Medical students at both Harvard and Brown are concerned about the ethical implications of current policies regarding the institutional influence of the pharmaceutical industry. Since Harvard Medical School received an 'F' in the American Medical Student Association's report on faculty conflict of interest last October, a group of students and faculty has mobilized to challenge the university's policy on ties to prescription drug companies, the New York Times reported March 2.
"Harvard Medical School is one of many schools facing this problem," and, as of now, the university is "not adequately addressing it," said Arnold Relman, professor emeritus at Harvard Med.
"Medicine should serve public interest and not corporate interest," said Relman, the former editor of the New England Journal of Medicine.
Under Harvard's current policy, faculty members must disclose to students which drug companies, if any, employ them for consulting and research. But Relman said it is unethical for professors to accept payment for their services to outside corporations.
"I don't consider industry to be evil - they're not Satan," Relman said. "But they have different imperatives. We're talking about millions and millions of dollars."
Professors employed by drug companies may have an incentive to misrepresent medications, Relman said, possibly leading to misinformed doctors who prescribe unnecessary treatments. In the long term, this may lead to increased health care costs and a loss of public confidence.
Ali Qureshi, vice president of Harvard Medical School's class of 2012, said the university is "on par with other medical schools" in terms of its conflict of interest policies. But, he added, the Student Council Advisory Board has recently created a Conflict of Interest Representative to increase dialogue about the issue.
Qureshi has never personally felt the influence of drug companies on his studies, he said, and explained that, by its nature, Harvard draws prominent professors who are also recruited by major drug companies. Harvard's power in controlling conflicts of interest is restrained because it does not own the hospitals where its faculty and students work, Qureshi added.
But the controversy has created a "healthy debate" on campus, Qureshi said, adding that while student views on the issue varied, all are "supportive of having a healthy conflict of interest policy."
Harvard Medical School's policy on conflicts of interest is quite strict when compared to other schools, said David Cameron, associate director of public affairs and media relations at Harvard Medical School.
"We require our researchers to disclose financial interests," Cameron said. "Depending on the nature of the disclosure, we have some very firm boundaries on what a researcher can and cannot do."
Harvard Medical School is currently conducting a comprehensive policy review, Cameron said. The "lack of language on conflict of interests in areas that are specific to a clinical setting" is a focus of the review, he said.
Policy is also being revised at Brown's Alpert Medical School, which is aiming to limit all conflicts of interest in teaching, Associate Dean of Medicine Philip Gruppuso said, explaining that pharmaceutical marketing is expected to be banned on campus under the new policy. He said the policy will be implemented before the end of the year.
"I think it is very clear that there will be support," for limiting the intervention of drug companies at the medical school, Gruppuso said. "More recently, people have recognized what a problem" it has created at medical schools in general, he added.
This policy change will require all lecturers to disclose their affiliation with drug companies at the start of each semester and aims to develop curriculum on the influence of the pharmaceutical industry on medical care, according to Gruppuso.
The student group 'Brown Pharmaceutical Policy Task Force' acted as the catalyst for this change by submitting recommendations to Dean Gruppuso.
"I converted their recommendations into an action plan," Gruppuso said. "We wanted this to be student-led."
However, Gruppuso added that, according to a survey result, "Those of us in the administration are more uniformly concerned than the population of students," he said.
Joelle Karlik '08 MD '12, the student leader of the Task Force, said while she thinks this new policy is a "step in the right direction," disclosures by lecturers do not erase influence on their teaching.
"Once money is accepted, there is that possibility for influence," she said.
The administration has been supportive of student recommendations, Karlik said, but has focused more on limiting pharmaceutical companies' influence on students and less on their influence on professors and hospitals.
"We're not going to get rid of influence in our education without removing industry influence on the greater community as well."
