In the past year or so, universities, medical associations and others have been criticized for their close financial ties to the medical device and drug industries. It has been argued that by allowing doctors to accept consulting and speaking fees – even free samples – from the industry, a conflict-of-interest has been created that puts profits above patient well-being. But now it seems the tide might be turning, as medical schools and other institutions have been reworking their policies in an attempt to lessen the extent that the drug and medical device industries are able to influence the practice of medicine.
One of the most frequent critics of these unseemly financial ties has been Sen. Charles Grassley (R-Iowa). Earlier this week, Grassley criticized a University of Texas researcher who worked on a National Institutes of Health study involving the GlaxoSmithKline antidepressant Paxil. The scientist had not disclosed more than $150,000 in consulting and speaking fees paid to her by the company.
Grassley’s has criticized other institutions, including Harvard and Stanford, for similar conflicts. He is also the ranking Republican on a House Committee that has contacted 20 universities over questions of potential conflict of interest with drug makers. Grassley is also sponsoring a bill to require drugmakers to report all payments to doctors. If passed, the would require that drug companies disclose everything from buying meals to flying them to conferences at resorts.
Under this increasing pressure, medical schools are finally beginning to address the problem of industry influence. According to the Associated Press, about a quarter of all U.S. medical schools have now implemented policies governing industry gifts. Some have gone so far as to ban drug company sales reps from handing out free samples, although drug companies can usually make donations to a central supply office.
Many schools no longer allow drug reps to freely roam their halls, looking to speak to doctors. At the University of Pittsburgh Medical Center, for example, drug reps must get a perfect score on an online training program about its rules to get appointments with the center’s doctors.
There has also been an attempt to stop the industries from exerting influence through the funding continuing medical education (CME). Doctors and other medical professionals must attend CME courses to keep their licenses current. But a 2007 report by the Senate Finance Committee concluded the drug industry used educational grants totaling $1 billion annually to increase the market for their products, including the promotion of drugs for uses not approved by regulators, also known as off-label uses. In June, the Association of American Medical Colleges put out guidelines that bar drugmakers from paying for CME courses on specific topics, but allow donations to a central fund.
The industry has also been taken to task by medical journals. This month, the New England Journal of Medicine (NEJM) criticized a Vytorin study that downplayed a possible cancer link with the drug. Last month, the NEJM sided against the drug industry in a U.S. Supreme Court case that could shield pharmaceutical companies from product liability lawsuits. And earlier, the Journal of the American Medical Association criticized Merck & Co. for using ghostwriters on some Vioxx studies, and for downplaying risks of the drug. Most journals have also started listing the conflicts-of-interest of study authors when they publish research.
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