It’s no secret pharmaceutical companies give money to faculty at the University of Kansas Medical Center.
At many American medical schools, drug companies pay professors to conduct research, offer professional advice and to speak to professionals about their products.
The university has a policy that governs these relationships and manages potential conflicts of interest. Many of these relationships, like industry-supported research, are considered beneficial collaborations that advance medicine. But according to critics, speaking services are oftentimes promotional endeavors that have no place in academia.
Since 2009, 18 KU Med faculty members received money to speak at company-sponsored events, according to a database released by ProPublica, a non-profit journalism organization. Faculty on the list ranged from volunteer professors to program directors, and they made anywhere from $600 to $161,000. KU Med employs 3,600 full-time, part-time and volunteer faculty members.
In total, 26 KU Med faculty have been paid for their research, consulting or speaking services by eight drug companies. They were also reimbursed for meals and travel. According to ProPublica, the information was gathered from company payment disclosures, some released as “the result of legal settlements with the federal government.”
The University Office of Compliance oversees industry interaction. According to Thomas Field, Associate Vice Chancellor for Compliance, no faculty listed on the ProPublica database have been found to violate any rules. But according to the American Medical Student Association, a national organization that reviews academic conflict of interest policies, the University should have stricter control over speaking relationships.
Drug companies pay health care professionals to present information about drugs and diseases to other practitioners. Sometimes, speakers are part of company “speaker bureaus,” a group that routinely presents lectures. Speakers are paid per event, and depending on how many they give, can make tens of thousands of dollars.
Pharmaceutical companies claim these lectures are valuable informational sessions. Field said faculties’ expertise make them qualified speakers.
“Speaking on conditions and medications is a way to educate other healthcare providers and create a dialogue,” Field said. According to university policy, faculty can speak on behalf of companies as long as the presentations are educational and non-promotional.
Critics of these lectures say they simply promote drugs. Even the university policy states “speaker’s bureaus are typically an extension of manufacturers’ marketing apparatus.”
“It’s pushing a product in a marketing way, not an educational way, and that’s when I get concerned about the way physicians and industry work together,” said Dr. Joseph Ross, assistant professor at the Yale School of Medicine who researches issues surrounding conflicts of interest and medical professionalism.
According to Ross, a conflict of interest exists because doctors receive payments from the companies that make the same drugs they give to patients, potentially influencing their prescribing habits.
Dr. Howard Brody, director for the Institute of Medical Humanities at the University of Texas Medical Branch, said medical school faculty could jeopardize not just their own credibility, but their schools’ as well.
“Do you want the credibility of the University of Kansas being used as a cover for this guy to go out and be a drug salesman?” said Brody, who has written books and articles about medical ethics.
Reshma Ramachandran, PharmFree fellow at AMSA, said paid speaking relationships could also jeopardize the objectivity of education. Her concern is that professors might use information presented in company-sponsored lectures in an educational setting.
But Bradley Grinage, a psychiatrist at the Topeka Veterans Affairs Medical Center, said speaking engagements are educational, not unethical.
Grinage has spoken for Pfizer, Johnson & Johnson and Astra Zeneca, making over $37,000 since 2009. During these talks, he said he has presented research-backed data provided by the companies. According to Grinage, his presentations have helped other doctors and made him a better psychiatrist.
“It does us more harm than good to stick our heads in the sand and not deal with the pharmaceutical companies,” Grinage said. “They offer education that helps and provide lots of good to psychiatry; if we ignore them, we can’t learn about any of it.”
Jim Gleisberg, Public Affairs Officer at the VA of Eastern Kansas, said administrators recently reviewed Grinage’s relationship with pharmaceutical companies but couldn’t comment on the results. Grinage said he has never been disciplined for his speaking activities, which he said have been cleared by his superiors.
Both Brody and Ross said some relationships with industry are beneficial, like research and other collaborations that solve medical problems.
“The issue of paying physicians is complicated by the fact that there are clear opportunities to collaborate between physicians and industry,” said Ross, who recently received a research grant from a medical device maker.
“There are some cases where a conflict of interest is something you deal with because not having that relationship would really harm some other interest you have that’s very, very important to your patient care or education,” Brody said.
KU Med policy
According to the Kansas University’s policy, faculty can give company-sponsored lectures if they are “solely responsible for designing and conducting the activity,” which must be educational and free from commercial bias.
“The committee believed that having policies in place that require faculty to make sure the ideas they present are their own would help address that issue,” Field said.
According to the American Medical Student Association, speaker bureaus are “unnecessary and detrimental.” The 2012 AMSA PharmFree Scorecard, which rates academic conflict of interest policies, gave the KU policy a “B.” According to AMSA, the university has a “strong” policy that “could be strengthened by clearly prohibiting long-term speaking relationships such as speakers bureaus.”
Like universities, drug companies also have policies to control presentations. These policies ensure the content is compliant with FDA regulations, and often times, require speakers to present company-created slides, sometimes in a specified order. Even Field said these policies could be conflicting.
“If you’ve got a pharmaceutical companies’ policy that tells one of their speakers they have to use all of the slides in a specific order, and we have a policy that says that our faculty (who) are speaking for a company have to be responsible for the design and development of the content, I think on the face of it those two are not congruent,” Field said.
Since 2010, GlaxoSmithKline has required doctors to only use company slides in a specific order. According to Eli Lilly’s policy, speakers must use certain slides but can choose the order. Pfizer also requires speakers to use company slides, but speakers can also present their own material if the company approves it. Merck does not require speakers to use its content but reviews all information before it is presented.
Field said doctors required to present company material do not violate the University’s policy as long as they could choose the order of them.
Ramachandran disagreed with Field. She said faculty give up control of the lectures when they are required to present company-created content.
“The slides are made by wonderful marketing teams to promote the drug,” Ramachandran said. According to her, the presentations often cite self-sponsored studies, not independent ones.
Field provided responses from each professor paid to speak. Some professors said they held informal question and answer sessions, while others presented slides that the company provided them.
Dr. Jennifer Klemp, an assistant professor, was paid $3,500 to educate nurses about cancer survivorship. Klemp said she used content she created.
Dr. Mazen Dimachkie, a neurology professor, has made $47,000 since 2009 speaking about Pfizer’s Lyrica. Field said Dr. Dimachkie is an expert on neuromuscular disease and chooses from a group of slides provided by Pfizer during his presentations.
Dr. Kurt Midyett, who has received $13,000 to speak about diabetes, said his presentations “were an opportunity to speak with other physicians who care for diabetic patients to advance their therapy and improve their lives,” according to a response provided by Field.
According to Brody, active speakers can make at least $50,000 a year, while the “high rollers” make up to $200,000. While he said he doesn’t approve of any speaking, those receiving a few thousand dollars a year are “small potatoes.”
Ross said universities have been moving away from the practice.
“Over the last 10 years, the landscape has changed a lot,” Ross said. “ Departments (and) medical schools are increasingly aware of how perverse these relationships were and how much money was changing hands.”
According to Ramachandran, universities, such as Harvard and Stanford, have started to ban speaking engagements. While some schools have had success limiting the activity, Ramachandran said prohibiting them is the most effective policy.
“More administrators have seen that speaking engagements are a problem, and you can’t manage them that well,” Ramachandran said. “It’s easier and sends a clear message when you ban them altogether.”
Field said his office is always reviewing its policy and continuing to educate professors about it. He said the committee considers AMSA’s critique when it reviews the policy.
According to a 2012 article in the New England Journal of Medicine, industry support for Continuing Medical Education events has dropped since it peaked in 2007.
In 2013, federal law will require pharmaceutical companies to disclose all payments of U.S. healthcare professionals.