Does Academic Medical Center Leaders’ Position on the Board of Directors of a Pharmaceutical Company Create a Conflict of Interest?
Last week I posted a blog on my other website – ethicssage.com – that dealt with whether it is a violation of ethical standards to have leaders of academic medical centers paid for their work to sit on the boards of big drug companies? I asked whether it creates a conflict of interest that could taint ethical decision-making. The blog was motivated by reporting of the results of a study Dr. Walid F. Gellad of the University of Pittsburgh and colleagues that was published online on April 2, 2014 in the Journal of the American Medical Association. They found 16 of the 17 largest U.S. pharmaceutical companies had at least one board member who also held leadership positions at one of the some 30 academic medical centers. Gellad opined that these “ties may open the door to industry influence over important medical center or university decision-making, and may negatively influence the perceptions and trust of patients, students and the public. These risks have to be considered alongside any potential benefits.”
I concluded that the danger of the practice of allowing leaders of academic medical centers to sit on the boards of drug companies is more than just the perception that independent judgment may be tainted by these relationships. Academic medical centers should serve the public good. How can they be expected to do so if a situation arises, for example, where the pharmaceutical product is of questionable value and the center is dependent on funding from the company? After all, the deans and directors who sit on boards are only human and just as board members of corporate entities might be biased toward the interest of the company and not the public interest, these academic leaders might overlook a problem with a drug that could threaten the public health.
I received two comments on my blog that were insightful so I decided to include them as offering other perspectives on the important issue of ethics in the academic workplace. The first opinion is from Dr. Ron Schwartz, Professor of Nuclear Cardiology, Rochester Medical School. Dr. Schwartz writes:
Academic institutions should promote the intercourse of elite academicians and faculty with industry in the best interests of public health. The best interests of public health require understanding and appreciation of potential great value to society for elite academicians and faculty to guide the informed investment of substantial capital to develop new therapeutics to help and to heal.
The potential for corrupting biases and actions to which humans are vulnerable should be checked by (1) policies of academic institutions to require full and open disclosure of the financial relationship; (2) regular periodic review and transparency to the public of the actions of faculty leaders and members in this capacity by a consortium council of institutions; (3) prohibition of the privatization in whole or part of the industrial developments academicians work to advance; (4) Oversight by the academic institution to ensure industry relationships do not compromise the central and fundamental responsibility of academicians to their institutions and their core mission of care, research and teaching. (5) Limitation of the level of compensation for the academician permitted by the institution to eliminate undue influence.
Puritanical divorce of academia and industry I do not believe best suits the needs for advances in medicine and public health. I concur with an editorial by then ACC President Alfred Bove several years ago which stated the assumption of conflict of interest based on the existence of a financial relationship is inappropriate. Full disclosure, transparency, and oversight and limitations to prevent undue influence provide a basis for managing the risks and benefits of relationships of academic and industry.
I appreciate Dr. Schwartz sharing his views that recognize the importance of having academics involved in decisions made by pharmaceutical companies to advance public health issues. I then received a response to Dr. Schwartz’s piece from a doctor-friend of mine, Dr. Dan Wohlgelernter. Here is Dr. Dan’s perspective.
I must confess that I have a much less trusting perspective on this issue. While I agree with the goal of healthy exchange of ideas between academe and industry, I don’t think the absolute needs for impartiality and objectivity in the pursuit of science are compatible with richly funded sinecures. In other words, $312,564 compensation for serving on the Board of Directors of a Big Pharma company is in the category of influence peddling on a “too big to fail” scale. Perhaps Warren Buffett would be unaffected by that level of compensation, but a medical school department chair facing a doubling of yearly income by serving on the board is certainly prey to unwholesome impulses and influences. I’m particularly offended by the hypocrisy of these Academic Medical Center Leaders, many of whom are vociferous about creating firewalls between pharmaceutical representatives and their medical students and residents. How ironic that the same medical school that doesn’t allow its residents to accept a pen or pizza from a pharmaceutical representative has a Department Chair accepting >$300K to serve on the Board of Directors of the Pharma company that employs the very same reps who are banned from campus!
These are strong points of view by both doctors. I find myself more in agreement with Dr. Dan. In particular, he makes a good point that “$312,564 compensation for serving on the Board of Directors of a Big Pharma company is in the category of influence peddling on a ‘too big to fail’ scale.”
Dr. Schwartz points out that “the assumption of conflict of interest based on the existence of a financial relationship is inappropriate. Full disclosure, transparency, and oversight and limitations to prevent undue influence provide a basis for managing the risks and benefits of relationships of academic and industry.”
My problem with that is full disclosure and transparency does not cure the ills of the practice. However, I am willing to concede that academics can play an important role as advisers to commercial organizations such as the pharmaceutical companies. I do believe Dr. Schwartz makes good points when he suggests: (1) Oversight by the academic institution to ensure industry relationships do not compromise the central and fundamental responsibility of academicians to their institutions and their core mission of care, research and teaching and (2) Limitation of the level of compensation for the academician permitted by the institution to eliminate undue influence. These are protections that, I believe, would do some good.
I looked at the individual financial conflicts of interest policy of Harvard Medical School but found the one for the University to be more to the point of this blog. It says:
An individual financial conflict of interest is a set of circumstances that reasonable observers would believe creates an undue risk that an individual’s judgment or actions regarding a primary interest of the University will be inappropriately influenced by a secondary financial interest.
The policy statement goes on to say:
A financial conflict of interest is a matter of objective circumstance, and, therefore, a distinction between “apparent” and “actual” conflicts of interest is not useful. A conflict of interest does not depend on the character or actions of the individual. It exists (or does not exist) regardlessofwhetherit is operative, that is, whether it is in fact influencing an individual’s judgment or actions.
The way I read this, Harvard errs on the side of caution by saying a conflict is a conflict even if it does not affect judgments because of the nature of the relationship between a faculty member and the secondary party. I couldn’t agree more.
The issues addressed by the commentators are important ones and I hope other medical professionals will speak out in these matters. My gratitude goes to Dr. Schwartz and Dr. Dan for sharing their views with me.
Blog posted by Steven Mintz, aka Ethics Sage, on April 10, 2014