Saturday, March 08, 2014

Three wrongs don't make a right, even for Deans

An important comment was submitted on my post below, in which I argued that the service of the University of Illinois Dean of Medicine on the Board of Directors of a medical device and pharmaceutical company was unwise.  Recall that I said:

I seek to present facts and context that, in my mind, again raise the issue of governance and propriety:  How can this person exercise a proper duty of care and loyalty to both institutions, not only in terms of time commitment, but also in terms of the overlapping scientific research and clinical interests of the two organizations?  I raise this issue not to accuse anyone of misbehavior, or engaging in conflicts of interest that result in personal gain, but as a matter of public trust.

The comment was as follows:

The governance rules that allow external leadership positions are not unique to UIC or to the city of Chicago. As examples, the Dean of Weill Cornell Medical College in New York is on the Board of Directors of Bristol-Myers Squibb Pharmaceutical Corporation, and the Dean for the University of North Carolina School of Medicine is on the Board of Directors of Eli Lilly. This is an issue that extends beyond the city limits of Chicago – a city that I call home and I love.

I checked it out.  Laurie Glimcher, the Dean at Weill Cornell, is indeed on the Board of Directors of the Bristol-Myers Squibb Pharmaceutical Corporation. She is an expert in rheumatology, immunology, skeletal biology and translational medicine.  You can understand why BMS would welcome her to their board, as they have a large presence in the immunology field.  She is also on the Board of the Waters Corporation, a laboratory equipment company.

Questions akin to those I have raised about UIC have been raised about Dean Glimcher's dual roles:  This article, for example, was published in 2012 in the Cornell Daily Sun:

In addition to receiving an academic salary from Cornell, WCMC Dean Laurie Glimcher receives six-figure salaries annually from pharmaceutical giant Bristol-Myers Squibb and the Waters Corporation, a laboratory equipment company, according to the companies’ filings with the U.S. Securities and Exchange Commission. There are no allegations that Glimcher has used her position at Weill to do anything illegal or to steer the school to purchase those companies’ products.

But leading research ethicists say such close financial ties to big business can prove harmful in less obviously wrong ways. Having a medical college’s top official personally and financially invested in the profits of the medical industry can stifle academic integrity and stain medical research with a subtle, if perhaps unconscious, corporate bias, they said.

“If medical faculty know they’re basically reporting to Bristol Myers Squibb, does that make them change what they do? Be more afraid to criticize certain priorities?” said Roy Poses, president of the non-profit Foundation for Integrity and Responsibility. “There’s a lot of evidence to [cause] concern [that it does] alter their behavior.”

Poses, who is also a professor of medicine at Brown University, pointed to board directors’ legal obligation to help the companies they work for.

“If you’re sworn to uphold these shareholders and you are good buddies with the management, are their interests always completely aligned with [those of] students and faculty [and] patients of the medical school?” Poses said.

William L. Roper is dean of the School of Medicine and vice chancellor for Medical Affairs at the University of North Carolina at Chapel Hill (UNC) and CEO of the UNC Health Care System.  He is an expert in pediatrics and social medicine.  He is not on the board of Eli Lilly.  But he is on the Board of Directors of DaVita, Inc., which provides a complete range of dialysis treatments and support services for patients.  DaVita reports: "Dr. Roper brings substantial expertise in the medical field, an in-depth understanding of the regulatory aspects of our business as well as clinical, financial and operational experience."  Dr. Roper is also on the Board of Directors of Express Scripts Holding Company, which provides pharmacy benefit management services and clinics healthcare account administration services.

As in the case of the UIC Dean, there is no evidence of any attempt to hide Glimcher's or Roper's relationships.  As you would expect, they are fully disclosed in both university and company documents.

So what's the problem?  It's the same one I mentioned at the start:  How can this person exercise a proper duty of care and loyalty to both institutions, not only in terms of time commitment, but also in terms of the overlapping scientific research and clinical interests of the two organizations?

In a era of diminished public confidence in our health care institutions and in the pharma companies, why introduce additional relationships that have the potential to erode public trust?  There are plenty of ex-Deans with scientific expertise to be tapped by public companies.  And for these three Deans, there will be plenty of commercial board opportunities when they step down some day.

6 comments:

From Facebook said...

A Facebook discussion:

Johann Odermann “If medical faculty know they’re basically reporting to Bristol Myers Squibb, does that make them change what they do? Be more afraid to criticize certain priorities?” said Roy Poses, president of the non-profit Foundation for Integrity and Responsibility. “There’s a lot of evidence to [cause] concern [that it does] alter their behavior.”

That's a bit of a stretch.

Naomi Kaufman Price Oh, these guys pale next to Duiz (spelling?) the dude who just left Duke for the IOM. He didn't even quit his board seats right away, only after a few folks started to raise questions. And who knows whether he still has bundles of Medtronic stock. Ditto Cassels. So so so much money. Which then results in trickle-down cynicism: faculty taking bucks for "research" that really isn't; "expert" talks or "advice" sponsored by pharma or device companies; kickbacks for using certain products (see Infuse by Medtronic) and no doubt the selection of knee/hip implants. Cesspool.
11 hours ago · Like

Johann Odermann Full disclosure should be a requirement. Where abuse exists it should be called out and the culprits held responsible. Assuming that someone is crooked or compromises patient care because they sit on a board or advise a company is as silly as assuming someone is straight or a good informed practitioner because they have no ties to any corporations.

Paul Levy I'm not assuming they are crooked. That's not the issue: It's whether it is possible to exercise a dual duty of care or loyalty.

Beverly Heywood Rogers Yes, it's far subtler than crookedness. It gets the person to feel more positively toward the company and promotes a subliminal desire for reciprocation toward them, which benefits them when buying decisions are made. Why do you think advertising is taking over the world?

Anonymous said...

Dear Paul,

One clarification…The Executive Dean of UNC (Marschall S. Runge, M.D., Ph.D) is on the Board of Directors of Eli Lilly.
Here is the link from Eli Liliy:
https://investor.lilly.com/releasedetail.cfm?releaseid=787586

So this takes the count to 4 and there are probably several more…….I know that the ex-Dean of Harvard Medical School had been on the Board of Directos of a Pharma company for 5 of his 10 year term because the rules allowed him to do so. This was reported in NY times.

Anonymous said...

Paul's right. There is a conflict of interest no matter what. Its about money guys. How many times have we seen subtle influences? If they want to do this stuff, get out of academic medicine and go sit on the boards. Then you'll see them making contacts with their former research friends at the school.

Sorry, its a conflict of interest. That's why us regular slogs who have one job get it put into our contracts we can't work another without permission and working for the "competition" is a no no.

Good job Paul - seen you quoted elsewhere.

Bob said...

You are exactly right. I'm wondering if there is a Board of Ethics for the AAMC?

Isn't this the big issue that emerges -- where does the AAMC stand? Do they address the issue? Has it come up? I would not be at all surprised at consistent evasion.

Mitch said...

The UI response is "Well they do it too!"

Weak. Keep after them......

From Facebook said...

More from Facebook:

Jerry Ackerman Disclosure of conflict is just an excuse. It doesn't address the problem.

Johann Odermann Disclosure of conflicts if interest (or potential) is necessary to ensure that potential conflicts do not become realized without knowledge. Disclosure of information isn't an excuse - it is a tool and resource to enable holding people accountable for their actions and responsibilities.

Roy M Poses Disclosure is necessary but not sufficient to address the problem. But failure to disclose is deceptive.

Jerry Ackerman Thank you, Roy, for saying it better.