Monday, January 4, 2010

Harvard on "Consultant" Pay--a Step in the Right Direction

It took some time, and, while "Harvard" (see further as to why the quotes) isn't the first institution to institute new and considerably more sane policies about conflict-of-interest in medical academia, it is the most renowned.

The story appeared in the Saturday NYT and I noticed a similar one in the Boston Sunday Globe. They note that Partners HealthCare, the parent corporation of two of the largest of the hospitals affiliated with Harvard Medical School, Massachusetts General Hospital and the Brigham and Women's Hospital (thus technically not the medical school itself), have established a set of rules intended to minimize conflict-of-interest and draw a sharper line at the boundary between industry and academia.

I say, "Bravo!" This is a huge step in the right direction. And because of the cachet that the name "Harvard" carries, other academic medical institutions are sure to follow suit. There are two main restrictions on academic physicians. First (and, to my mind, most important) is that docs affiliated with Harvard can no longer accept "speaking fees" from drug companies. For those unaware, these "talks" frequently come in the form of an after-dinner lecture where the drug company in question pays for dinner for the audience. These dinners aren't held at Burger King, it should be said. Officially, the editorial policy of drug companies is completely hands-off with respect to the content of the talk except for the general topic (like, say, emphysema). That said, only a fool would believe that there isn't an implicit plug-our-product directive, and that the audience isn't in on the arrangement. These speaking fees can net a doc who's willing to hustle a very nice little side income: say, $40 or 50 grand annually for two or three talks a month. That little gravy train is over at the Partners hospitals now.

The second restriction is on senior faculty who sit on the boards of various pharm companies. These policies apply to a much smaller group of physicians, and because of Harvard's privileged status, there's a disproportionate number of Harvard faculty on such corporate boards. The limits are still quite generous: they are allowed compensation for corporate board work, but now set the limit at "a level befitting an academic role," which the article states should be no more than $5,000 per day (!). The article further helpfully notes, just in case you're startled by this seemingly large amount, that "some [faculty] had been receiving more than $200,000 per year." There is also a great line by one Dr. Dennis Ausiello, who was compensated by Pfizer to the tune of $220K per year, about how he'll continue in his role on the Pfizer board with less cash in hand. "I think I should be compensated fairly...but if my institution rules otherwise, I will continue to work on the board." Apparently he thinks that five large a day isn't "fair compensation." Poor Dennis!

There are some quotes in the article from some academics expressing outrage at the leniency of the new policy, but for my part I am heartened. The problem of the relationship governing the most highly placed senior faculty making beaucoup bucks on the boards of Big Pharma seems to me to be minor compared to speaker's fees. The lecture circuit is widespread, obviously corrupt to anyone willing to think for more than two or three seconds, and virtually everyone's in on the joke. When medical faculty play along, they are sending an explicit message of "not to worry--you deserve these freebies that the drug companies toss out to us. You get the free fancy dinners, I get a thousand or two dollars. After all, aren't we entitled to this because we work so hard?" Needless to say, as much as I like nice dinners and making money, I don't think this is a good message to be sending in the medical community. And Harvard just took a definitive step toward shutting that message down. The battle ain't over, but I think that we just witnessed the turning of the tide.

Other stuff:
a. I had, of course, meant to write about some great books that I read in 2009 (a short list includes the fantastic book by Steven Johnson The Ghost Map about the cholera outbreak in London and the genius who solved the question of cholera's cause, John Snow; John Barry's classic book of a few years back but no more relevant than in 2009 The Great Influenza; The Wine Trials--don't ask as to why I think that belongs in a blog about medicine; Adam Gopnik's quirky little book about Darwin and Abraham Lincoln--a great book for the sesquicentennial of the publication of Origin of Species--called Angels and Ages). That got swept under the rug due to time and family constraints. But for those who are fans of Malcolm Gladwell, he has a new book that is a collection of his writings during his past 10+ years at The New Yorker, called What the Dog Saw. In it there is a gem of an essay about the development of the pill, women's menstrual cycles and its relationship to "female" cancers, and living in the industrial age. You will get your money's worth if you read nothing other than this essay. That said, the rest of his writing is equally riveting. For those who have the time for audiobooks, Gladwell reads his own work, and he's an exceptionally powerful reader. Leave aside his talent as a writer, I would say his reading ability is second only to that of the immortal Scott Brick. But this may be getting too far afield except for the die-hard audiobookers.

b. Did Brit Hume really say that? You gotta love the guy. Oh, wait. No, you don't. The skinny is that Brit took a potshot at Buddhism while discussing the recent troubles of a fairly well-known golfer who, according to Hume, "is said to be a Buddhist." Hume then explained that turning to the Christian faith would far outstrip whatever Buddhism had to offer. One of the comments at the website above notes, "I've said it before: there was a very good reason why Rome threw them to the lions." Billy couldn't help but chuckle.

c. Also in the "I wanted to write about this but no time to give it its proper due" category was this excellent discussion of the difficulty surrounding the use of sedation in end-of-life care. It's a Sunday NYT piece so it takes some time, but I recommend it highly.

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