Bitter Pills

It was like something out of Michael Clayton, only with Big Pharma as the villain: A Pfizer drug rep, clad in a black suit, was taking cell-phone pictures of students protesting Harvard Medical School's ties to the drug industry. Staged last October, the gathering was sparsely attended, with a few students holding signs and a petition delivered to an empty office (the dean was out of town). But the photographer's appearance was notable enough to merit a story in the New York Times, which eventually led to an investigation by U.S. Senator Charles Grassley.

And so it goes for Harvard Medical School, which has been under intense scrutiny since 2008, when a series of incidents put a spotlight on its symbiotic, if awkward, relationship with drug companies. The trouble started that summer, after Joseph Biederman, a Massachusetts General Hospital child psychiatrist and HMS professor, was found to have taken more than $1.6 million in payments (which he failed to fully disclose to the school) from the maker of a major antipsychotic he'd been prescribing. There were other stories, too, like the student who had sat in class listening to a professor drone on about the benefits of statins—only to find out later that his teacher had been paid by 10 drug companies, five of which made the cholesterol treatments he'd been advocating. Then came the Pfizer photog.

Such incidents haven't just embarrassed Harvard, though. They've also put the institution at the center of a national debate over the relationship between pharma and medical schools. It's a fight about ethics, prized research projects, and millions and millions of dollars, of course, but it's also personal. With two of HMS's highest-profile professors serving as standard-bearers for the opposing sides, an already-controversial topic has turned into a full-out battle of wills.

No other faculty member at Harvard has been as vocal a critic of the pharmaceutical industry as Marcia Angell. A pathologist and former editor in chief of the New England Journal of Medicine, she began raising the alarm in 2000, when she wrote in the NEJM that medical schools were becoming "increasingly beholden to industry." Harvard, she noted, had long prided itself on its strict conflict-of-interest stance, but she feared it was "in the process of softening its guidelines" in a bid to keep researchers from defecting to institutions with more-lax rules.

Instead, the school settled on a set of policies that was stringent, if not the nation's strictest. The rules, still in place today, put some limits on doctors but do not ban them from meeting with low-level drug reps. Doctors are allowed to own stock in businesses related to their specialties, but only $30,000 worth or less, and they can accept up to $20,000 in speaking and consulting fees per year from the companies. The problem is that Harvard's affiliated teaching hospitals have their own guidelines, which don't always match up with the school's. The patchwork system means doctors often might misinterpret the rules or not know which ones they should follow.

Angell wants the school to simplify the matter by basically cutting all ties to drug makers. Doctors "should have no financial interest in companies whose products they are evaluating," she argues. No stocks. No money for speaking or writing for industry forums. Drug reps shouldn't be allowed on campus.