Having been in academic medicine as a clinician and researcher for more than 2 decades, I have been able to witness first-hand the significant changes that have occurred in the relationship between academic medical centers and the pharmaceutical industry. It would seem that academia and the pharmaceutical industry are a good match. Academic medical centers identify clinical problems, and pharmaceutical companies try to solve them. Based on lessons learned from academic research, companies provide funding and develop new medications. These medicines are tested in clinical trials, often with academic medical centers participating.
Unfortunately, this mutual relationship has suffered substantially over the last decade due to, of all things, free lunches and pens! The pharmaceutical industry has been portrayed as using unethical techniques to promote unneeded medications. The high price of drugs often is touted as evidence of pharmaceutical industry greed at a time when the mean annual tuition for private medical schools has increased to almost $50,000 per year.
This conflict has created a void in education regarding new medications. Academic leaders who called for the virtual banishment of pharmaceutical representatives from academic hospitals did not develop a plan to educate house staff and faculty about new medications. Our previous system, whereby house staff arrived early at a symposium for a modest lunch provided gratis by pharmaceutical companies to hear about new medications for the first 5 minutes, in the presence of their faculty, has been replaced by house staff and faculty busily scurrying to get food, showing up 10–15 minutes late for the lecture, and coming away with little information about new medicines.
Fortunately, in my view, the pendulum is starting to swing back. The decrease in National Institutes of Health funding and the overall decline in resources for academic medical centers will encourage more interactions with pharmaceutical companies. There is a new emphasis on translation of medical research to help patients. Pharmaceutical companies have long been doing this, and I hope that academia will learn from these companies about translation in the future.
I still remember as a member of the house staff learning from pharmaceutical representatives about new medicines such as cimetidine, diltiazem, erythropoietin, and ranitidine. Then, as a young faculty member, I learned about omeprazole, amlodipine, siladenafil, atorvastatin, and sevelamer, among others. These medicines transformed healthcare and improved the health of our patients. I hope we can return to a more positive interaction with pharmaceutical companies that will enhance our knowledge about new medicines and lead to better ways to use them.
Anthony Bleyer, MD, MS Professor of Internal Medicine/Nephrology Wake Forest University School of Medicine Winston-Salem, N.C. B