When it comes to pharma meals, MA medical centers have already spoken

In its aggressive push to repeal the state’s gifts and meal ban, the Massachusetts restaurant industry (and pharma, the presumptive cooks in the kitchen behind this lobbying blitz) are hoping legislators will think the issue of doctors and drug companies is still, well, on the table. Since Bay State restaurant numbers don’t seem to have suffered from the law, these groups are betting that lawmakers will be willing to open the old and fundamental question: Should prescribers who are responsible for their patients’ best interests be letting pharma pay their way for meals, liquor and other perks?

But the question’s closed: Academic medical centers in Massachusetts have spoken loudly, and they’ve said that physicians and drug companies should work together at the lab bench, not the dinner table (or the bar). They’ve done this by developing and strengthening policies around industry marketing over the last four years, many of which set the bar nationally for rethinking conflicts of interest in the clinical setting, while protecting innovation.

UMass, Boston Medical Center, Tufts and Harvard Medical School have all demonstrated national leadership and done big work in setting ground rules to keep pharma’s marketing dollars out of doctors’ training, practice, and professional development. The American Medical Student Association scorecard, which evaluated conflict policies at all U.S. medical schools, recognized this leadership with top grades.   Specifically, all of these institutions received perfect “3s” on gifts and meals, meaning that “all gifts and on-site meals funded by industry are prohibited, regardless of nature or value.”

So, if Massachusetts’ flagship medical centers have done this, why all this hubbub over at the State House?

In 2008, lawmakers heard the message from these clinical centers about keeping medicine separate from marketing, and they realized that what’s good for patients and providers at UMass or Harvard is good for patients and providers outside the academic medical centers—on the Cape, or in Waltham, or Deerfield. Tchotchke-free waiting rooms and unbiased clinical care should be the norm everywhere in the state, and that could only be addressed by a state law. And so they passed a law limiting the kinds of gifts and meals drug and device companies could give docs—including the ‘educational’ wine-and-dines at some of the state’s priciest restaurants.

This wasn’t radical: This was the next step on ground cleared by AMCs and the industry itself (whose own code of conduct Massachusetts used as a template for its law).

The drive to preserve this law will be decided in the next few weeks.  The House voted to repeal the gift ban, but the Senate Ways and Means budget, released yesterday, does not include mention of repeal. Senate President Therese Murray championed passage originally as part of the effort to eliminate unnecessary health care spending, including that driven by drug company marketing.  And as for that claim that these meals are necessary educational opportunities for docs: What caliber of education do we really believe happens in the function rooms of Boston’s finest restaurants over a $40 cut of Kobe sirloin and a few bottles of a nice reserve cab?  (Dr. Carlat talks menus here.) Remember, the law doesn’t prevent companies from catering a legitimate program in the hospital, but that wouldn’t include liquor and elaborate meals.

So as the debate heats up again, let’s remember that we’ve already had this one—and physician leaders have said clearly that gifts, food and booze don’t have a place in the medicine being practiced our prestigious academic institutions.  We hope these leaders will take the opportunity to remind the public in the coming weeks why they took a stand for reforming the relationships between the industry and physicians, and why their new institutional policies and the Massachusetts gifts and disclosure law are important to upholding the state’s reputation for clinical excellence and medical education.

–Kate Petersen, PostScript blogger

Yesterday, Harvard Medical School announced strict conflict-of-interest rules that limit ties between its 11,000 faculty members and pharmaceutical and medical device makers, making it one of a growing number of medical schools across the country to address concerns about the influence of industry marketing on the education, training and practice of physicians.

Highlights of the new policy, which will be phased in by January 1, 2011, include:

• prohibiting all personal gifts, travel or meals from industry
• banning participation on speakers bureaus (company-controlled talks)
• capping at $10,000 annually per company the amount faculty can earn from a company whose technology or product they are investigating in clinical research
• requiring Harvard to post on its website faculty member financial interests in, or payments from, pharmaceutical and medical device companies
• prohibiting companies from sponsoring specific Harvard-run CME courses for physicians, unless more than one company sponsors the course and no one company funds more than 50 percent
• requiring industry exhibits and programs to be held at a separate time and place from Harvard CME courses

As one of the world’s most prestigious medical education and research institutions, Harvard’s decision to strengthen its rules is a powerful acknowledgement of the impact of aggressive industry marketing on medicine. It also sends a strong signal to other institutions that have yet to address industry’s presence on medical campuses. It is also a reminder to the Massachusetts legislature, which is debating efforts to repeal the state’s ban on industry gifting to prescribers, that the medical profession is increasingly embracing the need for these restrictions and ethical standards.

When the Prescription Project formed in 2007 with a goal of eliminating conflicts of interest at academic medical centers, conventional wisdom had it that change at Harvard and its affiliated hospitals would not come easily. After Boston University and UMass Memorial Medical Center released strong policies in 2007 and 2008 respectively, the Project convened all of the Boston-based academic medical centers with the hopes of building momentum for change at all of the Massachusetts-based schools and teaching hospitals.

Harvard’s new policy buttresses similar guidelines issued last year by Partners Healthcare, which employs thousands of Harvard physicians and operates two of Harvard’s teaching hospitals – Mass General and Brigham & Women’s.

As a number of other top institutions around the country – Stanford, University of Pittsburgh, University of California Davis – released new COI policies in 2008 and 2009, attention continued to focus on Harvard. A series of unflattering media exposés on Harvard physicians’ ties to industry, followed by a Congressional investigation by Senator Charles Grassley (R-Iowa) into whether the physicians had violated federal conflict-of-interest payments for failure to disclose large drug company payments, raised questions about the school’s policy and helped thrust the issue into the national spotlight.

In June of 2008, the American Medical Student Association (AMSA) released its Pharmfree Scorecard developed in partnership with the Pew Prescription Project. Harvard received an “F” score due to its failure to submit its policy. The score garnered unwanted media attention from several major national news outlets.

In addition to creating external pressure on Harvard, AMSA began to work internally to push for reform and signs of progress were beginning to surface. When the Harvard University Faculty of Medicine Committee on Conflicts of Interest and Commitment convened in late 2008, AMSA members from Harvard Medical School and across New England asked for involvement in the policy drafting process, increased transparency, mandatory lecturer disclosure and a reasonable timeline for drafting and implementation.

Last year, Harvard submitted policies to AMSA and received a “B” score on the 2009 Pharmfree Scorecard.

“Harvard’s policy represents an important milestone because many institutions look to Harvard to set an example,” said Chris Manz, Pharmfree Director at AMSA.  “While the policy revision has room for improvement, it sends the message that academic medical centers can responsibly collaborate with industry while also preserving the integrity of the medical practice, and we’re proud that PharmFree students played an integral role in its development”

In some areas, Harvard’s new rules may set standards for other schools, particularly in the area of faculty earnings from industry. The rules cap at $10,000 the amount Harvard faculty can earn from a company whose technology or product they are investigating in clinical research.

Despite that, the new rules on continuing medical education (CME) do not go as far as those at schools like UMass and Stanford, which the Project has cited as model policies. Nevertheless, it will be interesting to see how the CME policies impact Pri-Med, the Boston-based annual physicians conference that features Harvard lecturers and has been a carnival of industry marketing. The new rules propose a “firewall” between Harvard and the companies that use these events to market their wares in every spot imaginable, including, apparently, the bathrooms, which will no longer be allowed.

Overall, these are strong policies that will be hugely influential.

– Kathy Melley, Director of Communications

Reading the fine print

Glad we read the Boston Globe this week, where we stumbled across this great opinion piece by internal medicine resident Dr. Michael Hochman, who says that recent revelations about pharmaceutical companies ability to bury unfavorable studies (or just write better ones themselves) have got him and his colleagues at the Cambridge Health Alliance thinking twice about the sizeable chunk of industry-funded research in the medical literature.

“One of the more experienced doctors I work with, for example, told me that he no longer views industry-funded research as an unbiased source of information but rather treats these studies like advertisements for pharmaceutical products,” Hochman writes.

Though he says he’s encouraged by recent changes to limit marketing influence on good medicine, such as the Journal of the American Medical Association’s pledge to exorcise itself of ghostwriters, and Boston University School of Medicine’s recent introduction of strong policies that ban industry gifts and payments, he will “rely less heavily on studies funded by pharmaceutical companies when making decisions about my patients. And when I do read industry-funded studies, I will use the skeptical mindset I developed during my medical training not only to evaluate the study methods but also to consider the motives of the researchers involved.”

After the Wire, Under the Arch: med school policies in perspective

The Baltimore Sun ran this comprehensive article on the AAMC recommendations and the state of pharmaceutical conflict-of-interest work at the state, federal, and academic medical center level.  According to the Sun, “The Johns Hopkins University and the University of Maryland allow doctors and researchers to accept gifts that have “educational value” and to earn money for company-sponsored speeches. Officials at both schools say the policies are under discussion and might be tightened in response to the new AAMC guidelines.”

Here’s another good omnibus article in the St. Louis Post-Dispatch on the state of industry influence on academic medicine – and the effect of the AMSA Pharmfree Scorecard last year.

According to the Post-Dispatch, after the scorecard came out “Washington University adopted a policy to ban representatives from interacting with students without faculty supervision. Among other rules, representatives are barred from bringing food on campus.”

A second year medical school put it this way: “By the time I’m done, I’ll have paid a couple hundred thousand dollars for my medical education,” she told the Post-Dispatch.  “I think I’ll be well-qualified enough to educate myself.”

And the accompanying editorial says that it’s no coincidence that “Americans spent $216 billion on prescription drugs in 2006, an increase of nearly 80 percent over the $121 billion spent in 2000.

“The simple truth is that when drug and medical device makers offer a free lunch, the rest of us pay the bill.”

American College of Physicians mag looks at COI policies

Here’s a great look at what AMCs are doing about industry influence from a professional perspective.  The ACP Hospitalist talks with RxP and a whole starting line-up worth of adminstrators who have taken their organizations pharm free, including BUSM’s Dr. David Coleman, University of Pittsburgh Medical Center associate dean Dr. Barbara Barnes, and SMDC Health System’s Dr. Kenneth Irons, who took the out-of-sight-out-of-mind approach offshore, orchestrating the shipment of all his clinics’ pharma gizmos to Cameroon earlier this year.

In Heinz sight

And for anyone who doubts that pharmaceuticals have gotten away from the science in favor of lifestyle marketing campaigns run by brand-savvy MBAs, we bring you this nugget, courtesy of the WSJ Health Blog.