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Physician pharma conflicts of interest

Academic medical centers and drugmakers share directors, possible conflicts


By Melanie Evans
Posted: April 1, 2014 - 4:00 pm ET
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Nearly all of the nation's largest pharmaceutical companies have recruited directors from the leadership of academic medical centers, the training ground for future physicians and home to basic science research and clinical trials, according to a new study in the Journal of the American Medical Association.

Sixteen of the 17 largest U.S. drug companies reported that at least one of their 2012 directors was also a top executive, department or division leader, dean or governing board member from one of the nation's medical schools, health professions' schools or teaching hospitals and health systems, researchers found.

The study, which examined the governing board composition of the 50 largest drug companies worldwide, comes months before the required public disclosure of drug industry payments to doctors and teaching hospitals mandated under the Physician Payments Sunshine Act. The study's results underscore the close and sometimes conflicting ties between industry, physicians and academia that the 2010 law seeks to expose.

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Reporting closed Monday for the Sunshine Act—a part of the Patient Protection and Affordable Care Act—but data will not be public until this fall. Industry board compensation paid to non-physician leaders at academic medical centers likely will not be included under the reporting requirements.

There is limited research and data on how academic institutions manage such relationships to maximize benefits, such as fostering innovation, research and educational opportunities, while avoiding the perception that academic research can be bought and sold, said Eric Campbell, a professor of medicine at Massachusetts General Hospital and Harvard Medical School, both in Boston.

In 2007, Campbell and a several other researchers published survey results in JAMA suggesting that nearly two out of three department chairs at the nation's medical schools and teaching hospitals had some ties to industry, including 11% who served as corporate directors. Campbell rejected the idea that academic-industry relationships should be banned at the expense of the benefits they provide. But without data, policymakers lack the resources to make informed relationship-management decisions and determine which relationships are potentially unacceptable, he said.

Executives and board members who set the clinical, research and educational agendas of the nation's top academic medical centers have been overlooked in the scrutiny of relationships between drug companies and medicine, said Dr. Walid Gellad, one of the study's authors and an assistant professor of medicine at the University of Pittsburgh School of Medicine.

More attention has focused on “pens in the hands of medical students, and going to dinner and consulting” among prescribing physicians who work most closely with patients, said Gellad, who is also a staff physician with the Veterans Affairs Department Pittsburgh Healthcare System's Center for Health Equity Research and Promotion.

While academic leaders must meet their institutions' educational and clinical agenda, drug company directors must meet their obligations to shareholders. “There have to be instances where those two organizations don't have the same goals,” Gellad said. “We need to have frank and open discussions about the risks that these relationships entail, as much as we need to discuss the benefits they might entail.”

Among the 50 largest global drug companies, as judged by 2012 revenue, 19 had recruited one or more directors from the leadership of prestigious and competitive research and medical schools.

“The fact that this relationship exists at all was a surprising finding, given that we're not talking about just any relationship with industry, we're talking about relationships where one person has responsibility at both places,” Gellad said.

Among the academic medical center leaders who served on drug company boards, 25 also served on the governing boards of hospitals, medical schools or universities. Seven served as clinical department chairpersons or directors. Six were top executives at hospitals and health systems and another six were deans. Two were university presidents.

Irvine, Calif.-based Allergen, which produces Botox, recruited directors from Johns Hopkins University School of Medicine in Baltimore, the University of Southern California Keck School of Medicine in Los Angeles and the Children's Hospital & Research Center Oakland in Oakland, Calif.

USC said in a statement that its faculty and administration “abide by a strict set of ethical guidelines” and follow several conflict-of-interest disclosure policies. Johns Hopkins said no one was available to comment on deadline and Children’s Hospital & Research Center Oakland did not respond to a request for comment.

One drug company paid directors sums ranging from $107,000 to $557,000 over the course of 2012, the highest annual tally in the study. The mean award for directors was about $312,500. Information for three pharmaceutical companies was not public.

Follow Melanie Evans on Twitter: @MHmevans


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