Tuesday, April 01, 2014

How NOT to set an example

[First, a bit of a rant:  Why can't JAMA allow its articles of general interest to be viewable by the public? Other journals, like NEJM, do so. Now, on to the substance.]

JAMA has just published a research letter entitled "Academic Medical Center Leadership on Pharmaceutical Company Boards of Directors," in which it presents a list of deans and other high officials from academic medicine who are on the boards of directors of the top pharma companies.

Since we can't read the article, we go to the reports of two health care journalists to find out what's up.

John Fauber from the Milwaukee Journal Sentinel provides a more appropriate title: "Medical school leaders cash in on drug company boards."  Excerpts:

While university doctors who moonlight for drug companies have faced intense scrutiny in recent years, new research suggests much larger sums of money are being paid to their bosses — the leaders of medical schools and hospitals who serve on drug company boards.

Looking at the world's 50 largest drug companies, reseachers found that 40% had at least one board member who held a leadership position at a U.S. academic medical center — including medical school deans, chief executive officers, department chairs and university presidents.

The average annual compensation from the drug companies was $313,000, according to the paper published today in JAMA.
"These relationships present potentially far-reaching consequences beyond those created when individual physicians consult with industry or receive gifts," the researchers wrote.
He quotes an national expert on such matters:
"I don't know how they can manage a conflict like that," said Susan Chimonas, an expert on conflicts of interest in medicine. "My gosh, there is so much money they are making for a little side job.

Serving in dual roles raises so many potential conflicts that it would be wiser to eliminate them, said Chimonas, associate director of research for Columbia University's Center on Medicine as a Profession.
And also me:
"You cannot serve two masters, even if you are highly intelligent. In fact, if you are highly intelligent, you will rationalize the problems away by saying that you cannot be personally corrupted."
Charles Ornstein at ProPublica offers another take: "Leaders of Teaching Hospitals Have Close Ties to Drug Companies, Study Show."  Excerpts:

Pharmaceutical company payments to doctors extend far beyond rank-and-file clinicians — and deep into the leadership of America’s teaching hospitals, according to a study published today in the Journal of the American Medical Association.

All told, the research team found that 41 of the companies’ 2012 board members held leadership positions at academic medical centers. Six of the 41 were pharmaceutical company executives who served on hospital boards of directors or held other leadership posts. 

Excluding the industry executives, the academics earned an average of nearly $313,000 that year for their board service.

As board members of drug companies, academic leaders take on a fiduciary duty to those companies’ success. That can “conflict or compete” with their other responsibilities, the study says. 

“Given the magnitude of competing priorities between academic institutions and pharmaceutical companies, dual leadership roles cannot simply be managed by internal disclosure,” the authors conclude.

Here's the list.  I think it is humorous (and maybe hypocritical) that JAMA decided not to include the names of the board members since the whole article is about transparency and since the names are available from the web sites of all of the companies.  For example, one notable board member of Alnylam Pharmaceuticals--not listed below--has been Victor Dzau, who is leaving his position as chief executive officer of the Duke University Health System to head up the Institute of Medicine. (He was also on the Medtronic Board.)


Anonymous said...

I guess I should reprint my comment from your previous post, eh. But instead I have a personal anecdote from that much-hated profession by doctors - lawyers. When I had to hire a divorce lawyer, I couldn't have the best one that I wanted, because her firm determined that since another partner had seen both my husband and I ,ONCE, for estate planning 3 years prior (we never pursued the plan), that posed a conflict of interest and the firm could not represent me in my divorce.
Compare that to the situation you describe here. Which is the profession with the greater ethical sense, my fellow physicians?

nonlocal MD

Anonymous said...

Thank you Mr. Levy, for the very extremely informative information. I'm delighted with the blog and it is helpful in navigating the world of medicine.

Thomas said...

The same academic “leaders” are the ones who take drug samples away from docs who used them to help patients who couldn’t afford them. They rant about a dinner or a pen with the drug’s name on it while taking $$$. Life ain’t fair. I get that.

jamzo said...

interlocking boards are a common feature of corporate ecology


for profit execs sit on health system boards and health system execs sit on for profit boards

not new

current raised eyebrows on practice is heartening

what will it lead to?

will it gain traction like open access to clinical trial data

will need spokespersons to make this happen