Medical Conflicts of Interest

To the editors:

We appreciate The Crimson’s coverage of conflict-of-interest policy at Harvard Medical School. As the dialogue on this important topic continues, we hope that discussions will focus on the need for broad, structural change in academic medicine, not specific physicians. We regret that some articles—in particular the November 14, 2008, piece, “Harvard Medical School Students Push to Codify Conflict of Interest Polices”—have placed unwarranted emphasis on individuals as opposed to the systemic issue at hand. In this letter, we wish to clarify Dr. Paul Richardson’s role in our course as described by The Crimson and also the process that led to the implementation of a formal HMS policy requiring faculty disclosure of conflicts of interest.

As mentioned by The Crimson, first-year medical students have weekly “clinics” during which physicians present patients to provide clinical context to basic science. During one such clinic, Dr. Julian Adams—the lead developer of the drug bortezomib—described the drug’s scientific discovery and clinical development. Dr. Richardson then interviewed a patient who was being successfully treated with bortezomib-based therapy, providing a very human perspective to the presentation. The discussion of the patient’s experience with both the disease and treatment was inspirational and relevant to our course material.

Very importantly, Dr. Richardson broke no HMS policy during his presentation. There was no existing policy mandating disclosure of potential conflicts of interest, and there is absolutely no indication that he supports anything but transparency. In no way do we question Dr. Richardson’s character or his commitment to his patients or to us as students. The context of the presentation simply made students aware that no formal conflict-of-interest disclosure policy existed.

Following the clinic session, students worked with our course director and dean of medical education to create formal rules on lecturer disclosure. The following week, the HMS Curriculum Committee created new policies requiring lecturers to disclose conflicts of interest when they are relevant to the lecture material. This process demonstrates how collaboration between faculty, students, and administration can lead to swift institutional changes.

The quotations from David Tian and Shamsher Samra (HMS ’12) in The Crimson’s coverage were taken out of context. We want to be clear that they were not meant to describe our otherwise very positive interactions with Dr. Richardson and faculty members during the creation of the lecturer disclosure policy. Rather, these quotes described the challenges of advocating for policy changes on conflict of interest beyond the lecture disclosure policy, a topic that also has no bearing on Dr. Richardson.

As The Crimson recently noted, HMS has announced the formation of a committee to update its conflict-of-interest policies. We believe that such an approach correctly focuses on system-wide issues and not on individual doctors. We look forward to working with this committee to bring our institutional policies in line with those of our peer institutions and with the recommendations of the Association of American Medical Colleges.


KIRSTEN AUSTAD, SIMEON KIMMEL, SHAMSHER SAMRA, and DAVID TIAN
Boston, Mass.
March 31, 2009