Taking on Big Pharma

Where Corporate Excess Meets Medical Ethics

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AS THE PHARMFREE campaign became more sophisticated, Pfefferkorn became more involved in its work. In 2006, the organization launched a national survey of medical schools to determine if they had policies to limit the influence of pharmas and the medical device industry. The result was AMSA’s PharmFree Scorecard, which graded U.S. medical schools on a scale of A to F. Scores were based on the existence of ethics and conflict-of-interest courses in the curriculum, as well as schools’ policies on accepting gifts and meals from the industry, disclosing consulting relationships, accepting free drug samples, allowing industry-funded speaking relationships, exposing medical staff to industry sales representatives and other potential areas of concern.

The scorecard received national publicity. In 2008, strictly through peer pressure, the project was able to attract the participation of most of the nation’s 150 medical schools, only 21 of which received a grade of A or B. Sixty received a failing grade. Summarizing the findings, The New York Times wrote, “Most medical schools in the United States fail to police adequately the money, gifts and free drug samples that pharmaceutical companies routinely shower on doctors and trainees….”

Pfefferkorn became the director of the 2009 national scorecard project while he was earning a master’s degree in public health. It was a monumental task. Although he had a staff responsible for doing the actual grading, it fell solely on him to respond to the queries from all the participants. “The day before the first deadline, I received 90 e-mails,” he recalls. “Many were just submissions, but many had detailed questions about methodology, grades, etc. There were a handful of schools that felt they deserved an A no matter what. Often we had to agree to disagree. Nobody really seemed to understand that it wasn’t me who was grading.”

The impact of the scorecard has exceeded anyone’s expectations. About 85 percent of the schools participated in the last survey, up from 60 to 70 percent in the first years. It also helped shape the congressional debate on health care reform. Sen. Charles Grassley of Iowa, the ranking Republican on the Finance Committee, waged an all-out war last year on pharmas and device manufacturers. “I saw a great picture of our scorecard map in Grassley’s office,” Pfefferkorn says. “That was a wonderful moment.”

Grassley’s investigation rode a wave of public resentment over pharmaceutical costs. He uncovered more than $4 million in industry payments to three Harvard University psychiatrists who had promoted antipsychotic medicines for children, and disclosed Pfizer payments to at least 149 faculty members at Harvard Medical School. He investigated $800,000 in unreported payments from GlaxoSmithKline to the chair of Emory University’s psychology department; charged that a prominent cardiologist affiliated with Columbia University Medical Center failed to report millions of dollars in pharma income; and hunted down some of the nation’s most influential advocacy associations, including the National Alliance on Mental Illness, that coordinated lobbying campaigns with drug makers.

Grassley and Wisconsin Sen. Herb Kohl, a Democrat from Wisconsin, introduced a bill last year that requires pharmas and device manufacturers to disclose what they give to doctors in gifts, honoraria, travel and other items of cash value. The so-called Physician Payments Sunshine Act was folded into the House and Senate health care reform measures approved and amended by Congress. Grassley, who came under intense pressure last summer in his conservative home state, ultimately became a leading voice against the health reform measures.

Overall, the industry has essentially been given a pass in the health reform debate. A recent report from the Sunlight Foundation, a nonpartisan government watchdog group, suggests why. According to the report’s author, Paul Blumenthal, the pharmaceutical industry worked secretly with the White House last year to inoculate itself from serious regulation by agreeing to spend more than $100 million in advertising to support health care reform.

In addition to his work on the scorecard, Pfefferkorn also received plaudits from the American Public Health Association for his efforts to force Abbott Laboratories to reverse its withdrawal of the drug Zemplar from the Thailand market. Zemplar, used to treat chronic kidney disease, was developed by a University of Wisconsin researcher. The university’s technology transfer arm, Wisconsin Alumni Research Foundation (WARF), then licensed Abbot to produce the drug.

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