In May of 2000, shortly before I stepped down as editor-in-chief of the New England Journal of Medicine, I wrote an editorial entitled, “Is Academic Medicine for Sale?” It was prompted by a clinical trial of an antidepressant called Serzone that was published in the same issue of the Journal.
The authors of that paper had so many financial ties to drug companies, including the maker of Serzone, that a full-disclosure statement would have been about as long as the article itself, so it could appear only on our Web site. The lead author, who was chairman of the department of psychiatry at Brown University (presumably a full-time job), was paid more than half a million dollars in drug-company consulting fees in just one year. Although that particular paper was the immediate reason for the editorial, I wouldn’t have bothered to write it if it weren’t for the fact that the situation, while extreme, was hardly unique.
Among the many letters I received in response, two were especially pointed. One asked rhetorically, “Is academic medicine for sale? These days, everything is for sale.” The second went further: “Is academic medicine for sale? No. The current owner is very happy with it.” The author didn’t feel he had to say who the current owner was.
The boundaries between academic medicine—medical schools, teaching hospitals, and their faculty—and the pharmaceutical industry have been dissolving since the 1980s, and the important differences between their missions are becoming blurred. Medical research, education, and clinical practice have suffered as a result.
Academic medical centers are charged with educating the next generation of doctors, conducting scientifically important research, and taking care of the sickest and neediest patients. That’s what justifies their tax-exempt status. In contrast, drug companies—like other investor-owned businesses—are charged with increasing the value of their shareholders’ stock. That is their fiduciary responsibility, and they would be remiss if they didn’t uphold it. All their other activities are means to that end. The companies are supposed to develop profitable drugs, not necessarily important or innovative ones, and paradoxically enough, the most profitable drugs are the least innovative. Nor do drug companies aim to educate doctors, except as a means to the primary end of selling drugs. Drug companies don’t have education budgets; they have marketing budgets from which their ostensibly educational activities are funded.
This profound difference in missions is often deliberately obscured—by drug companies because it’s good public relations to portray themselves as research and educational institutions, and by academics because it means they don’t have to face up to what’s really going on.