Trials of Money and Medicine

The Class Symposium of the HMS Class of 1981 highlighted some of the nontraditional career paths that the former classmates have taken in the 25 years since graduating from medical school, including working in the pharmaceutical industry, finance, and government. By recounting their personal and professional experiences, the speakers often returned to larger issues: conflicts of interest and the role of industry and economics in medicine.

Prize Drugs
Ilona Rimm left an academic track at Dana–Farber Cancer Institute for a position at Wyeth Pharmaceuticals because she found advancement difficult in academia, where one male professor, she said, told her she needed to be “more seductive.” Rimm noted the great distance between the worlds of patient care and the drug industry, in which few people have ever seen a patient. Now Rimm works in health care investment banking as the director of MEDACorp Institutional Consulting; she enjoys aiding drug development by “putting money in the right place.”

Robert Tepper, president of research and development at Millennium Pharmaceuticals, argued that a large-scale collaboration between academia and industry is needed to make use of the vast information from the Human Genome Project. Medical education should educate students about drugs and clinical trials to make those connections stronger. He cited the example of Gertrude Elion, who won the Nobel Prize in 1988 for her work in industry, synthesizing new drugs for a variety of conditions. “If drugs are ‘prizes to humanity’ to better human health, why do we not teach students how they are discovered and developed?” Tepper asked.

“You can’t do evidence-based medicine if you don’t have all the studies,” said Deborah Zarin, who has been leading a government-sponsored effort to register and track clinical trials and their outcomes.

The Dollar Trail
Other speakers pointed to recent concerns about close ties between academic medicine and industry. Deborah Zarin, director of ClinicalTrials.gov, talked about how her career has shown her the flaws and biases in the current system. Evidence-based medicine is difficult to trust when “our entire evidence base is subject to industry influence and bias,” she explained. Zarin believes that simply listing a researcher’s conflicts is not a sufficient cure for the problem. “As a consumer, what do you do with that information? ”

The goal of ClinicalTrials.gov is to register and track clinical trials to prevent companies from hiding results. Last year, a U.S. law mandated that certain studies be registered, and the International Committee of Medical Journal Editors said that registration would be required for publication in their journals. Zarin said that compliance with the law has been poor among industry studies, but that the “journal editors’ policy, which is not legally binding, has had a huge impact.” Yet some drug companies, she said, have figured out ways to enter information in the system that is uninformative or misleading—for instance, registering a drug under different serial numbers so the companies can choose which trials to publish.

Richard Stone, HMS associate professor of medicine at DFCI, offered an insider’s view of how academic clinical researchers get entwined with industry, from attending paid advisory board meetings in tropical locales to putting their names on industry-funded papers without ever seeing the full data. This relationship helps the companies, but it also helps researchers publish, gain esteem among their peers, and pay for their children’s college tuitions. “Bias is inherent,” he said. If the system did not allow these entanglements, Stone wondered, “Would we be able to run clinical trials at the same pace that we do now? ”

During the discussion, one class member noted that the talks highlighted the “trail of money through medicine,” which is a powerful force beyond the control of the average physician.

—Courtney Humphries

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