March 1st, 2010
What Should the Relationship Be Between Pharmaceutical Companies and Fellows?
Andrew M. Kates, MD
Recent publications, including a scientific advisory in Circulation on rosiglitazone, the industry response to a Senate Finance Committee’s report on the drug, as well as a commentary in Forbes by Harlan Krumholz, have made me consider further the role that pharmaceutical companies play in the context of fellowship training programs.
The relationships between training programs and these companies, and their potential influence, have undergone significant changes over the past several years. Practices that were in place when I was in training (about 10 years ago) no longer exist. Beyond industry’s self-imposed restrictions, many medical institutions have placed significant restrictions, both personal and financial, on the access to fellows by pharmaceutical companies and their representatives. Still, pharmaceutical companies have many avenues by which they can influence fellows. Some of these may be fairly trivial, such as providing lunch or breakfast for conferences, and others reach further, such as funding support for CME conferences, grant support for career development, and salary support for fellowship positions.
Restrictions, including those here at my own institution, have greatly changed the access that pharmaceutical companies and their representatives have with fellows, but whether these restrictions have changed industry influence remains unclear. Several issues here merit discussion. Are you, as fellows, comfortable with the role that pharmaceutical companies have in your training? Are the imposed changes adequate or unnecessary? Or do they not go far enough?
Issues concerning the role of pharmaceutical companies in your research also merit discussion. As you advance towards junior faculty positions, what role should industry support have in your research and career development? In terms of grant applications, how do you perceive funding support from industry? Are you leery of clinical trials because of the influence of pharmaceutical companies? We are eager to hear what you think.
3 Responses to “What Should the Relationship Be Between Pharmaceutical Companies and Fellows?”
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playing together in a sandbox
I think this is a great topic of discussion and has been so for the past few years. I think the reality is that academic medicine and the biotech industry (including pharma) have more of a symbiotic relationship rather than a parasitic one! For all the “negatives” that the media has focused on, there are a number of “positives” that are often overlooked. They have to find a way to play together in a sandbox, since they both need each other for the advancement of science and therapeutics.
A majority of the cardiology trials published in journals such as NEJM, JAMA, and Lancet, were industry-sponsored, large-scale, clinical trials with significant clinical impact. Do we really believe that these types of trials (international, multi-center, with up to tens of thousands of patients) could be been completed with NIH funding alone? For particularly complex trials involving collection of multiple data points, including imaging based biomarkers, could they have been performed with the same efficiency with federal funding alone?
The second point is regarding the impact of industry-sponsored grants for trainees and early career investigators. I am not yet at this stage but, from talking to and communicating with colleagues, it seems that industry-sponsored grants and funding can play a major role in supporting senior fellows and young faculty members in the advancement of their careers. As such, there seems to be a disconnect in policies that allow this type of academic support but disallow industry-sponsored lunches for conferences that are completely run by academics for fellows and trainees. And the sad reality is that drug company sponsored activities/lunches actually work to fill the conference rooms. Ever since our institution’s policies disallowed industry sponsored lunches at faculty- and fellow-run lecture series, attendence has dropped by 80%! Perhaps a compromise that could bring us closer to the right balance would be something like back-end pooled industry funding of a CME front-end organization that continues to support training and research endeavors at academic institutions…
A tale of two countries
I have worked in Ireland and in the US. When I was in Ireland, there were minimal restrictions on what industry representatives could offer house officers. By the time I moved to Boston, the restrictions that Maulik refers to were already in place. And I found this a healthier atmosphere, without as many distractions. From a personal perspective, I have chosen not to attend dinners at high end restaurants that pharmaceutical companies host, not because I am “holier-than-thou” but rather because I just don’t enjoy them.
However, I do have one concern about the manner in which fellows and junior faculty are being restricted from exposure to industry sponsorship. I do not know if it is the right approach for senior physicians and leaders to instruct junior colleagues to steer clear of these monies. But rather I think it should be more of a choice based on the experiences, preferences and ambitions of the junior faculty and fellows and based on a risk-benefit ratio with perhaps senior physician advice as to long term sequela of such over- or under-involvement having already experienced it.
I am not a trialist but also when a major study is published that involves pharmaceutical or device company sponsorship, health care professionals are very quick to question the results because of conflicts in interest. I would like to hear from faculty who review manuscripts for publication as to how they interpret this data and balance it, because clearly as Maulik alludes to, these trials cannot be all bad and much of the information and life saving interventions that we have today, we would not have had without these trials.
An Interesting Example
Here’s a link to a story I wrote last year about Jim Stein, the well known Wisconsin cardiologist who “repented” after many years of deep ties to industry. Any thoughts?
http://cardiobrief.org/2009/05/01/confessions-of-a-repentant-cardiologist/