowment has lost 22 percent of its value
since last July and the recession has caused philanthropic contributors to retrench.
The school said it was unable to provide annual measures of the money flow to
its faculty, beyond the $8.6 million that pharmaceutical companies contributed
last year for basic science research and the $3 million for continuing
education classes on campus. Most of the money goes to professors at the
Harvard-affiliated teaching hospitals, and the dean’s office does not keep
track of the total.
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 rules, though, do not require them to report specific amounts
received for speaking or consulting, other than broad indications like “more
than $30,000.” Some faculty who conduct research have limits of $30,000 in
stock and $20,000 a year in fees. But there are no limits on companies’ making
outright gifts to faculty — free meals, tickets, trips or the like.
Other blandishments include industry-endowed chairs like the three
Harvard created with $8 million from sleep research companies; faculty prizes
like the $50,000 award named after Bristol-Myers Squibb, and sponsorships like Pfizer’s $1 million annual
subsidy for 20 new M.D.’s in a two-year program to learn clinical investigation
and pursue Harvard Master of Medical Science degrees, including classes taught
by Pfizer scientists.
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.
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.
A smaller rival faction among Harvard’s 750 medical students has
circulated a petition signed by about 100 people that calls for “continued
interaction between medicine and industry at Harvard Medical School.”
A leader of the group, Vijay Yanamadala, 22, said, “To say that because
these industry sources are inherently biased, physicians should never listen to
them, is wrong.”
Encouraging them is Dr. Thomas P. Stossel, a Harvard Medical professor
who has served on advisory boards for Merck, Biogen Idecand Dyax, and has written widely on academic-industry ties. “I
think if you look at it with intellectual honesty, you see industry interaction
has produced far more good than harm,” Dr. Stossel said. “Harvard absolutely
could get more from industry but I think they’re very skittish. There’s a huge
opportunity we ought to mine.”
Brian Fuchs, 26, a second-year student from Queens, credited drug
companies with great medical discoveries. “It’s not a problem,” he said,
pointing out a classroom window to a 12-story building nearby. “In fact, Merck
is right there.”
Merck built a corporate research center in 2004 across the street from
Harvard’s own big new medical research and class building. And Merck
underwrites plenty of work on the Harvard campus, including the immunology lab
run by Dr. Laurie H. Glimcher — a professor who also sits on the board of the
drug maker Bristol-Myers Squibb, which paid her nearly $270,000 in 2007.
Dr. Glimcher says industry money is not only appropriate but necessary.
“Without the support of the private sector, we would not have been able to
develop what I call our ‘bone team’ in our lab,” she said at a recent student
and faculty forum to discuss industry relationships. Merck is counting on her
team to help come up with a successor to Fosamax, the formerly $3
billion-a-year bone drug that went generic last year. But Dr. Marcia Angell, a faculty member and former editor in chief of The New England Journal of Medicine, is among the professors who argue that industry
profit motives do not correspond to the scientific aims of academic medicine
and that much of the financing needs to be not only disclosed, but banned. Too
many medical schools, she says, have struck a “Faustian bargain” with
pharmaceutical companies.
“If a school like Harvard can’t behave itself,” Dr. Angell said, “who
can?”
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