Students Push Comprehensive Hospital COI Policies

Brandishing signs on the steps of Harvard Medical School’s Gordon Hall, about 40 students flanked by colleagues from Tufts and Boston University rallied for stronger policies against pharmaceutical-industry influence at Harvard’s affiliated hospitals last month.

A petition signed by over 200 faculty and students was delivered to the office of Medical School Dean Jeffrey S. Flier, who was traveling at the time. The event drew the attention of representatives from the pharmaceutical company Pfizer and former New England Journal of Medicine editor Arnold S. Relman, a Medical School professor who extemporaneously addressed the group.

Students at the Medical School said that they have been nudging the administration to revamp the school’s conflict of interest policies both in the classroom and at the affiliated hospitals for roughly six years to little or no avail. Students spend their third and fourth years at the affiliated hospitals for their clinical education training.

“We really view this issue as something that is key to the integrity of medical education at Harvard,” said David C. Tian, a first-year student who recently pushed the administration to adopt a policy addition mandating that faculty and students disclose financial ties to pharmaceutical companies when discussing drugs developed by those companies in the classroom.

“Starting with our third year, our teachers are the doctors who are interacting with industry on a daily basis in ways that the Medical School currently doesn’t standardize or set standards for,” Tian added.

Gretchen A. Brodnicki, the dean for faculty and research integrity, said that the administration is taking the student concerns seriously. She noted that Flier, who took the helm of the school in July 2007, convened a town hall meeting two weeks ago during which he addressed these concerns.

But with students still demanding a stricter policy to govern their final two years of medical school, the issue shows few signs of being put to rest.

FIFTEEN HOSPITALS

The students pushing the Medical School to adopt a policy that applies to clinical education at the affiliated hospitals have run into a barrier in the relationship that the Medical School has with its teaching facilities.

Unlike many other medical schools across the country, the Medical School does not own or operate its hospitals. The 15 affiliated hospitals are independent, non-profit entities, each of which operates under its own public charter and is governed by a separate board of trustees.

Faculty members who work at the hospitals are subject to the school’s conflict of interest rules, but are paid by the hospitals or physician organizations at the hospitals, not by Harvard.

Though the Medical School’s conflict of interest policies do not extend to the clinical setting, Brodnicki, who has previously worked at Harvard-affiliated Beth Israel Deaconess Medical Center, said that the conflict of interest policies at the hospitals “go well beyond where we stop.”

“We can’t force the hospitals,” said Brodnicki, who also worked at Partners Healthcare, the non-profit organization that owns Harvard-affiliates Mass. General and Brigham and Women’s. “We work with them and see what makes the best sense for them and the medical students.”

But students said that applying a uniform policy across the hospitals may prove difficult, Yale, though, provides one model for a comprehensive policy.

Like Harvard, Yale Medical School does not own its five affiliated hospitals, but it has a comprehensive conflict of interest policy that extends to the hospitals where third-year medical students undertake their clinical training.

“My first response would be that it’s been done before,” said Shamsher S. Samra, who is also a first-year medical student. “Secondly, just because it’s difficult doesn’t mean it’s an undertaking that is not worthwhile.”

Mass. Gov. Deval L. Patrick ’78 signed a law this August requiring pharmaceutical and medical device-making firms to publicly disclose gifts worth more than $50. The law also bans certain types of gifts such as sports tickets and free travel.

Brocknicki said that the statute will standardize certain policies for all health care providers in the state.

“But we’re going to be looking into [conflict of interest policies],” Brodnicki said. “We don’t want to step on the hospitals’ toes, and it will be great to work with them to ensure some consistency.”

TOWN HALL

In response to vocal student concerns, Flier allocated roughly 25 minutes to a discussion on conflict of interest policies at a town hall meeting two weeks ago. Other topics addressed in the meeting included housing needs for non-traditional students and use of the Harvard Catalyst, a cross-school initiative providing resources to all of Harvard’s divisions.

Flier told the students that their concerns would be addressed in a University-wide review of industry-related practice and policy that was scheduled for this fall. David Korn ’54, a former dean of Stanford University School of Medicine who began his term as Harvard’s first vice provost for research this week, will be leading the review committee, which has yet to be formed.

But this was not news to many students.

Coming out of the lunchtime meeting, many expressed their dissatisfaction as the bulk of their questions remained unanswered.

“There wasn’t very much to learn other than the fact that David Korn would be coming soon,” Tian said. “There is frustration on the part of the students because there is a general lack of information.”

The students were hoping to hear in more concrete terms what the Medical School will be pushing for as the University embarks on the review process in the coming months, Tian said.

But Korn had just arrived on Monday, and he has just begun to meet with administrators across the University. And at this point, the members of the review committee and a timetable for setting recommendations have yet to be established, University spokesman John D. Longbrake said.

Flier said at the meeting that the Medical School would not initiate a separate review until it was “fully clear” how the University-wide review would proceed.

“I actually think that Dean Flier was as candid as he could be,” Brodnicki said. “He was very clear about what he did know, and what he didn’t know.”

Additionally, students clamored for the administration to be more transparent as the review process unfolds.

Though Flier could not guarantee at the meeting that the students will be actively involved in the discussion, Brodnicki said, the administration will be figuring out how to best receive feedback from the student body and update the students on the committee proceedings.

As students had pressed for a Town Hall meeting dedicated to the discussion of conflict of interest issues, Flier said that he will be organizing a panel discussion in January.

“He stated that he was sensing a bit of suspicion based on the questions he was receiving, and he was concerned about where it was coming from,” Brodnicki said. “Part of the challenge is that there are some things we just don’t know yet. But that doesn’t mean we’re not trying to figure those answers out.”

—Staff writer June Q. Wu can be reached at junewu@fas.harvard.edu.