A recent report in the Journal of Medical Ethics took aim at the actions of university lecturers who have ties to pharmaceutical companies — including those at U of T.
The study — written by Dr. Navindra Persaud, a practicing physician at St. Michael’s Hospital — questions the validity of the content taught in one of the mandatory lecture series he attended as a medical student at the university in 2004. The lecture on pain pharmacotherapy used a modified classification chart from the World Health Organization (WHO) to show oxycodone as both a “weak and strong opioid,” comparable to codeine. However, as Dr. Persaud’s report indicates, oxycodone is at least “1.5 times more potent than morphine” a drug that the WHO lists as a strong opioid. Dr. Persaud’s study also claims that the drug’s adverse side effects were downplayed by the lecturer.
Even more problematic than the lecture content was the free reference book that was given to students, published by Purdue Pharmaceuticals — the same company that makes Oxycontin®, the brand name tablet containing oxycodone. The lecturer, Dr. Roman Jovey, was working for Purdue Pharma while lecturing at U of T.
“It’s called a ‘reference book’ to take with you, maybe some of them [students] are using it today, and might believe the content is endorsed by medical schools,” said Dr. Persaud.
After graduating, Persaud says he discovered that the information regarding oxycodone-based opioids in both the lecture and reference book was incorrect.
Dr. Persaud argues that this case shows the problems with pharmaceutical companies playing a role in teaching, saying that issues like these have “a direct result on patient care.”
Oxycodone use and abuse in Canada was at an all-time high in 2010; the university finally canceled the controversial lectures after Dr. Persaud brought to light the conflict of interest he had uncovered.
“It is the responsibility of medical educators to confirm the accuracy of lectures,” said Persaud, arguing that it is unreasonable to expect students or junior faculty members to regulate it themselves.
However, Persaud also feels that the university administration should be proud of having removed the lecturer once the issue was brought to its attention.
In 2010, Purdue changed the oxycodone-based Oxycontin® tablet to make it less alterable by those addicted to the drug and abusing it.
Health Canada was also forced to post a “Misuse and Abuse of Oxycodone-based Prescription Drugs” fact sheet on its website, stating: “This long acting tablet marketed under the brand name OxyContin®, is formulated to release oxycodone over a long period of time. However, when crushed or chewed and either inhaled by the nose, injected or swallowed, the oxycodone will be released and absorbed rapidly producing a heroin-like effect euphoria. For this reason, OxyContin® is often referred to as ‘Hillbilly Heroin’.”
Dr. David McKnight, the associate dean of equity and professionalism at U of T’s Faculty of Medicine, says the university is constantly trying to get better and was in the process of creating external relationship guidelines for lecturers when Dr. Persaud came forward with the conflict of interest allegations.
“The process was started in 2007, but it is a slow process,” said Dr. McKnight.
The guidelines were finally approved and passed earlier this year.
“The kind of goals the guidelines set out are to help people think about their external relationships to avoid inappropriate influence,” added McKnight.
When the issue was brought to light, the university severed its relationship with Dr. Jovey and issued a PDF document outlining the new federal guidelines around opioids. Although many former students were contacted, McKnight points out that not all the students who were present for the lectures — which ran for approximately six years — have been contacted.
“Students who hadn’t graduated yet were notified of the new standards,” he said.
Both Persaud and McKnight agree that it is also up to those who are now practicing to make sure they are well versed and up-to-date in all areas of medicine, including pharmacotherapy.
Last week the first comprehensive study into issues of conflict of interest at Canadian medical schools was published in the peer-reviewed, open access journal PLOS ONE. The study indicates that while big pharmaceutical companies have an increasing presence on medical school campuses, the conflict of interest guidelines are “generally permissive” when it comes to regulating the role and information these companies provide.
The University of Toronto ranked seventh out of the 17 Canadian medical schools in the PLOS ONE study.
“The ranking was based on the 2004 guidelines, not the new revised guidelines,” argues Dr. McKnight. “Since the work was done for that paper we have come a long way.”
While guidelines and regulations are great on paper, Persaud remains adamant that there is a simpler approach that should be adopted: “Doctors shouldn’t be working for pharmaceutical companies and lecturing at universities at the same time, they need to be excluded.”
