BOSTON – (Oct. 20, 2008) A group of doctors-in-training is accusing Harvard Medical School of allowing drug marketers to push unnecessary and possibly unsafe medical products on its future practitioners, thanks to weak or nonexistent conflict of interest policies on campus.
At least 41 of those students gathered in front of the massive stone pillars facing the quad of HMS’ Longwood campus Friday afternoon to protest what they say is an unhealthily permissive atmosphere for pharmaceutical and medical device companies, which they accuse of seeking to influence medical students before they even begin practicing as residents.
Though the event focused on HMS policies, medical students from Boston University, Brown University and the University of Connecticut joined the demonstration. Davida Schiff, a first-year Boston University School of Medicine student, said any effort pharmaceutical companies take to influence future doctors ultimately hurts the people they treat.
“Whether that be a free lunch or continuing medical education or talks sponsored by drug companies, studies have shown that that kind of psychological influence actually impacts what you prescribe for your patients,” she said.
The American Medical Students Association publishes a scorecard of medicals schools’ conflict of interest policies as part of a nationwide initiative to build stronger safeguards against corporate influence at medical schools. Criteria include written policies on gifts and meals, oversight mechanisms to detect lapses and sanctions when instructors or administrators do not comply. Harvard received an F.
First-year Harvard medical student Simeon Kimmel said he and a group of classmates grew suspicious of their school’s policies last month when a specialist lecturing on the cancer drug Velcade suggested offhandedly that it could be prescribed before any other therapies, instead of as a “third-line” solution used when other treatments fail, a claim which he didn’t seem to support with any data.
Kimmel said he and some classmates looked up the lecturer, HMS associate professor Paul Richardson, on PubMed.com, a medical journal database, and found he hadn’t mentioned his work as a consultant for Millenium, the company that owns the patent to Velcade.
“In peer-reviewed journals, you’re supposed to publish your conflicts of interest,” Kimmel said. “We found out that this guy had been paid by the company that made this drug Velcade, and hadn’t disclosed that in his class.”
Richardson said in an email he was surprised by the AMSA students’ response, considering he had delivered the lecture during the past two years without incident. Though he acknowledged his work as a consultant for Millenium, he said he is “very careful to declare this at any lecture in which this is required.”
In addition, Richardson said his lecture was clearly informal – he came to present a patient as a case study of the drug’s uses, not to deliver a formal lecture – and added his appearance was not paid for “by anybody.”
Randall King, the course director who invited Richardson, said he took the students’ concerns seriously and noted that the school adopted a new disclosure policy six days after the students made their concerns about the lecture known.
“I agreed with their assessment that the medical school needed to have a formal conflict of interest disclosure policy,” King said in an email. “As a result, I contacted all of our course faculty, and asked that they disclose any such relationships that might be relevant in subsequent lectures.”
Kimmel said the newly formalized policy on lecturing was “just the tip of the iceberg,” however, next to company-sponsored lunches and free samples, all permitted under an unenforced conflict of interest policy.
These efforts not only compromise students’ integrity but also influence patients’ care, said Allan Coukell, policy director for the Prescription Project, a Boston nonprofit group that collaborated with AMSA to develop the medical school scorecard.
“Often these drugs are no better than the older, cheaper drugs, and sometimes they’re less safe,” he said.
As for pharmaceutical companies funding or otherwise influencing clinical trials at research universities, Coukell said the project is choosing to focus on the companies’ influence on current and future practitioners. Research is simply too complicated an issue, he said.