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A Piece of My Mind
November 10, 2020

Relationships Between Academic Medicine Leaders and Industry—Time for Another Look?

Author Affiliations
  • 1Brigham and Women’s Hospital, Boston, Massachusetts
JAMA. 2020;324(18):1833-1834. doi:10.1001/jama.2020.21021

In July of this year, I was invited to volunteer for an important phase 3 coronavirus disease 2019 (COVID-19) vaccine trial in Boston. As a semiretired physician, I was thrilled to be able to contribute to science, support my colleagues, and hasten the discovery of a vaccine to help end this terrible pandemic.

While doing background research on the vaccine and its parent company, I learned that some company executives sold extra shares of stock just as the first positive press releases came out, and then sold additional shares following publication of the phase 2 study.

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    4 Comments for this article
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    Thank You!
    Betsy Blazek-O'Neill, MD | Allegheny Health Network
    Thank you for your thoughtful piece. These relationships have disturbed me for years. Big Pharma is embedded in many prominent medical school campuses in our nation, and this is not helping us create better medicine. It's causing treatment bias in our teaching facilities and making a very small subset of people very rich.
    CONFLICT OF INTEREST: None Reported
    Bioethics of Physicians' Relationships with Pharma
    Humberto Martinez Cordero, Hematologist | Instituto Nacional de Cancerología Colombia
    Few practicing physicians can say they have never had any contact with the pharmaceutical industry, as sales representatives have been approaching physicians since the 1800s.

    It is necessary to recognize that many advances in medicine have emerged from industry, for example, in the 2000s with development and commercialization of the STI 571 molecule today known as Imatinib. This drug changed the paradigm of cancer treatment, as it was the first to be recognized as a targeted therapy. Many dubbed this drug the "magic bullet for treating cancer." However, on other occasions the effects of drugs in many diseases are
    marginal, the studies lack scientific methodological rigor or have rigged results, and it is then that the industry needs to apply pressure on the " access controls," that is to say, the doctors.

    A recent document gives an account of the strategies used by laboratories to increase the pressure in the formulation of their drugs (1). What is most impressive about the document is that they show how the best laboratory sales reps have the ability to profile physicians in various categories. They begin by talking about friendly, highly influential doctors; going through the disbelievers and who prefer the competition to the opinion leaders. For each of these profiles there is a specific type of perk that ranges from outings to lunch, small gifts to trips and hiring for conferences.

    Doctors must be aware that the prescription of drugs must be based on the best available scientific evidence, resorting to their clinical criteria and honoring the precepts of the Hippocratic Oath and considering bioethical principles imperatively.

    References:
    1. Fugh-Berman A, Ahari S. Following the script: How Drug Reps Make Friends and Influence doctors. Plos medicine. April 2007.
    2. Fung J. Gleevec’s False Dawn https: //medium.com/@drjasonfung/gleevecs-false-dawn-4315062d690d
    CONFLICT OF INTEREST: None Reported
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    Compensation Benefits Should be Shared with AMCs
    Edward Volpintesta, MD | Retired General Practitioner
    Kudos to Dr. Carolyn Becker for her courage in calling attention to upper level leaders from non-profit academic medical centers (AMCs) who by serving on the board of directors of for-profit biomedical companies receive extravagant compensations.

    It might be said that they believe that they are acting ethically; that because of their contributions to the boards’ decisions and the companies’ successes they deserve to be compensated; that they are merely recipients of good fortune—and most important of all that that they are not doing anything illegal.

    On the other hand it might be said
    that any compensation a representative from an AMC derives from sitting on a board of directors of a biomedical company should shared fairly with the AMC, by a formula acceptable to all.
    CONFLICT OF INTEREST: None Reported
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    History Repeats Itself as Farce
    Jim Recht, M.D. | Cambridge Health Alliance - Harvard Medical School Dept. of Psychiatry
    Thanks to Dr. Becker for this thoughtful, thought-provoking piece.

    In 2008, a courageous group of medical students and early career physicians led a "pharma-free" initiative. It was based on some inconvenient truths: first, financial conflicts of interest result in harmful behavior; and second, disclosure does not resolve these conflicts. The initiative included a number of goals, including the freeing of medical school education,
 residency training, and continuing medical education from private industry financial support; and along with this, the re-invigoration of publicly funded research and education for health professionals and the creation and dissemination of commercial-free information sources
    for
 the general public.

    These students and young professionals were trying to teach us something important, and our leaders failed to listen. 12 years later, what we get is disgraceful behavior on the part of our most prestigious leaders.
    CONFLICT OF INTEREST: None Reported
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