Aubie Angel, MD (Senior Fellow)
Since April 2006, Junior Fellows in the Health Sciences have been meeting monthly to discuss current topics and professional issues in the format of Grand Rounds (MGR). In an effort to involve a wider community, MGR organized a Symposium (April 18th, 2007) entitled, “Medical Schools: A Nexus of Education and Industry”. A group of Junior Fellows, including Martin Betts (MED3), Fiona Menzies (MED3), Jai Shah (MED3) and Patrick Wong (MED2), under the guidance of Dr. Aubie Angel, MD, Sen ior Resident/Fellow, provided an interesting and provocative program, bringing representatives of our academic community, relevant graduate programs and industry leaders together to discuss challenges and opportunities. The Symposium was fully subscribed and animated by lively discourse.
Dr. Lawrence K. Altman, Senior Medical Correspondent from the New York Times, was the keynote speaker and enlivened the discussion by exploring a variety of conflicts of interest that go beyond the medical-industrial complex. He noted that the very structure of medical publishing limits communication due to a set of built-in biases, and that academic freedom is often constrained by confidentiality agreements. The peer-review system has faults because reviewers are often competitors and editors can select colleagues to adjudicate. He also provided an overview on the evolution of medical research funding, dating back to the idealistic days of Banting and Best. It was also noted that medical students nowadays do not have a sense of history in the evolving relations of the medical profession to industry, government and fellow practitioners.
Dr. Alan Detsky, Professor of Medicine and Health Policy Management Evaluation at U of T, discussed “Conflicts of Interest in Academic Medicine: Some Evidence” and presented evidence regarding how interactions with industry affect medical decision-making. Detsky explained that clinical practice guidelines are developed by individuals, but funded by industries that produce and market the same drugs that are being addressed in those guideline recommendations. He cautioned all to recognize the subtle influence of gifts and blandishments, because they often affect objectivity.
Ms. Leslee Thompson, VP Health Systems Strategies of Medtronic Canada, addressed the “Changing Landscape: One Company’s Experience.” She pointed out that her company, like many corporations involved in health care devices, has promulgated codes of conduct to provide a framework for ethical business relations. She acknowledged the continuing interdependency of industry and health care providers, and the collective responsibility borne by both – to retain the public trust by being objective and honest.
Dr. Lorraine Ferris, Professor of Public Health Sciences at U of T, defined commercial incentives that unduly influence professional judgement, pointing out the way in which these activities can influence clinical decision making. Industry is heavily involved in post-graduate education and it is important to ensure that content levels reflect the educational requirements of the participants, rather than the marketing priorities of sponsors. Simply put, “we must learn to dance with the porcupines’, so that we can get what we want and they get what they want, while maintaining our values (Editor’s note: But when one dances with porcupines, can one help but get pricked?!?).
Dr. John Evans, Chair of MaRS Discovery District, chaired the session on Models for a Constructive Relationship and led the interactive panel discussion. He described MaRS as ‘a neutral sandbox’ with its own set of rules to govern interaction with industry. These rules of engagement differentiate the goals and priorities of education, and the creative endeavours of those in industry, through the commercialization of products in a way that is simultaneously protective of freedoms and respectful of corporate goals. Hopefully, such rules could offset behaviour described by Dr. Irfan Dhalla, Chief Medical Resident at St. Michael’s Hospital in Toronto, in which some pharmaceutical representatives offered baseball tickets to physicians to influence their prescribing habits. Dr. Patrice Roy, Executive Director of Rx&D, countered this perspective with industry programmes that sponsor trainees through grants with no strings attached.
Ms. Maureen Brosnahan, Senior National Correspondent of CBC News, broke away from the academic-industrial debate and turned to the reality of health reporting by journalists who do not even hold medical degrees. Reluctance on the part of medical researchers to talk to journalists makes it harder for one to communicate the latest developments to the public.
Dr. David Goldbloom, Senior Medical Advisor of CAMH, in his summary remarks, believes that there continues to be some self-deception in the Faculty of Medicine in the line ‘we do not have the resources’ when it comes to education, particularly continuing medical education. We should not perpetuate the dependence on Industry to subsidize our educational responsibilities.
In short, Massey Grand Rounds provided a unique opportunity for these 8 speakers, students and mentors to address an issue of growing concern. Forging partnerships with industry is essential in order to support advances in care and the development of effective products. The academic community has the role of cultivating some of the best minds in medical schools, but it has an even greater responsibility of ensuring that knowledge translation occurs in an environment that embraces the highest ethical standards.
MGR is grateful to the following sponsors for providing unrestricted funds to cover the conference and publishing costs: U of T Faculty of Medicine, Medtronic Canada, Merck Frosst Canada, Friends of Canadian Institutes of Health Research (FCIHR), Massey College (U of T) and Waters Biomedical Inc.