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US President Advocates for Research Integrity

US President Barack Obama announced a new emphasis on the integrity of science used to help make public policy decisions. As <a href="http://www.nytimes.com/2009/03/10/us/politics/10obama.html">summarized by the NY Times</a>, <blockquote> President Obama’s directive on Monday to 'guarantee scientific integrity' in federal policy making could have a far-reaching impact.... The document orders Mr. Obama’s top science adviser to help draft guidelines that will apply to every federal agency. Agencies will be expected to pick science advisers based on expertise, not political ideology, the memorandum said, and will offer whistle-blower protections to employees who expose the misuse or suppression of scientific information. The idea, the president said in remarks before an audience of lawmakers, scientists, patients advocates and patients in the East Room, is to ensure that 'we make scientific decisions based on facts, not ideology'.... </blockquote> Here are some key parts of the <a href="http://www.whitehouse.gov/the_press_office/Memorandum-for-the-Heads-of-Executive-Departments-and-Agencies-3-9-09/">memorandum written by the President</a>: <blockquote> Science and the scientific process must inform and guide decisions of my Administration on a wide range of issues, including improvement of public health, protection of the environment, increased efficiency in the use of energy and other resources, mitigation of the threat of climate change, and protection of national security. The public must be able to trust the science and scientific process informing public policy decisions. Political officials should not suppress or alter scientific or technological findings and conclusions. If scientific and technological information is developed and used by the Federal Government, it should ordinarily be made available to the public. To the extent permitted by law, there should be transparency in the preparation, identification, and use of scientific and technological information in policymaking. The selection of scientists and technology professionals for positions in the executive branch should be based on their scientific and technological knowledge, credentials, experience, and integrity. By this memorandum, I assign to the Director of the Office of Science and Technology Policy (Director) the responsibility for ensuring the highest level of integrity in all aspects of the executive branch's involvement with scientific and technological processes. Specifically, I direct the following: 1. Within 120 days from the date of this memorandum, the Director shall develop recommendations for Presidential action designed to guarantee scientific integrity throughout the executive branch, based on the following principles: (a) The selection and retention of candidates for science and technology positions in the executive branch should be based on the candidate's knowledge, credentials, experience, and integrity; (b) Each agency should have appropriate rules and procedures to ensure the integrity of the scientific process within the agency; (c) When scientific or technological information is considered in policy decisions, the information should be subject to well-established scientific processes, including peer review where appropriate, and each agency should appropriately and accurately reflect that information in complying with and applying relevant statutory standards; (d) Except for information that is properly restricted from disclosure under procedures established in accordance with statute, regulation, Executive Order, or Presidential Memorandum, each agency should make available to the public the scientific or technological findings or conclusions considered or relied on in policy decisions; (e) Each agency should have in place procedures to identify and address instances in which the scientific process or the integrity of scientific and technological information may be compromised; and (f) Each agency should adopt such additional procedures, including any appropriate whistleblower protections, as are necessary to ensure the integrity of scientific and technological information and processes on which the agency relies in its decisionmaking or otherwise uses or prepares. </blockquote> Unfortunately, we rarely post about what could be called good news on Health Care Renewal. But I really think it is really good news when the President of the United States makes scientific integrity a headline issue; speaks for scientific integrity and specifically against suppression and manipulation of science; advocates specific standards for scientific integrity for every government branch and agency; advocates for the transparency of science and the scientific process used in policy decisions; and argues for the protection of whistle-blowers. We have again and again documented instances of threats to scientific integrity (specializing, of course, in the integrity of clinical and health services and policy research) including suppression of research, manipulation of research, and protection of whistle-blowers. It's nice to see these causes gain moral, and in this case legal support, especially from one of the most powerful political leaders in the world. Nice work, Mr President!

US President Advocates for Research Integrity

US President Barack Obama announced a new emphasis on the integrity of science used to help make public policy decisions. As summarized by t...

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BLOGSCAN - An Example of Spinning Clinical Research Results

BLOGSCAN - An Example of Spinning Clinical Research Results

On the Clinical Psychology and Psychiatry blog , the anonymous blogger did a great job analyzing an article supported by pharmaceutical comp...

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The Color of Money: What Sort of School Doesn't Pay Its Faculty to Teach?

A <a href="http://www.nytimes.com/2009/03/09/opinion/l09harvard.html">letter to the NY Times </a>by Dr Daniel Becker in response to the recent controversy at Harvard Medical School over financial relationships among industry and faculty (see our post <a href="http://hcrenewal.blogspot.com/2009/03/harvard-medical-students-against.html">here</a>) brought up an interesting point: <blockquote> I take issue with the implicit assumption that faculty members who accept drug money are driven exclusively by greed; this issue is much more complicated than it may seem at first. Harvard Medical School’s 'drug money' problem relates, in part, to a little-known fact: Harvard rarely pays the salaries of its medical faculty directly. Despite substantial revenue from tuition, most faculty members teach medical students on a volunteer basis. Similarly, the salaries of research faculty are not paid by Harvard, but rather by grants from the National Institutes of Health, private foundations and in some instances, grants from pharmaceutical companies. If these financing sources dry up, professors are often forced to find a new job. </blockquote> Wait a minute, it's a medical school, so shouldn't the faculty be paid to teach and do research? That's what faculty are supposed to do. The above letter, although it may be a bit simplistic, fits in with other anecdotal evidence that, in fact, medical schools do not pay faculty much to teach or do research. Instead, they are mainly tasked with raising money from external sources to "cover" the academic work one would think should be central to their jobs. Failing that, they must bring in fees for their clinical work. In 2005, we <a href="http://hcrenewal.blogspot.com/2005/01/medical-schools-charge-more-for.html">quoted</a> the editor of JAMA as saying, "few medical schools provide adequate, if any, reimbursement for teaching time." In 2007, we <a href="http://hcrenewal.blogspot.com/2007/03/flash-harvard-medical-school-to-start.html">noted</a> that it was news when Harvard Medical School pledged to actually start paying hospital-based faculty meaningful amounts for teaching medical students. Previously, they were paid an average of $30/hour for doing so. However, I have not seen any follow-up as to whether the school carried out the promise. Moreover, at that time, we noted that Harvard required its faculty "to teach or volunteer on committees 50 hours a year, but Harvard does not track how many hours doctors teach and does not actively enforce the policy." Again, one might be forgiven for thinking that a faculty member generally should spend a substantial amount of time teaching. But at Harvard, they only apparently need to spend about 2% of their time doing so. Later in 2007, we <a href="http://hcrenewal.blogspot.com/2007/04/medical-schools-to-faculty-show-me.html">discussed</a> a medical school dean's revelation that his school primarily judge faculty was by how much external funding (grants, contracts, practice income, etc) they brought in, not by how well or how much they taught, or the quality and quantity of their research. Finally, in 2009, we <a href="http://hcrenewal.blogspot.com/2009/03/were-only-in-it-for-money.html">discussed</a> how two-thirds of the salary of one university president seemed to come from his medical school, even though that school accounted for only one-eighth of his students. Putting it all together, it seems that the "faculty" at some, maybe most medical schools are not faculty in the ordinary sense. There is little expectation that they teach. Instead, they are supposed to do research funded by external grants, or failing that, collect fees from direct patient care. They are judged by how much money these pursuits provide, not by the quality of their research, and certainly not the quality of their teaching. The money they provide disproportionately goes to fund parts of the university outside of the medical schools. Presumably, the pressure to bring in ever more money drives "faculty" entanglements with pharmaceutical, biotechnology, device and other corporations. If one must constantly pursue grants, now mostly available from industry, one must constantly interact with industry representatives. Under this sort of pressure, is it any wonder that "faculty" might find it hard to turn down consulting work, speakers' fees, and offers to serve on advisory boards from the same people they must please to obtain grants? So I believe Dr Becker is right. The problem is simply not the greed of "faculty" members (although some, of course, can become greedy.) Much of the problem appears to be the greed of university administrators who see their medical schools and academic medical centers as cash cows, and see nothing wrong with hiring "faculty" who scarcely teach, as long as they keep bringing in the cash.

The Color of Money: What Sort of School Doesn't Pay Its Faculty to Teach?

A letter to the NY Times by Dr Daniel Becker in response to the recent controversy at Harvard Medical School over financial relationships am...

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The Minneapolis...Or Is It Hartford?...Two-Step

Conjure yourself as a wallflower: You are a shy early-adolescent compelled by your parents (who at all times adhere to the operative cultural norms) to attend your first dance.  You would rather not be there at all.  Your life as it was was perfectly acceptable.  You were happy with the old, self-sufficient ways.  But now, along with your peers, you are entering a new phase.  From now on the world will work dyadically.  More and more, you will be required to operate in conjunction with a second party.  And this second party, in many respects, is not sympatico. Its motives and methods and  do not always align with yours.  Yet still you hope for the best...<div> </div><div>Bring up the music, turn down the lights - the moment has arrived.  Your expectations are shaped by what you believe you are owed: a polite and respectful pairing; civility, if nothing else.  Instead you are greeted with a rude awakening.  Your partner is an arrogant lummox, indifferent to your sensibilities. While the band plays waltz music you are dragged through a lumbering bump-and-grind.  In the process your hair is mussed, one foot is mashed,  an earring is dislodged. What's worse: at the end, there's no apology, no acknowledgement of the brutishness of what has just transpired; indeed, you are quite convinced that you are not alone - you are merely the first of many hapless victims for that evening alone.</div><div> </div><div>Welcome to the rhythms of "step therapy," yet another barbed arrow in the quiver of managed care, still seemingly in ascendency, a galling procedure whereby "prior authorization" for a prescriber's first choice of medication is "denied" until such time as (usually two) "preferred alternatives" from an insurance company's formulary have been tried and have proven either ineffective or intolerable.  I had thought it insult enough that patients be required to "fail" two trials of medications with inferior clinical profiles (e.g., adolescents in my psychiatric practice are now "required" to try two generic stimulants whose short or intermediate duration of action is guaranteed to leave them without any therapeutic benefit during the second half of the school day - unless, that is, they wish to submit to the stigma of presenting to the school nurse every day for their "stupid pill" - before they can receive the long-acting medication that is the standard of care recommended by the American Academy of Child and Adolescent Psychiatry) before gaining access to what, from the beginning, simple common sense held to be the proper choice.  Despite years of steeling myself to callousness of the managed care organizations, I was nonetheless appalled by my most recent encounter with step therapy requirements, since the process has been rendered EVEN MORE LUDICROUS by the inventive touches of faceless executives bent on achieving promotion, I would wager, through demonstrations of their ability to concoct ever more sociopathic obstructionistic schemes. Consider this excerpt: A new patient presents to my practice, having moved to Rhode Island from a different state.  For a year or more, she has been taking Strattera, with good results, for her ADHD, having experienced adverse effects from previous trials of methylphenidate and mixed amphetamine salt preparations.  In conjunction with her move, however, her health insurance has changed. When the first prescription for Strattera reimbursable under the new plan is presented to a Rhode Island pharmacy, a prior authorization form is faxed to us by the insurer.  The PA asks for documentation of failures on two formulary drugs, a condition which the patient's clinical history does satisfy.  My office submits the PA form, properly executed.  Several days later, we receive notification that the PA request has been denied, because, in the standard boilerplate, the Strattera is not "medically necessary."  I then instruct my office manager, as I do quite frequently these days, to request a "peer to peer" review in appeal of the decision.  More time passes.  Finally, I am called by a retired (probably on the basis of "burn-out," if he has had many such experiences as I am relating) psychiatrist NOW EMPLOYED BY THE INSURER (no conflict of interest there!).  After a little perfunctory back-and-forth, he informs me that the denial will have to stand because, as I have failed to note in the fine print, treatment failure with the formulary alternatives did not occur IN THE LAST SIX MONTHS.  My efforts to cajole him into a different opinion through the use of logic fail.  His decision is firm.  In essence, I am told: IT DOESN'T MATTER THAT THE FORMULARY PRODUCTS WERE ALREADY TRIED AND PRODUCED ADVERSE EFFECTS.  IF YOU WANT THIS PATIENT TO RECEIVE REIMBURSEMENT FOR STRATTERA UNDER OUR PLAN, WE WILL REQUIRE YOU TO AGAIN GIVE THE PATIENT MEDICATIONS WHICH, AS THE PATIENT HAS TOLD YOU, PRODUCED ADVERSE EFFECTS.  End of conversation.  Click.</div><div>Expletive deleted.</div><div> </div><div>How will the story end?  Happily, I predict.  The reason being that I will prescribe one tablet of Ritalin to the patient and, then, one tablet of Adderall.  The patient will be instructed to fill each prescription in sequence, and then flush each tablet down the toilet.  The insurer's preconditions will thus be satisfied and the patient will be able to use their insurance benefit.</div><div> </div><div>At least two lessons, it seems to me, can be derived from this anecdote.  Number one: the chaperones have failed at their task.  Which is to say, WHERE ARE THE INSURANCE REGULATORS?  How can this kind of grossly manipulative, illogical protocol be allowed to exist?  And sadly, number two: PLAYING THE SAME KIND OF MENDACIOUS LITTLE GAMES THAT THE INSURANCE COMPANIES PLAY OFTEN IS THE ONLY ETHICAL COURSE OF ACTION.  And so it goes - two-stepping with the Leviathan.</div><div> </div>

The Minneapolis...Or Is It Hartford?...Two-Step

Conjure yourself as a wallflower: You are a shy early-adolescent compelled by your parents (who at all times adhere to the operative cultura...

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The Computer Will See You Now

This in, from the New York Times. Emphases mine: <blockquote>March 6, 2009 Op-Ed Contributor <a href="http://www.nytimes.com/2009/03/06/opinion/06coben.html?_r=1" style="font-family: arial;">The Computer Will See You Now</a> By ANNE ARMSTRONG-COBEN FOR 20 years, I practiced pediatric medicine with a “paper chart.” I would sit with my young patients and their families, chart in my lap, making eye contact and listening to their stories. I could take patients’ histories in the order they wanted to tell them or as I wanted to ask. I could draw pictures of birthmarks, rashes or injuries. I loved how patients could participate in their own charts — illustrating their cognitive development as they went from showing me how they could draw a line at age 2 and a circle at 3 to proudly writing their names at 5. Now that I’ve been using a computer to keep patient records — a practice that I once looked forward to — my participation with patients too often consists of keeping them away from the keyboard while I’m working, for fear they’ll push a button that implodes all that I have just documented. We have all heard about the wonderful ways in which electronic medical records are supposed to transform our broken health care system — by eradicating illegible handwriting and enabling doctors to share patients’ records with one another more easily. The recently passed federal stimulus package provides doctors and hospitals with $17 billion worth of incentive payments to switch to electronic records. The benefits may be real, but we should not sacrifice too much for them. The problem is not just with pediatrics. Doctors in every specialty struggle daily to figure out a way to keep the computer from interfering with what should be going on in the exam room — making that crucial connection between doctor and patient. I find myself apologizing often, as I stare at a series of questions and boxes to be clicked on the screen and try to adapt them to the patient sitting before me. I am forced to bring up questions in the order they appear, to ask the parents of a laughing 2-year-old if she is “in pain,” and to restrain my potty mouth when the computer malfunctions or the screen locks up. I advise teenagers to limit computer time as I sit before one myself for hours each day until my own eyes twitch and my neck starts to spasm. In short, the computer depersonalizes medicine. It ignores nuances that we do not measure but clearly influence care. In the past, I could pick up a chart and flip through it easily. Looking at a note, I could picture the visit and recall the story. Now a chart is a generic outline, screens filled with clicked boxes. Room is provided for text, but in the computer’s font, important points often get lost. I have half-joked with residents that they could type “child has no head” in the middle of a computer record — and it might be missed. A box clicked unintentionally is as detrimental as an order written illegibly — maybe worse because it looks official. It takes more effort and thought to write a prescription than to pull up a menu of medications and click a box. I have seen how choosing the wrong box can lead to the wrong drug being prescribed. So before we embrace the inevitable, there should be more discussion and study of electronic records, or at a minimum acknowledgment of the downside. A hybrid may be the answer — perhaps electronic records should be kept only on tablet computers, allowing the provider to write or draw, and to face the patient. The personal relationships we build in primary care must remain a priority, because they are integral to improved health outcomes. Let us not forget this as we put keyboards and screens within the intimate walls of our medical homes. Anne Armstrong-Coben is an assistant clinical professor of pediatrics at Columbia.</blockquote> What Dr. Armstrong-Coben is describing is what I term a "mission hostile user experience" (<a href="http://tinyurl.com/hostileuserexper">link to my series on this point</a>), but she goes further, recognizing the paradigm change between paper and IT. She questions the wisdom of this still-exploratory change in medical practice. Interestingly, renowned Merck scientist emeritus Dr. Maurice Hilleman, inventor of most of the vaccines we received as kids, also expressed similar concerns to me regarding biomedical research IT (<a href="http://www.ischool.drexel.edu/faculty/ssilverstein/scotsilverstein/hilleman.jpg">link</a>). I've seen the following wisdom on the web as well by Scott Haig at Time.com<a href="http://www.time.com/time/health/article/0,8599,1883002,00.html?xid=rss-fullhealthsci-yahoo"></a>. I think it sums up the controversy over this attempted paradigm change well: <blockquote><a href="http://www.time.com/time/health/article/0,8599,1883002,00.html?xid=rss-fullhealthsci-yahoo">Electronic Medical Records: Will They Really Cut Costs?</a> ... the doctors I know wince whenever electronic medical records are held up as some kind of silver bullet. Before we had them on every countertop, computers held such promise for us in medicine: doctors and patients live in a world of painful, pressing questions, the answers might be in there. Or so we thought. Twenty nine years from the night I first sat in a hospital in front of a computer screen the questions persist. And I still don't see the profit-maximizing, cost-controlling physician with his nationwide computer treating patients any better than the great physicians I've known have. With pen and paper, personal commitment to each patient and judgment born of practical experience. None of which I have found in a machine.. </blockquote>Indeed. I emphasize that I am an advocate for healthcare IT ... but only if that HIT is done well. That means not just technically, but operationally in real world settings, taking into account the clinical, social and organizational ramifications and realities of these technologies in clinical settings. It's those two words "done well" that truly exemplify the old saying that the devil is in the details. -- SS Addendum: the NY Times <a href="http://www.nytimes.com/2009/03/11/opinion/l11medical.html?_r=1&scp=5&sq=The%20Computer%20Will%20See%20You%20Now&st=cse">published letters from a varied audience</a> in response to Dr. Armstrong-Coben's piece, largely agreeing with the issues above.

The Computer Will See You Now

This in, from the New York Times. Emphases mine: March 6, 2009 Op-Ed Contributor The Computer Will See You Now By ANNE ARMSTRONG-COBEN FOR ...

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Power down for the planet

Do you leave your fridge door open after grabbing what you need? Do you leave your vacuum cleaner running when you aren't cleaning? Of course not. The idea of doing either of these things sounds silly, yet many people don't think to turn off their computers after using them. By using <a href="http://www.climatesaverscomputing.org/learn/saving-energy-at-home/">power management tools</a> on your computer and buying <a href="http://www.climatesaverscomputing.org/tools/smarter-computing-catalog/">more efficient computers</a>, you can save nearly half a ton of CO2 and more than $60 a year in personal energy costs. To do our part, Google co-founded the <a href="http://www.climatesaverscomputing.org/">Climate Savers Computing Initiative</a> (CSCI) to promote a smarter, greener computing future. The simple changes above can have a HUGE collective impact; our goal is to reduce carbon dioxide emissions by 54 million tons per year by 2010 — the equivalent of taking 11 million cars off the road. The biggest obstacle we face is not technological, it's awareness. That's why we're excited that CSCI has launched the Power Down for the Planet <a href="http://www.powerdownfortheplanet.org/video/">video contest</a>, a challenge to you and your friends to develop original and creative videos that educate, entertain, and inform others about the importance of energy efficient computing. So pick up a camera and make a video telling your own Climate Savers Computing story. How will the environment benefit from advances in computer power management? How do poor computing practices waste energy? What does a sustainable computing future look like to you? Let your imagination go wild. <a href="http://www.climatesaverscomputing.org/individual-join/">Join us</a>, <a href="http://www.powerdownfortheplanet.org/promote/tellafriend/">gather some friends</a>, and broadcast your vision of efficient computing. The team with the most compelling video can win up to $5,000 and energy efficient laptops; students at <a href="http://www.powerdownfortheplanet.org/about-the-challenge/participating-universities/">participating universities</a> are also eligible to win $5,000 and <a href="http://www.specialized.com/bc/SBCBkModel.jsp?spid=40433&eid=178">Specialized Globe bicycles</a>. We can't wait to see what you create. <object height="295" width="480"><param name="movie" value="http://www.youtube.com/v/jABb8L89G44&hl=en&fs=1"></param><param name="allowFullScreen" value="true"></param><param name="allowscriptaccess" value="always"></param><embed src="http://www.youtube.com/v/jABb8L89G44&hl=en&fs=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="480" height="295"></embed></object> Posted by Bill Weihl, Green Energy Czar

Power down for the planet

Do you leave your fridge door open after grabbing what you need? Do you leave your vacuum cleaner running when you aren't cleaning? Of...

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Harvard Medical Students Against Marketing in the Guise of Medical Education

An article by Duff Wilson <a href="http://www.nytimes.com/2009/03/03/business/03medschool.html">in the New York Times </a>this week provided a new look at the pervasiveness of financial relationships among academic medicine and health care corporations, and the beginnings of resistance to them. The Scope of the Relationships <blockquote> 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. </blockquote> Academic Medical Leaders' Defense of Their Relationships with Industry <blockquote> 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. </blockquote> So maybe it is not surprising that: <blockquote> 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. </blockquote> But, <blockquote> 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. </blockquote> Note that we discussed Dr Martin's directorship of Baxter on Health Care Renewal <a href="http://hcrenewal.blogspot.com/2006/08/disclosing-conflicts-of-interest-story.html">here</a> in 2006, and that we also found that he was on the board of biotechnology company Cytyc. Note also that we have discussed how serving on the board of a health care corporation can produce particularly intense conflicts of interest for academic medical leaders, since such board service implies not just warm and fuzzy feelings for the company, but "unyielding loyalty" to the financial interests of the company and its stockholders (e.g., see <a href="http://hcrenewal.blogspot.com/2009/03/meet-new-boss-same-as-old-boss-health.html">this post</a>). Unsurprisingly, faculty who have their own lucrative relationships with industry are all for more of the same: <blockquote>Encouraging them is Dr. Thomas P. Stossel, a Harvard Medical professor who has served on advisory boards for Merck, Biogen Idec and 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.' </blockquote>Note that Dr Stossel defended academic-industry "interaction," but did not explain why such interaction seems always to generate large money flows from industry to academic institutions and their individual faculty members. People can surely interact without paying each other. Note further that Dr Stossel may have even more financial relationships with industry than appeared in the NY Times article. When we analyzed some of the logical fallacies Dr Stossel employed in favor of industry payments to physicians <a href="http://hcrenewal.blogspot.com/2007/04/can-people-with-conflicts-of-interest.html">in 2007</a>, we cited Stossel's <a href="http://content.nejm.org/cgi/reprint/353/10/1060.pdf">attck</a> on the rigorous conflicts of interest rules re-imposed on the US National Institutes of Health (NIH) in which Stossel had to disclose "having received consulting fees from <a href="http://zymequest.com/">ZymeQuest</a>, owning stock options in ZymeQuest and Biogen, and having pending and issued patents, owned by Brigham and Women's Hospital, some of which are licensed to ZymeQuest." [Stossel TP. Regulating academic-industrial research relationships - solving problems or stifling progress? N Engl J Med 2005; 353: 1060-1065.] In this <a href="http://muse.jhu.edu/journals/perspectives_in_biology_and_medicine/v050/50.1stossel.html">paean</a> to a laissez-faire approach to conflicts of interest, Stossel also disclosed that he "is a member of the Board of Directors of Zymequest Inc, and the Scientific Leadership Advisory Board of Merck & Co. The author is a founding scientist of Critical Biologics Corporation and a consultant to Boston Scientific, Inc., and Gerson-Lehrman, Inc." [Stossel TP. Regulation of financial conflicts of interest in medical practice and medical research. Perspect Biol Med 2007; 50: 54-71. ] Another defender of the status quo also has her own major relationships with industry: <blockquote> 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. </blockquote> Note that Dr Glimcher now seems to view her role not as someone seeking to discover and disseminate the truth, but as someone seeking to develop commercial products. Again, maybe that is not surprising, since she is supposed to have an "unyielding loyalty" to the prominent pharmaceutical company on whose board she sits. The NY Times article did not quote anybody in favor of financial relationships between academic medicine and industry who did not themselves have such relationships. I don't believe I have ever seen a defense of these relationships not authored by someone who was not already personally profiting from such relationships. The Revolt of the Medical Students While he documented how Harvard faculty who also lead huge pharmaceutical firms have no qualms about industry pouring money into medical academics, Mr Wilson found that medical students seem to have figured out the downside of being taught by pharmaceutical, biotechnology and device company employees: <blockquote>In a first-year pharmacology class at Harvard Medical School, Matt Zerden grew wary as the professor promoted the benefits of cholesterol drugs and seemed to belittle a student who asked about side effects. 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. </blockquote> Note that the example, while anecdotal, shows how financial relationships could lead to biased education. The students have made surprising progress: <blockquote> 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. </blockquote> Unfortunately, many academics of my generation have become so used to making some extra dollars by working part-time for companies selling health care goods or services that they cannot see how these relationships have distracted them from the academic mission and their professional ideals. Maybe the rising generation of students, now living in a time when the consequences of arrogance, greed, and corruption among our leaders has become so apparent, will put professionalism ahead of personal enrichment.

Harvard Medical Students Against Marketing in the Guise of Medical Education

An article by Duff Wilson in the New York Times this week provided a new look at the pervasiveness of financial relationships among academic...

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