Braunwald: “In all fairness, what was OK three years ago is not OK now.”

A new policy from Partners Healthcare that limits compensation to doctors from industry is provoking lots of discussion (see below), at least in part because of a story in the New York Times by Duff Wilson. (Click here to read the press release Partners issued last April. Click here to read the full report.) One reason, of course, is that Partners is a major teaching affiliate of Harvard Medical School and includes top-rated Brigham and Women’s Hospital and Massachusetts General Hospital. Another reason is that the chairman of the policy-writing group was Eugene Braunwald.

Two details in particular received lots of attention in the Times story:

• Although Partners doctors can still serve on the board of directors of companies (as does Dennis A. Ausiello, chief of medicine at MGH and the chief scientific officer at Partners, who sits on the board at Pfizer), their compensation for these duties will now be limited to $500 an hour, or $5,000 per day. That may seem like a lot to some observers, but it’s a big step down from the $220,000 Ausiello received last year from Pfizer for a few days work on Pfizer’s board.
• Partners employees– including, according to the Times, 8,000 doctors with Harvard appointments– can no longer receive speaking fees from industry.

You can click on the links below to read lots of discussion about this story. For now, just a few observations:

The importance of Braunwald’s involvement should not be underestimated. Previous efforts at reform– despite the imprimatur of such august bodies as the Institute of Medicine and JAMA— have not been terribly effective, at least so far. One reason may be a feeling in mainstream medicine that the movement is the result of mavericks and malcontents. But nobody has ever accused Braunwald of being an outside agitator, at least for a very long time. And anyone who has had dealings with Braunwald knows that he is a supremely practical person. If he thinks it’s time for reform then it may be time to place your bets with the reformers.

But reform only goes so far in the new guidelines. Although there’s a strict ban in the new rules against accepting speakers fees from industry, there is no such ban against industry-supported CME as long as it is approved by an internal review committee. And many others believe that academic physicians should never serve on a company board. The full report includes many other instances in which close interaction with industry is allowed.

Finally, people appear fascinated with a quote from Braunwald that closes the Times story:

“In all fairness, what was O.K. three years ago is not O.K. now.”

I’ve heard all sorts of off-the-record responses to this remark. One compared the remark to baseball players saying it was OK to take steroids years ago. Another took the position that it’s in everyone’s best interest to let bygones be bygones, like the reconciliations that took place in South Africa and Eastern Europe after the fall of apartheid and communism. My own view is that Braunwald isn’t making any kind of moral judgment but is instead making a simple assertion of fact.

Links:

Report: Partners Commission on Interactions with Industry (PDF of the Partners report)

Partners HealthCare to Implement New Industry Interaction Recommendations (Partners press release)

Harvard Teaching Hospitals Cap Outside Pay (New York Times story by Duff Wilson)

MGH parent curbs fees to staff from drug makers (Boston Globe)

“Should Doctors Serve on Drug Company Boards?” (The Carlat Psychiatry Blog)

One Small Step Towards Reducing Conflicts of Interest Affecting Academic Medical Leaders (Health Care Renewal)

Boston Hospitals Limit Pharma Board Compensation (Pharmalot)

JAMA writers call for medical groups to sever financial ties to industry (CardioBrief)

Conflicts of interest threaten public’s trust in medicine: IOM report (CardioBrief)