Should Manufacturers Be Permitted to Influence Endorsements?

In 2006, Stanford University took a tough and unpopular stand with its medical school professors. They banned what might be characterized as “payola”. Stanford put a stop to free lunches, trinkets with drug company names inscribed and have now barred professors from giving paid promotional speeches for pharmaceutical companies. This was a responsible and appropriate position to take, but, sadly, without  any checks and balances in place to assure compliance.

In most countries the title of professor is not given out lightly. Typically the only people possessing that title have long years of experience and are highly recognized in their field of expertise, but in the US we have assistant professors, associate professors, professors, tenured professors, non-tenured professors, etcetera. Still, even in the US, the title of professor carries with it  a certain respect for knowledge possessed and excellence attained.

It is disappointing to many that drug companies have been buying the authorship of articles from professors, some very noted professors, and purchasing the support for certain drugs from professors who quite often have no knowledge of the drugs except the information fed to them by drug manufacturers.

Academic institutions have “conflict of interest” policies that are supposed to prevent and control these efforts on the part of  drug companies, medical device manufacturers and others in bartering of academic support. Unfortunately, many of these institutions have relied on the candor of the professors being solicited and have not put into place any formal structure for policing this problem.

Some question why professors should be so tightly controlled. The fact is large amounts of money from manufacturers are in play and professors, even the best, are but human. It seems innocent to be paid to deliver a speech about a drug, for example, and particularly so when you have decided you think the drug is a good one. The problem is many-fold, though. Drug companies and medical device manufacturers typically pick the audience, the topic of the speech and provide the information they want the professor to use in their speech. Seems innocent enough unless the manufacturers desire to sell product exceeds their responsibility to safety – a problem we see repeated far too often.  This is a  problem best illustrated by the chair of a national panel examining conflicts of interest:

“You’re giving someone else’s messages, someone else’s talk, someone else’s judgments,” said Dr. Bernard Lo, a medical professor at University of California, San Francisco who chaired a national panel examining conflicts of interest in medicine. “We don’t allow our students to use someone else’s work.”

Dr. Richard Krugman, vice chancellor for health affairs at the University of Colorado thought his conflict of interest of policy was working fine and was surprised to learn that as many as 13 UC professors had been paid by drug companies for speeches given.

Most physicians see their participation as an academic exercise in which they provide information to the audiences to whom they are speaking. For example, Dr. Michael McDermott at the University of Colorado Hospital:

“From my standpoint, the value of my programs is purely educational for the attendees,” he wrote in an e-mail. Selling of the drug is left to company reps “to be done at a time that is different than when I give my talk.”

The problem, in addition to the control asserted by manufacturers over the speeches, is that an academic’s title imposes a certain built-in credibility and that professor’s approval of the drug or other product because of the educator’s reputation.

Efforts to control conflicts and to prevent manufacturers’ manipulation of presentations demonstrate responsibility and good governance on the part of teaching institutions. It is much safer and healthier for patients if academics study drugs and medical devices independently and provide the medical community and the public with unvarnished evaluations of these products.