Walid Gellad, MD, MPH, is both assistant professor of medicine and assistant professor of health policy at the University of Pittsburgh and a physician in the US Department of Veterans Affairs (VA) Pittsburgh Healthcare System. He is coauthor of a recent research letter in the Journal of the American Medical Association (JAMA) [Academic Medical Center Leadership on Pharmaceutical Company Boards of Directors, also by Timothy Anderson, MD, Chester Good, MD, MPH, and Shravan Dave, BS] that reveals almost all US large drug companies and 40 percent of all drug companies studied have leaders in academic medical centers on their boards. These drug company board members include deans, chief executive officers, department chairs, trustees at academic medical centers, school of pharmacy officials and university presidents.
Rosenberg: Your recent JAMA paper exposes shocking industry/academic relationships many would not expect and was covered by the Associated Press, the Milwaukee-Wisconsin Journal Sentinel and a Wall Street Journal blog. What inspired you and your colleagues to investigate this?
Gellad: There is a lot of talk right now about physician conflicts of interest, whether the discussion is about medical students accepting pens or lunches from the pharmaceutical industry or physician consulting and speaking payments becoming public with the Physician Payment Sunshine Act. Yet the issue of dual leadership—academic medical center leaders serving on pharmaceutical company boards of directors—has not really been addressed. We investigated these relationships for 2012 using publicly available data.
Rosenberg: Just as shocking as academic leaders serving two masters was the sheer money involved—an average of $300,000 was paid to academic leaders or members of boards of trustees serving on drug company boards. One article defending the board positions said “$300,000 is not buying anyone’s ethics,” but I think most of the world would disagree.
Gellad: These amounts of compensation are typical for serving on large corporate boards. The corporate governance that board members provide includes oversight over executive leadership and fiduciary responsibility to shareholders. Remember, not all the academic leaders we found who are serving on drug company boards are deans, presidents or CEOs of hospitals. Some are on boards of trustees and not entrusted with running day-to-day operations of academic health centers—but they all had leadership roles at both academic centers and in industry. Also remember that we are not saying anything negative about academic/industry relationships in general, or necessarily about these particular relationships, but we feel that they need to be in the open and understood by the general public, patients, and doctors, just like other potential conflicts of interest . . .
Rosenberg: Your paper does not spell out specific risks of these relationships. But a JAMA Viewpoint last month (by Etta Pisano, MD with the Medical University of South Carolina, Robert Golden, MD with the University of Wisconsin and Laura Schweitzer, PhD with Union Graduate College) does. The authors ask if leaders will “direct business inappropriately” to the drug company they serve or “inappropriately use information.” They also note the drug company board position would have a “chilling effect” on competing companies when it comes to business dealings.
Gellad: Certainly there are lots of decisions that academic health center leaders make with regard to the educational, clinical and research missions of their institutions that could potentially be affected by their board positions with drug companies. Some academic medical centers have internal policies covering these relationships, perhaps requiring someone who is serving on a corporate board to recuse his or herself on certain decisions. The purpose of our paper was not to answer the question about what should or should not be done about these relationships; the purpose was to get people asking that very question.
Rosenberg: Since we reporters are not allowed to take so much as a cup of coffee or a book from those we are writing about, it is hard to imagine a defense of this policy from industry, academic institutions or the recipients of this double income.
Gellad: Pharmaceutical companies don’t view it as a conflict of interest; they would say representatives from academic medical centers offer important scientific and clinical insights to help corporations frame and develop new research, which they argue is ultimately for the benefit of patients.
Rosenberg: Yes and cynics would say “new marketing directions.”
Gellad: The question here is, if there are benefits to these relationships, which there may be, can we get the benefits without the inherent risks of having an academic leader responsible to shareholders of a public corporation while also managing large, often nonprofit and taxpayer subsidized, institutions. It is striking that there are now clear limitations on medical students accepting a pen or lunch yet these high-level dual leadership positions have gone relatively unexamined.
Martha Rosenberg is an investigative health reporter. She is the author of Born With A Junk Food Deficiency: How Flaks, Quacks and Hacks Pimp The Public Health (Prometheus).