An informal survey of medical schools by NPR found that some schools rely on funding from pharmaceutical and other health-industry sources.
The issue is taking on increasing importance. Government funding for medical research is not expected to increase in coming years and could decline. Medical schools will be more reliant on private, for-profit industry for funding. That raises concerns about academic freedom and restrictions on what researchers can and cannot say in print and in public.
The informal survey was done by searching financial information on the Internet and through phone interviews. It found that between 2 percent and 16 percent of medical schools' yearly budgets come from the drug industry. The survey included budgets for fiscal 2003 and 2004. (See chart below.)
To illustrate how valuable this financing can be to some schools, consider the University of Oklahoma Health Sciences Center. The Oklahoma facility is a medium-sized medical school with two campuses, one in Oklahoma City and one in Tulsa. It had 585 students in 2004.
About 13.5 percent of the medical center's budget came from industrial-pharmaceutical sources in fiscal 2003. Drug giants such as AstraZeneca gave $818,440; Merck gave $801,858; Novartis gave $677,944; and Pharmacia & Upjohn gave $591,430. There were 183 industrial-pharmaceutical grants that year totaling $13.8 million. (The largest grant was a payment from the hospital company that operates the university's teaching hospitals and is omitted from this analysis.)
More than half of the medical center's budget came from federal sources in fiscal 2003. It received $58.8 million from the National Institutes of Health and other federal agencies. That represents 57.6 percent of total grants given to the center that year from all sources.
Still, the money from the drug industry is valuable to the medical center. "It's an important consideration financially, but it's not critical," says Dr. Joseph Waner, vice president of research at the Oklahoma facility. Losing a grant would mean some juggling, but there are many sources for private funding of medical research, he says. Grants are used to supplement faculty incomes, pay for technical support and other research necessities.
Waner says some faculty members do feel pressure to keep their funders happy. So-called "clinical faculty" are doctors who have busy practices and see a lot of patients. But they can't engage in research full-time like research faculty can. They want to continue to participate in research, so they seek out and accept offers of funding from drug companies for studies, speeches and other services. Waner says that this pharmaceutical funding "makes available research protocols that wouldn't be available otherwise" to patients.
In NPR's story about Merck's influence over independent doctors and medical schools, reporter Snigdha Prakash details how one drug company applied pressure to censor a critic of a popular painkiller.
A former Merck employee at the center of the story, Dr. Louis Sherwood, made phone calls to the department heads at several medical schools, complaining about faculty members who were critical of Vioxx. Sherwood told NPR in an interview that no threats were ever made to cut off funds or influence a person's academic position.
But whether threats are made in these situations, academics do feel pressure.
"The problem is that faculty, particularly the kind of faculty we're talking about here, don't have tenure," says Lisa Bero, a researcher at the University of California, San Francisco, told NPR's Snigdha Prakash. "They don't have security of employment. They're in a more junior position, which is very vulnerable to influence from their department chair. It's very tenuous.
"So they could potentially lose their job, lose their employment," she told Prakash. "Or if they don't, their life can be made quite miserable in terms of receiving adequate research space, not receiving administrative support or something like that."
Waner of OUHSC says it's important for the deans of medical schools and department heads not to let that happen: "You have to create an atmosphere to give support to the junior faculty so that they can refuse to go along." If a company makes an unacceptable demand, he says, faculty should understand that saying no won't result in adverse consequences.
Though our survey could not establish the full scope of industry funding at medical schools, it's important to note that some institutions get very little money from industry. Washington University Medical Center, for example, ranks second in federal health funding. But it gets just 1.9 percent of its budget from drug makers and other health-industry sources.
Joe Neel is NPR's health editor.