Comment on Harvard Alumni Magazine article 9-15-09

1. September 15, 2009
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   I’m glad that President Drew Faust “is on it” wrt Harvard’s financial situation and endowment. However, I would have liked to hear that she’s “on it” wrt the shameful conflicts of interest arising out of improper financial relationships between Medical School professors and drug companies. The fact that the Medical School recently adopted a policy requiring advance permission from the school administration from students for contacts with the media indicates that the School has not come to grips with the situation, even though the policy has been rescinded. Newspaper accounts that Dean Jeffrey Flier sees no conflicts indicate that the matter requires the attention of President Faust and the Board of Overseers. Perhaps a search committee for a new dean should be established.

   ralph deeds, MBA 1960

 The Institute of Medicine issued a critical report calling for doctors to stop taking money, free drug samples and other gifts from drug and medical device companies. "It is time for medical schools to end a number of long-accepted relationships and practices that create conflicts of interest, threaten the integrity of their missions and their reputations, and put public trust in jeopardy," the report concluded.

The report calls on Congress to pass legislation that would require drug and device makers to publicly disclose all pamyments made to doctors.

Drug companies spend billions of dollars wooing doctors--more than they spend on research or comsumer advertising. Much of this money is spent on giving doctors free drug samples, free food, free medical refresher courses and payments for marketing lectures. the Institute's report recommends that nearly all of these efforts end.

In a tiny nod to appease critics, last year several major drug companies agreed to stop giving pens, pads, and other gifts of small value, but defended other practices as valuable to doctors and patients. Here's a link to a NY Times article by Gardiner Harris on the Institute of Medicine's highly critical report.

http://www.nytimes.com/2009/04/29/health/policy/29drug.html?scp=3&sq=Gardiner%20harris&st=cse

Minnesota is the first of a few states to require drug companies to disclose payments to doctors. The records of these payments are quite revealing. From 1997 to 2005 drug makers paid more than 5,500 doctors, nurses and other health care workers in Minnesota at least $57 million. Another $40 million went to clinics, research centers and other organizations. The median payment per consultant was $1,000; more than 100 people received more than $100,000.

Doctors typically receive money for delivering lectures about drugs to other doctors. Some of the doctors receiving the most money sit on panels that prepare guidelines inctructing doctors nationwide about when to use medicines.

Comments:

"I hate to say it out loud, but it all comes down to ways to manipulate doctors."

Kathleen Slattery-Moschkau, former sales rep for Bristol-Meyers

"If a doctor says that he got flown to Maui, stayed at the Four Seasons--and it didn't influence him a bit? Please."

Jamie Reidy, a drug sales rep for Pfizer and Eli Lily who was fired in 2005 after writing a humorous book on his experiences.

"You're paying him for the talk. You're increasing his referral base so he's getting more patients. And you;re helping to develop his name. The hope in all this is that a silent quid quo pro is created. I've done so much for you, the only think I need from you is that you write more of my products."

Gene Carbona, who left Merck as a regional sales manager in 2001.

Between 1997 and 2005, Dr. Grimm earned more than $796,000 from drug companies. In 2003 alone, Pfizer paid Dr. Grimm more than $231,000. Pfizer markets Lipitor, a cholesterol drug that last year had $12.9 billion in sales, more than any other drug in the world.

Dr. Donald Hunninghake served on a government-sponsored advisory panel that wrote guidelines for when people should get cholesterol-lowering pills. The panel's 2004 recommendations that far more people get the drugs became controversial when it was revealed that eight of nine members had financial ties to drug makers. The full extent of those ties have never been revealed.

In 1988 alone, Pfizer paid Dr. Hunningshake $147,000, and he earned at least $420,000 from drug makers between 1997 and 2003.

Comment: Judges are expected to disqualify themselves from cases in which they have a personal interest or even an appearance of bias. Apparently medical ethics don't include such a rule or expectation.

Here's a link to a 3-21-07 NYTimes story by Gardner Harris and Janet Roberts:

http://www.nytimes.com/2007/03/21/us/21drug.html?_r=1&hp&oref=slogin