Banning Logo Coffee-Mugs, Soliciting $5 Million Donations

A story from the Connecticut Business Journal suggests the extent that medical schools now seek money from for-profit health care corporations.

The Yale School of Medicine has mounted an aggressive fundraising campaign targeting drug makers, according to internal university documents recently reviewed by Business New Haven.

The documents, part of a confidential briefing for School of Medicine Dean Robert Alpern, outline an effort to raise more than $40 million in philanthropic dollars through 2008 from pharmaceutical companies.

Fund-raising efforts involving specific pharmaceutical companies included,

• "a suggestion to send Yale President Richard C. Levin to Germany to meet with Bayer Pharmaceutical's president to help secure $5 million in funding for the new Yale Cancer Center."
• "Merck & Co., under fire in recent years in the Vioxx scandal, is targeted for a $5 million appeal for the Yale Mouse Phenotyping Center, Yale officials confirmed. "
• "Yale has a particularly close relationship with Pfizer, which opened a clinical research facility adjacent to the university in 2005. Pfizer and the university also collaborated on the Yale Positron Emission Tomography Center, which opened earlier this year with help from a $5 million gift from the drug maker and a pledge of $2 million a year in research funding. "

The size of the total fund-raising effort is notable.

Corporate and foundation donations make up about 25 percent of Yale's annual fundraising take, [Vice President for Development Inge] Reichenbach says, with the rest coming from alumni donations. The pharmaceutical company push is part of a larger five-year effort, which includes a $100 million campaign for the Yale Cancer Center.

Reichenbach says that development officials often highlight links between ongoing research and a company's interests. Pharmaceutical companies have a natural stake in medical research and fund efforts on all levels at many schools, she adds.

'Basically we are making matches. That's what we do, we provide matches of interest,' Reichenbach says. 'When you have a medical school, it's a pretty obvious match.'

While Yale drums up such corporate funding, it has cracked down on relatively small transactions between individual faculty and commercial health care organizations.

Yale has in fact been at the forefront of cracking down on drug company efforts to influence individual researchers and clinicians, says David Rothman, a professor of social medicine at Columbia University and associate director of the Prescription Project, an effort to limit conflicts of interest in academic medicine.

A former Yale professor serves on the Prescription Project's advisory committee and drafted a series of cutting-edge guidelines for Yale on 'impeccable financial relationships between the pharmaceutical industry and physicians.' The guidelines restrict doctors' access to free meals and samples offered by companies.

There seems to be a striking contrast between how Yale addresses possible conflicts of interest affecting individual faculty, and how it addresses institutional conflicts of interest.

Yale has guidelines and an internal committee that probes for conflict of interest in research, says Stephanie Spangler, deputy provost for biomedical and health affairs. Any research funded by corporations is governed by strict set of rules and subject to peer review.

Much of Yale's formal ethics rules govern doctors and their interactions with pharmaceutical company representatives, long known for handing out free gifts and meals in an attempt to influence prescription-writing habits.

"We work very hard at an institutional level to make sure that any institutional relationships we have don't reach the individual clinician," Spangler says.

But there are no ethical guidelines in place regarding philanthropic gifts and their effects on research priorities. 'There's a spectrum of outside interests,' Spangler says. 'There aren't bright lines and hard and fast rules.'

That struck one external observer, Merrill Goozner, as hypocritical.

'Yale has put itself up for sale,' says Merrill Goozner, director of the Integrity in Science project at the Center for Science in the Public Interest in Washington, D.C. 'That's a fairly sad day for academic medicine.'

'The reality is that pharmaceutical company influence over the nation's medical schools is pervasive and unfortunate because it's skewing research,' Goozner says. 'You would think that medicals schools would take greater precautions, that they would draw a bright line.'

Even Rothman conceives that there is room for improvement.

Rothman of the Prescription Project says it may be time for the focus of concern over drug company influence to shift from individual doctors and researchers to universities as a whole.

'Is it an important issue? Absolutely. Is a frontier issue? Absolutely,' Rothman says. 'This kind of material compels us to go up one notch and start thinking long and hard about institutional conflict of interest.'

We have noted before that academic institutions which seem to be willing to ban financially small conflicts of interest affecting students and faculty seem unwilling to address larger conflicts affecting top leaders and the institution as a whole. Obviously, it is easier for leaders to tell their medical students not to accept coffee mugs or pizza from pharmaceutical company x than to themselves forego lucrative consulting agreements, or memberships in speakers bureaus or even boards of directors.

The temptation of corporate largesse is that it allows the leadership to continue to live in the style to which they have become accustomed. But if leaders are really worried how much a coffee mug may influence how a medical student thinks, they should be much more worried how much a $5 million donation may influence how they themselves think.