A student at the U's Medical School and a member of the conflicts-of-interest
committee chaired by Pepsico board member (or former board member) Dean Deborah
Powell, has a well-written, informative piece in the MN Daily.
http://mndaily.com/2009/02/28/true-conflicts-interest-policy
I think his description of the drug industry activities at the University is
especially informative.

A true conflicts-of-interest policy
DEAN POWELL’S PROPOSED COI REFORM FOR THE MEDICAL SCHOOL IS SIGNIFICANTLY
DILUTED.

BY JOSH LACKNER
PUBLISHED: 03/01/2009

A conflict of interest is the distraction from one's primary goal (patient care)
by a secondary interest or influence (like gifts from a pharmaceutical
representative). The University of Minnesota’s Medical School needs to
maintain working relationships with the pharmaceutical and device industries,
but it also needs to remain focused on the humanitarian principles of medicine.

Dean Deborah Powell’s office recently released its second-draft
conflict-of-interest policy recommendations for the Medical School. This
document is based on recommendations made by her COI committee — of which I
was a member — but Powell’s draft is substantially diluted. Whereas the
American Medical Students Association applauded the COI committee’s
recommendations, the association — which grades COI policies across the nation
—regards the new recommendations as “borderline.” Though Powell’s draft
still contains some good and needed policy, it ignores key committee
recommendations that would have put us on par with the best medical school
conflict-of-interest policies.

Continuing medical education

Powell’s draft, unlike her committee recommendations, permits industry-funded
CME. We know that pharmaceutical companies have successfully manipulated CME to
promote off-label drug prescribing and delimit the focus of CME to topics that
result in increased prescribing of their drug product. The University's
Department of Family Medicine and Community Health has already removed industry
funding from CME. Our commitment to scientific objectivity in patient care
behooves us to independently fund CME.

Big pharma, small gifts

Small gifts are marketing items of nominal value, such as mugs and pens given by
pharmaceutical salespeople. Though cheap, they serve as durable advertisements
for a drug product or company. They are inexplicably allowed in Powell's second
draft. We know from experimental social psychology that nominal gifts affect
behavior and we have numerous accounts of former pharmaceutical representatives
on the effectiveness of small gifts. The Saint Mary's Duluth Clinic system and
others in Minnesota have already banned small gifts. The best-rated medical
school COI policies do as well.

Similarly, Powell’s draft permits pharmaceutical industry on campus, without
stipulation, as long as there is departmental approval. From a seminal review
article in 2000 out of McGill University, we know that industry representatives
include misinformation in their pitches and we know that such misinformation is
retained. Drug marketing does not belong on campus.

Marketing talks

Powell’s draft allows a professor to deliver drug talks as long as he or she
is also hired as a consultant. We know these presentations skew prescribing.
From an internal Merck document obtained by the Wall Street Journal in 2005, we
know that, in the case of the drug Vioxx, “doctors who attended a lecture by
another doctor wrote an additional $623.55 worth of prescriptions for the
painkiller Vioxx over a 12-month period compared with doctors who didn't
attend.” Marketing talks are commercials in the guise of education. Professors
in the medical school should not deliver them.

Research and the public interest

Though the COI committee did not address the availability of research products,
the University’s mission statement makes explicit our commitment to the public
good. The HIV drug Abacavir was developed at the University during the 1990s and
licensed to GlaxoSmithKline. Though a public relations battle ensued in which
many implored the University to make the drug available to the poorest
countries, this never happened. Today, many schools have policies that allow
limited generic licensure, permitting availability of the drug to the poor while
protecting the profits of the academic institution and of the industry partner.
Our stated priorities would make such a policy highly appropriate.

Research bias

Industry funding impinges on several characteristics of research. A sweeping
review performed by researchers at Yale in 2003 found that industry-funded
research is more likely to use inactive controls or sub-optimal dosing of a
competitor drug in head to head trials. The review found that researchers funded
by industry were more than twice as likely to take commercial considerations
into account when selecting research topics. We must somehow mediate these
effects.

Consultancies

From a 1994 Journal of the American Medical Association article examining
physician formulary requests (the formulary is the list of drugs carried by the
hospital), we learn that physicians who made specific requests had nearly 20
times the odds of having a financial relationship with the maker of the drug
than other physicians. Powell’s draft requires that these financial
relationships be subject to an “approved written agreement defining such
aspects as specific deliverables, goals, services and fair market
compensation.” This is the standard, according to the American Medical
Students Association, but we also need to limit and monitor these positions, as
they very likely affect behavior.

If we, as an academic community, are sincere in our mission statement, and are
to adhere to the principles of a publicly funded institution, we need to take
this opportunity to create a sound conflict-of-interest policy. Why should we
settle for mediocre when we could have a top-notch COI policy that insures the
integrity of medical education, patient care and research? One that truly
prioritizes public health?

Josh Lackner is a student at the Medical School and a member of the erstwhile
COI committee. Please send comments to letters@....