Partners adopts tougher limits on doctors' ties to industry

By Liz Kowalczyk, Globe Staff

Doctors at Partners HealthCare no longer will be allowed to accept gifts and meals from drug and device companies, or travel the country as paid members of company "speakers bureaus,'' as the state's largest hospital and physician network adopts tougher restrictions to counter industry's influence over the drugs and treatments doctors prescribe.

Partners, which includes the Harvard-affiliated Massachusetts General and Brigham and Women's hospitals in Boston, also is placing new limits on how physicians interact with company sales representatives and increasing oversight of these relationships. Overall, the changes, which also apply to senior Partners executives, go further than a new state law governing doctors' conflicts of interest and generally will bring the organization in line with other major US teaching hospitals that have adopted tougher standards.

Many Mass. General and Brigham physicians are top researchers, making drug and device companies eager to collaborate with them on developing new treatments for patients -- relationships Partners executives said they want to preserve. But because of their status as "thought leaders," these doctors also are attractive targets for helping companies spread their marketing messages through speakers bureaus and medical education.

"We don't want our faculty being on the road" as "hired guns," said Dr. Peter Slavin, president of Mass. General and a member of the commission that developed the new policy, referring to the decision to prohibit speakers bureaus. Slavin said the group decided to prohibit physicians from eating meals on a company's tab, including lunches bought for doctors-in-training in the hospital, because it "doesn't promote a positive image of physicians and increases health care costs."

Company salespeople are frequently seen in the hallways of Mass. General and the Brigham, but the new rules make them less welcome. They won't be able to visit doctors without an invitation from the physician, and the policy forbids company representatives from providing free drug samples directly to doctors, a practice that's been used by companies to encourage the use of newer and usually more expensive brand-name drugs. Instead, they will be able to donate samples only to hospital pharmacies or some other central repository.

Partners' policy, which was disclosed to staff today and will be implemented by October 1, goes further than a state law passed last year to restrict doctors' relationships with industry. The law allows companies to pay for certain meals and to distribute drug samples directly to doctors.

The rules also go further than some other teaching hospitals', by banning all gifts and meals and forbidding speakers bureau participation and ghost writing -- when researchers allow themselves to be listed as authors on papers written by others, often by drug company staff.

But in other respects, Partners did not go as far as Stanford University School of Medicine, which recently barred drug companies from paying for specific continuing medical education courses for doctors, or as Memorial Sloan-Kettering Cancer Center in New York City, which banned industry support for the courses altogether. Partners placed further restrictions on medical education funding, but still will allow industry support, as long as at least two companies pay for a specific course and it is approved by a newly-created Educational Review Board.

Stanford and the Cleveland Clinic plan to disclose on their websites which doctors receive consulting payments from industry -- and the new Massachusetts law will require public disclosure of some of these relationships as well, starting in July 2010. Partners' new policy does not address public disclosure, but Slavin, who will oversee implementation of the policy, said the hospitals will develop a plan for disclosure to patients.

The changes come as Mass. General and several of its psychiatrists are under scrutiny from Congressional investigators over their relationships with pharmaceutical companies.

US Senator Charles E. Grassley, Republican of Iowa, has accused Mass. General child psychiatrist Dr. Joseph Biederman of failing to tell Harvard Medical School until last March about most of the more than $1.5 million that the pharmaceutical industry paid him in consulting and speaking fees between 2000 and 2007. Biederman has said in statements and letters to the Globe that he has been conscientious about disclosure requirements.

Last month, federal prosecutors alleged that another Mass. General psychiatrist, Dr. Jeffrey Bostic, became a "star spokesman" for New York-based Forest Laboratories Inc., which paid him more than $750,000 between 2000 and 2006 for his presentations on treating depressed children. Bostic has not been charged with any crime and, through hospital lawyers, denied that he promoted the company's drugs.

Partners must work out details of the ban on speakers bureaus; one or two presentations by a doctor a year at a company-sponsored meeting might be allowed, but repeated talks paid for by a company will not be. Doctors still will be allowed to act as paid consultants for companies, but hospital oversight of these activities will be more rigorous.

Grassley and several groups advocating for tougher conflict-of-interest rules praised the new policy.

"It’s good that the hospitals associated with Harvard are responding to these concerns," Grassley said in a written statement. "I’m especially glad that these hospitals are taking a national lead on issues such as ghostwriting and speakers’ bureau fees. ... I’ll follow the progress closely."

Partners executives said they did not adopt the stricter policy because of Grassley's investigation; the commission began its work in late 2007. But Dr. Eugene Braunwald, who chaired the group, said Grassley's inquiry was a "confirmation that people are watching us. If the public, as represented in Senator Grassley, doesn't trust us, we need to remedy that."

Not everyone applauded all aspects of the new rules.

Dr. Arnold Relman, a Harvard Medical School professor and former editor of the New England Journal of Medicine, said the medical education provisions don't go far enough. "There should be no, zero, industry funding for any particular educational program," he said. "If you know your CME program is dependent on money from a company, it's impossible not to be influenced by that fact."

Dr. Thomas Stossel, a physician at Brigham and Women's who was an advisor to Merck several years ago, said that growing restrictions on the interactions between doctors and industry could end up hurting patient care. "We have all these tools now (for caring for patients) and those tools have come from physicians working with industry," he said. He likened the current atmosphere to a "witch hunt."

But Dr. William Hoffman, a critical care physician at Mass. General, said stricter rules are needed. He said he usually tells drug representatives to "stop by when they're in the building," and if he has time, he sees them. He said he's unlikely to go to the trouble of issuing invitations.

"On the surface, most people here will say this policy is needed to rein in the influence of companies," he said. "But there are people I'm sure who supplement their income substantially who are going to miss it."