It's not often that a place like Harvard Medical School gets an F particularly when rivals Stanford, Columbia and the University of Pennsylvania are pulling A's and B's. But that's what happened recently when the members of the increasingly influential and increasingly noisy American Medical Student Association (AMSA) decided to grade 150 med schools on just how much money and gifts they're collecting from drug companies. The more goodies a school is vacuuming up from the industry, the worse its grade.
There's always been reason to worry about the influence of Big Pharma on the practice of medicine. When doctors are being lavished with meals and speaking fees by the likes of Pfizer and Merck, can you really trust them when they later write prescriptions for those companies' drugs? Medical schools were long considered above such vulgar stuff. Now, however, it turns out that many professors and instructors are, legally, on the dole as well, and students are beginning to worry that what they're being taught is just as one-sided as what patients are being prescribed. Campaigns to curb the med-school cash are growing on campus, in Congress and in local governments and Harvard, at the moment, is at the center of it. (See pictures of the college dorm's evolution.)
The issue exploded this week, when the New York Times published a pair of stories tracking Harvard's industry ties. The school might have turned a whole new shade of crimson when its flunking grade from AMSA was made public last summer, but things got even uglier in November when 40 med students rallied on campus to demand that industry and academia make a clean break. The facts, they argued, justify their outrage. Of Harvard's 8,900 professors and lecturers, 1,600 admit that either they or a family member have had some kind of business link to drug companies sometimes worth hundreds of thousands of dollars that could bias their teaching or research. Additionally, pharma contributed more than $11.5 million to the school last year for research and continuing-education classes. The Times covered these details in its stories and included the damning fact that during the November demonstration, a Pfizer employee was on campus photographing protesters with a cell-phone camera. Pfizer did not deny the account but contended that the employee did nothing wrong. (See the top 10 scandals of 2008.)
The tug-of-war between industry and research is long-standing. Major medical journals require any doctors publishing work in their pages to disclose board memberships or other moneymaking arrangements they have with drug companies. Last summer, the Pharmaceutical Research and Manufacturers Association prohibited salespeople from treating doctors to meals and golf excursions and even banned the ubiquitous company-branded pens, mugs and notepads that clutter waiting rooms and reception desks. Just this week, federal officials revealed a newly aggressive plan to begin pursuing civil and criminal charges against doctors who accept kickbacks or demand speaking or consulting fees for prescribing drugs or medical devices.
But medical schools are a new low. After the Times stories were published, Senator Charles Grassley, an Iowa Republican and longtime critic of drug-company influence, fired off a letter to Pfizer chairman and CEO Jeffrey Kindler describing himself as "greatly disturbed" by the reports and accusing Pfizer of trying to "intimidate young scholars." Grassley cited the 149 Harvard professors or instructors who have received payments or benefits from Pfizer specifically and demanded a detailed accounting of all of them. He closed with a terse "I look forward to hearing from you by no later than March 10, 2009." Pfizer has pledged to cooperate. (Read "The Year in Medicine 2008: From A to Z.")
The outrage comes easily for Grassley and the students and when it comes to doctors and professors accepting what look like legal bribes or drug companies strong-arming protesters, it should. But there are some gray areas. Medical-school professors get their jobs in the first place because they know their fields. Forbid such educated people to consult with the companies that develop new medicines and you cut off a valuable source of knowledge. What's more, pharma's largesse also flows to the schools themselves in the form of multimillion-dollar endowments. Whether or not the companies are trying to curry favor, they're also building labs and bankrolling scholarships something that becomes increasingly important as the deteriorating economy causes philanthropic giving to dry up. No one disagrees that isolating academia from the industry may be ideal, but even many academics concede that the cooperation yields more good than harm. And while Harvard might be the highest-profile name that was posted on AMSA's grade list, it was hardly the only one that flunked: 40 out of the 150 schools surveyed received F's; only 22 got an A or B.
Washington is sure to keep an eye on the brouhaha, and the states may take a look too as Massachusetts Governor Deval Patrick did last August when he signed a law banning certain types of gifts to doctors and requiring the industry to disclose any others over $50 in value. Harvard has convened a 19-member committee made up of representatives of its medical school, affiliated teaching hospitals and research institutes, and the student body to review its pharma policy, though the university is hedging on whether it actually plans to change the way it operates. "We cannot speculate on the outcomes of the review process" is all a spokesman is willing to say. And as of Wednesday, Pfizer had apologized to Grassley for what it called the "unfortunate incident" that has "overshadowed the importance of collaboration between industry and leading academic medical institutions." That may be nothing more than a well-spun half-apology but it doesn't mean there's not some truth to it too.