U.S. Medical Schools, Drug Makers Share Strong Ties
TUESDAY Oct. 16, 2007 -- More than half of department chairs at U.S. medical schools and teaching hospitals have financial ties with the drug industry, a new study finds.
These institutional relationships seemed to be just as widespread as those of individual physicians or scientists with industry.
"There is not a single aspect of medicine in which the drug companies do not have substantial and deep relationships, affecting not only doctors-in-training, resident physicians, researchers, physicians-in-practice, the people who review drugs for the federal government and the people who review studies," said lead researcher Eric Campbell, associate professor at the Institute for Health Policy at Massachusetts General Hospital and Harvard Medical School in Boston.
"Drug companies have relationships with everyone," he continued. "They're involved in every aspect of medicine. Someone has to decide which of these is OK."
The study, the first to examine the extent of these institutional relationships, is published in the Oct. 17 issue of the Journal of the American Medical Association.
Although Campbell himself reported no financial conflicts, one co-author did report having served as a consultant for drug makers Genentech and GlaxoSmithKline.
"I think the paper is a very valuable contribution, in that it provides what's probably the first comprehensive documentation of the extent of relationships that involve department chairs, and department chairs are certainly the key agents of overseeing and maintaining the day-to-day operations of a medical school or teaching hospital," said Dr. David Korn, senior vice president, division of biomedical and health sciences research at the Association of American Medical Colleges in Washington, D.C. "The extent of the relations is not surprising," added Korn, who was not involved with the study.
He said his association has already established a task force that's looking into the broad issues of industry support of medical education, which is not necessarily detrimental.
"Supported research is fulfilling a social mandate," he said. "After all, the public support of NIH [U.S. National Institutes of Health] funding is really driven by the desire to see practical results . . . and the only way those practical results can come to pass is by having productive relationships between the discoverers of new information and the organizations that our country has established to determine whether that information can be developed into useful products for public health."
The issue of medicine's ties to industry has been a hot one of late.
One study found that third-year medical students get, on average, one gift or attend one activity sponsored by a drug maker each week. This type of marketing by pharmaceutical companies apparently begins before students enter medical school, in the weeks and months after students graduate from college.
There have also been calls recently by some doctors and academic leaders for a ban on all pharmaceutical gifts, including free meals, to doctors at academic medical centers.
There is, however, no national data to describe the extent of these institutional academic-industry relationships.
To help supply that data, Campbell and his colleagues surveyed the department chairs of 125 accredited medical schools and the 15 largest independent teaching hospitals in the United States. Of 688 eligible chairs, 459 completed the survey, for a response rate of 67 percent.
Sixty percent of department chairs reported some form of personal relationship with industry such as being a paid consultant (27 percent), a member of a scientific advisory board (27 percent), an officer or executive of a company (7 percent), a founder of a company (9 percent), a member of a board of directors (11 percent) or a paid speaker (14 percent).
Chairs of clinical departments -- such as medicine and psychiatry -- were more likely to have served on a speakers' bureau than chairs of nonclinical departments -- such as microbiology.
Two-thirds of departments had relationships with industry, with clinical departments more likely than nonclinical department to receive research equipment (17 versus 10 percent), unrestricted funds (19 percent versus 3 percent), research seminar support (36 percent versus 13 percent), support for residency and fellowship training (37 percent versus 2 percent) and support for department-administered continuing medical education (65 percent versus 3 percent).
Clinical departments were also more likely to receive funds to buy food and beverages, support for professional meetings and subscriptions to professional journals.
"I have a master's degree in adult education and curriculum instruction and in my schooling, I don't ever remember learning that the first thing you do is pass out food sponsored by the companies whose products you're about to teach about," said Campbell. "A very large percentage of medical departments report getting money for food and beverages from drug companies. It's nice to have but, in the end, it's not necessary. It's not a principle of good education as far as I know."
More than two-thirds of department chairs felt that having a relationship with industry had no effect on their professional activities, while 72 percent thought that a chair engaging in more than one industry-related activity had a negative impact on a department's ability to carry out independent research.
"Now it's up to the policymakers and people who run medical schools," said Campbell. "They need to come up with some rules and they need to be new rules. I believe there's very little reasonable justification for why drug companies should be involved in the education of medical students. What knowledge do they have that is not currently available in the biggest medical schools in the country?"
To learn more, visit the Institute on Medicine as a Profession.
Posted: October 2007