Tuesday, November 18, 2008

A Classroom Encounter Leads to a New Conflict of Interest Policy for Harvard Medical School

Last week, the Harvard Crimson reported from another angle on the issue of conflicts of interest affecting academic medicine:

In early September, the first-year Harvard Medical School students in a biochemistry class expected to learn about protein degradation. Instead, they came out of lecture ready to push for more comprehensive conflict of interest policies.

Addressing a weekly clinic for 'The Molecular and Cellular Basis of Medicine,' a required introductory course for first-year medical and dental students, Medical School professor Paul G. G. Richardson was accompanied by a patient diagnosed with myeloma, a potentially deadly blood cancer.

The patient was being successfully treated with a bortezomib-based therapy, a drug marketed as Velcade by the Cambridge-based Millennium Pharmaceuticals. Students said that during the clinic discussion, Richardson suggested bortezomib can now be used as a first-line treatment—meaning that physicians can prescribe use of the drug at diagnosis, rather than only as a second or third-line therapy when the disease has recurred.

Intrigued by his presentation, several students later looked up some of his peer-reviewed articles and found that Richardson was on Millennium’s advisory board—a potential conflict of interest that was not disclosed during the session with Richardson and his patient.

Richardson, a physician and clinical researcher at the Harvard-affiliated Dana-Farber Cancer Institute, did not violate any existing policies. In an interview, he said that he did not disclose his ties to Millennium because he wanted to keep the discussion centered on the patient and because it would have been insensitive to bring up the tie with Millennium in front of him.

It turns out that this incident was the catalyst for a long-discussed change in the medical school's conflict of interest policy.

'I think that the student-administration cooperation on the [conflict of interest] issue to this point hasn’t been wonderful,' said [first year medical student Daivd C] Tian, who is also a member of the Harvard Chapter of the American Medical Student Association.

Shamsher S. Samra, a first-year medical student, said that students had been prodding the administration to revamp the Medical School’s conflict of interest policies for roughly six years to little effect.

But after the latest incident,

In response to the student concerns, the school’s curriculum committee revised the school’s student handbook last month to include a section of new policies mandating that faculty and students disclose all financial ties to pharmaceutical companies when discussing drugs developed by those companies.

If Richardson were to give the same presentation on bortezomib today, he would be required to disclose his relationship with Millennium, though he said he would likely do this either on the syllabus or on the course Web site.

Well, it only took six years, but I supposed Harvard Medical School should get at least polite applause for finally getting around to writing a conflict of interest policy covering the education of medical students.

Note Professor Richardson's response to his failure to disclose his relationship to Millenium, that doing so would be insensitive. Medical academics often seem so uncomfortable talking about their financial relationships. And one aspect of the anechoic effect is that it has become impolite, if not politically incorrect, to discuss such relationships. But if talking about such relationships is uncomfortable, then the relationships themselves should inspire discomfort among those who cultivate them.

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