Ex-editor of NEJM tells how Big Pharma has corrupted academic institutions

In the May/June issue of the Boston Review, Dr. Marcia Angell, former editor-in-chief of the New England Journal of Medicine, details the sordid story of how corporate dollars have corrupted research and education at academic medical centers — including at her current place of employment, the Harvard Medical School.

The article is adapted from a talk she gave at Harvard last December. Angell, of course, has written about this topic many times before, most notably in her 2004 book, “The Truth About the Drug Companies.”

Writes Angell:

The boundaries between academic medicine — medical schools, teaching hospitals, and their faculty — and the pharmaceutical industry have been dissolving since the 1980s, and the important differences between their missions are becoming blurred. Medical research, education, and clinical practice have suffered as a result.

The article provides plenty of examples of exactly why health consumers should worry about this money-driven blurring of missions. Here are some highlights (but do read the entire article):

• “To a remarkable extent … medical centers have become supplicants to the drug companies, deferring to them in ways that would have been unthinkable even twenty years ago. Often, academic researchers are little more than hired hands who supply human subjects and collect data according to instructions from corporate paymasters. The sponsors keep the data, analyze it, write the papers, and decide whether and when and where to submit them for publication. In multi-center trials, researchers may not even be allowed to see all of the data, an obvious impediment to science and a perversion of standard practice.”

• “[Drug] manufacturers typically prefer to work with academic medical centers. Doing so increases the chances of getting research published, and, more importantly, provides drug companies access to highly influential faculty physicians — referred to by the industry as ‘thought leaders’ or ‘key opinion leaders.’ These are the people who write textbooks and medical-journal papers, issue practice guidelines (treatment recommendations), sit on FDA and other governmental advisory panels, head professional societies, and speak at the innumerable meetings and dinners that take place every day to teach clinicians about prescription drugs.”

• “Medical centers increasingly act as though meeting industry’s needs is a legitimate purpose of an academic institution…. Academic leaders, chairs, and even deans sit on boards of directors of drug companies. Many academic medical centers have set up special offices to offer companies quick soup-to-nuts service.”

• “Increasingly, industry is setting the research agenda in academic centers, and that agenda has more to do with industry’s mission than with the mission of the academy. Researchers and their institutions are focusing too much on targeted, applied research, mainly drug development, and not enough on non-targeted, basic research into the causes, mechanisms, and prevention of disease.”

• “[D]rug companies often contract with academic researchers to carry out studies for almost entirely commercial purposes. For example, they sponsor trials of drugs to supplant virtually identical ones that are going off patent…. There’s a high scientific opportunity cost in serving the aims of the pharmaceutical industry. For example, new antibiotics for treating infections by resistant organisms are an urgent medical need, but are not economically attractive to industry because they are not likely to generate much return on investment.”

• “In addition to distorting the research agenda, there is overwhelming evidence that drug-company influence biases the research itself. Industry-supported research is far more likely to be favorable to the sponsors’ products than in NIH-supported research.”

• “Conflicts of interest affect more than research. They also directly shape the way medicine is practiced, through their influence on practice guidelines issued by professional and governmental bodies and through their effects on FDA decisions.” Angell offers several examples, including this one: “[I]n 2004, after the NIH National Cholesterol Education Program called for sharply lowering the acceptable levels of ‘bad’ cholesterol, it was revealed that eight of nine members of the panel writing the recommendations had financial ties to the makers of cholesterol-lowering drugs.”

• “Drug companies support educational programs even within our best medical schools and teaching hospitals, and are given virtually unfettered access to young doctors to ply them with gifts and meals and promote their wares. … This is marketing masquerading as education. … But doctors do learn something from all the ostensible education they’re paid to receive. Doctors and their patients come to believe that for every ailment and discontent there is a drug, even when changes in lifestyle would be more effective. And they believe that the newest, most expensive brand-name drugs are superior to older drugs or generics, even though there is seldom any evidence to that effect because sponsors don’t usually compare their drugs with older drugs at equivalent doses.”

Angell offers several recommendations for reforming the current, broken system:

• Medical schools that conduct clinical trials “should not accept any payments from drug companies except research support, and that support should have no strings attached.”

• Doctors “should not accept gifts from drug companies, even small ones, and they should pay for their own meetings and continuing education.”

• Finally, “academic medical centers that patent discoveries should put them in the public domain or license them inexpensively and non-exclusively.”

“[A]pologists might argue that, despite its legal transgression the pharmaceutical industry is merely trying to do its primary job — furthering the interests of its investors — and sometimes it simply goes a little too far,” Angell concludes. “[But] doctors, medical schools, and professional organizations have no such excuse; the medical profession’s only fiduciary responsibility is to patients and the public.”