A recent study showing medical institutions are as likely to sign up for financial relationships with industry as individual physicians and researchers will likely spur greater scrutiny of those arrangements, but a wholesale ban is unlikely, healthcare policy experts say.
The study, conducted by researchers at the Massachusetts General Hospital Institute for Health Policy in Boston, questioned 459 clinical and nonclinical department chairs at 125 U.S. medical schools and the 15 largest independent teaching hospitals about their individual and institutions financial relationships with industry. Researchers found 60% of individual faculty and staff members had financial-support relationships with pharmaceutical companies and devicemakers compared with 67% of departments at medical schools and teaching hospitals (See Many department heads in deep with vendors: study, Nov. 5 ).
The release of the study coincides with renewed scrutiny by federal prosecutors and lawmakers of such relationshipswhich often include physicians and researchers serving as consultants for companies and hospitals and medical schools providing research services for new products. In late September, five orthopedic-device makers agreed to pay $311 million to avoid federal prosecution on charges they created phony consulting agreements that paid orthopedic surgeons to use their hip- and knee-replacement products. That same month, Sen. Chuck Grassley (R-Iowa) launched an inquiry into the nature of physician-consulting deals and continuing medical-education programs financed at hospitals and medical schools by devicemaker Medtronic.
The studys findings, which appeared in the Oct. 17 issue of the Journal of the American Medical Association, suggest that the influence pharmaceutical and medical-device companies exert on the practice of medicine through such practices is multilayered in academic settings, says lead researcher Eric Campbell. Imagine if you ran a department of psychiatry and you were a consultant for a company that makes a depression drug. The question is: To what extent do you think that department is going to teach its students about nonpharmaceutical methods for treating depression? Campbell says.
Factor in the possibility that the medical school may also be receiving payments from the pharmaceutical company for a drug it helped develop, and influence from industry could be deeply entrenched, Campbell says. The question is: Is it appropriate for medical schools to take money from drug companies? I dont believe it is, Campbell says.
Barbara Barnes, M.D., associate dean of continuing education at the University of Pittsburgh School of Medicine, says she isnt surprised by the studys findings. But she notes that while she and many other medical professionals believe such relationships can exert undue influence over medical institutions decisions on research, curriculum, patient-care and purchasing, a blanketed ban of these arrangements could create other problems.
I think one of the strengths of the U.S. healthcare system is innovation in diagnostics and treatment, and that comes about as a result of collaboration between industry and medical schools and hospitals, Barnes says. Also, the funding from the federal government for medical research and education has flattened, so I think there has to be a relationship between industry and medical faculty and schools. But Id also agree with the author that these relationships create a responsibility for academia to mandate disclosure (of their existence) and closely monitor them.
David Korn, M.D., senior vice president of the biomedical and health-science research division for the Association of American Medical Colleges, heads an association task force that is working to craft a set of recommendations to help academic medical institutions address such conflict-of-interest issues. Korn says only a few medical schools and their affiliated teaching hospitals have created policies that require faculty and staff to make full disclosure of industry relationships and subsequently limit their decisionmaking powers on issues where they have industry relationships.
Those institutions include, according to Korn, the University of Michigan Medical School, Stanford University School of Medicine, the University of California at Davis School of Medicine and the University of California at Los Angeles School of Medicine, Boston University School of Medicine, the University of Toledo College of Medicine, the University of Pittsburgh School of Medicine and Washington University School of Medicine.
Some institutions also have banned departments from accepting certain types of industry funding and have placed strict limits on medical-product companies access to faculty, staff and students. But the institutions implementing such broad-coverage disclosures and bans arent uniform in their approach, Korn says.
What (the AAMC) would like to see come out of the task force is a set of principles that we all agree to, and eventually wed like to develop recommendations for institutions to follow.
According to the JAMA study, financial support from pharmaceutical and medical-device companies took a variety of forms, with 14% of institutions receiving research equipment, 13% accepting unrestricted funds, 25% accepting money for residency and fellowship training, 38% receiving funds to pay for food and beverages, 46% accepting funding for continuing medical-education programs, and 20% developing licensing and intellectual-property income-sharing agreements with medical-products companies. Individual department chairs compensated work for industry included: 14% providing paid speaker services, 11% serving as board members, 27% acting as consultants and 27% participating on advisory boards. While such relationships appear widespread, there are efforts even among medical providers to cut the ties between industry and providers. The National Physicians Alliance, for example, recently announced that it will partner with the Prescription Project to promote evidence-based prescribing and recommend limits on direct-to-physician marketing practices.What do you think? Write us with your comments at [email protected]. Please include your name, title and hometown.