Harvard Feels the Heat: Conflict of Interest and the Issue of Disclosure

By Bruce W. McNulty, MD
This article is part of our MedRIB project and was published March 06, 2009.

A New York Times story from March 3, 2009 reveals how the topic of our Medical Research Ethics Blog is becoming more recognized. The story can be found at:

http://www.nytimes.com/2009/03/03/business/03medschool.html?_r=1&scp=1&sq=medical%20ethics&st=cse

The article discusses how a group of more than 200 students at Harvard Medical School, along with some sympathetic faculty, are questioning the ties of businesses like pharmaceutical companies to their teachers. It recounts the story of a student being taught about a lipid lowering agent. When another student brought up concerns about the drugs side effects, his concerns were dismissed. Digging deeper the student found that his full time Harvard medical school professor was also a paid consultant to 10 drug companies, including 5 who make cholesterol lowering drugs.

The question the students raise: is it possible to teach medical students in an unbiased manner while being on the payroll of companies that have the potential to profit from what is being taught to the next generation of physicians who will go on to be prescribers of drugs for their patients?

As always, the issues are complex, and there are strong feelings on both sides. It will not get less complicated in today’s troubled economy. With endowments dropping, academic centers and labs will seek funding where ever they can find it. Many schools point to these sources of funding as critical to their investigators and laboratories – and to crucial discoveries made.

However, at a minimum, full disclosure in warranted. The article points to ratings given to schools by the American Medical Student Association (site: http://www.amsa.org/) with regards to their control and monitoring of drug industry money. Harvard rated an embarrassing ‘F’.

There is a link on the AMSA site that brings students to a pledge that they can sign:

AMSA’s PharmFree Pledge
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I am committed to the practice of medicine in the best interests of patients and to the pursuit of an education that is based on the best available evidence, rather than on advertising or promotion.
I, therefore, pledge to accept no money, gifts, or hospitality from the pharmaceutical industry; to seek unbiased sources of information and not rely on information disseminated by drug companies; and to avoid conflicts of interest in my medical education and practice.
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It seems hard to argue with that sentiment, but we also need to be careful not to throw the baby out with the bathwater. The fact that physicians/researchers work for pharmaceutical companies need not suggest that they are compromising their research integrity. Nor should we assume that all information from drug companies is tainted. But the ethical breakdowns in this sector have dealt a devastating blow to its credibility and the public is justified in withholding its trust.

Without full disclosure there is a clear risk of conflict of interest. Clearly, we are in need of two things: First, established protocols on disclosure regarding employment or other financial or non-financial benefits from industry received by those working in the medical field (including related branches such as medical education). Second, clear and stringent guidelines on conflict of interest for those working in the medical field need to be articulated and become part of the established standards for working in this field. Until we have made much more progress in these areas, the precautionary approach articulated in the AMSA’s Pledge may be needed to establish the kind of “Chinese Wall” that will help to ensure that conflicts of interest can be avoided.