The September 29th Lab Seminar was led by Kirsten Austad, an Edmond J. Safra Lab Fellow, and medical student at Harvard Medical School. While Kirsten's research specifically targets the influence of the pharmaceutical industry on the education of medical students, she opened the seminar by describing the economy of influence that pervades the entire medical system. It is a complex arrangement, comprised of researchers, journals, medical schools, speaker's bureaus, consultants, advisory boards, physicians, patients, and pharmaceutical companies, though this is hardly an exhaustive list. Within such an extensive network, there are innumerable opportunities for the pharmaceutical industry to exert their influence, whether through direct interactions with physicians, or more subtly through their funding of medical research. Kirsten is particularly interested in the ways that pharmaceutical companies may influence medical students, and the seminar discussion revolved around the particular methods she will use to examine this relationship, as well as possible tools that could be created to address these conflicts of interest in the medical profession.
Kirsten's project will survey medical students at various points in their training. It will be a cross-sectional, stratified random sample of medical students from 120 medical schools, and will assess exposure and attitudes toward pharmaceutical marketing, as well as attitudes and behaviors related to evidence-based medicine, and how these attitudes may change over the course of the student's training. The survey results will be considered alongside the institutional characteristics of the medical school attended by each respondent, to see whether those characteristics shape the attitudes or behaviors of the students. There was some debate about what would be the most relevant institutional characteristics to consider. Some participants suggested examining funding differences across universities, and whether a significant portion of a school's funding comes from pharmaceutical companies. Others were interested in whether faculty members are expected to raise a percentage of their salary, and how that percentage may vary across institutions. All of these are factors that may affect a medical school's culture, and by extension, the attitudes and behaviors of medical students.
Following Kirsten's presentation, seminar participants considered the specific strategies and tools that could be implemented to address conflicts of interest in the medical profession. Though many universities and hospitals require doctors to report any outside funding they receive, the methods that are used in collecting this information lack uniformity, and tend to be rather complicated. It was suggested that the implementation of a database, with a simple electronic form for collecting funding information from physicians and researchers would allow more efficient identification of potential conflicts of interest. It was also suggested that the availability of such data could possibly create a market for independence among physicians, thereby generating a financial incentive for physicians to maintain their independence from pharmaceutical companies.
In summary, participants discussed the economy of influence within the field of medicine, and provided feedback on a research project that aims to examine how the attitudes and behaviors of medical students may be shaped by the institutional characteristics of their medical school. The seminar concluded with a discussion of tools that could implemented to more efficiently assess potential conflicts of interest in the medical profession.