Last months morning raid by federal agents on the Tampa, Fla.-headquarters of WellCare Health Plans embroiled at least one prominent healthcare scholar into the mysterious fray: Harvard Business School professor and healthcare researcher Regina Herzlinger.
Mixing business and academics?
Researchers may need to disclose their affiliations
Herzlinger, the author of the seminal Market-Driven Health Care published in 1997, serves on the board of directors of WellCare, which administers government-sponsored coverage for 2.3 million members nationwide (Feb. 20, 2006, p. 14).
Company filings with the Securities and Exchange Commission reveal that Herzlinger and some WellCare executives sold company stock in recent months before the raid. Herzlinger sold shares worth $2,323,230 between Aug. 28 and Aug. 31, according to the SEC filings. The 24,000 shares sold reflect 57% of what she held before the transactions. The average share price was $97.15. Last week, WellCare stock was trading for approximately $23 per share.
In addition to everything else, WellCare officials said in an Oct. 26 news release that the company received requests for information from the SEC on Oct. 25. The company said it is cooperating with federal and state authorities.
A prolific researcher who has sometimes skewered the managed-care industry, Herzlinger vehemently denied in an e-mailed response that her position on the WellCare board raised any conflict-of-interest issues. But Herzlingers relationship to the company and directorships held by other healthcare thought leaders who are highly critical of various aspects of the industry raise questions as to whether these sometimes lucrative relationships with for-profit healthcare companies should be disclosed to readers when these scholars publish.
In my opinion there is no aspect in the practice of medicine in America in which relationships to industry is not prevalent, said Eric Campbell, an associate professor at the Institute for Health Policy at 902-bed Massachusetts General Hospital and Harvard Medical School. They have benefits and they have risks, and they have to decide when the benefits outweigh the risks. I think these things have to be managed, and I think they have to be reported because you cant manage what you dont know about.
For her part, Herzlinger said that her books disclose my serving as a director of for-profits and nonprofits. But in general, if research is positive about the work of certain institutions and the researchers do not disclose their financial interests, they have a conflict, she said. If it is negative and they have a financial interest that could be damaged by their negative research disclosure is not as much of an issue because the researchers are doing what they should doi.e., research that is not affected by their financial interests.
Brandeis University professor and economist Stuart Altman, who has helped shape national healthcare policy under four presidents, said he does not typically disclose his affiliations unless it is directly relevant to the subject matter. Altman serves on the boards of publicly traded Visicu, a Baltimore-based provider of an advanced remote-monitoring system for intensive-care units, and Lincare Holdings, Clearwater, Fla., a publicly traded provider of oxygen, home medical equipment and other respiratory therapy services. He also serves on the not-for-profit boards of EmblemHealth, a successor to HIP Health Plan of New York, which is trying to convert to for-profit status, and the 283-bed Tufts-New England Medical Center in Boston.
As a Lincare director, Altman earns an annual retainer of $60,000 and was awarded stock options valued at $489,894 in fiscal 2006 for a total of $559,894, according to company filings. Altman joined the Lincare board in December 2001. In 2006, Altman earned $6,000 as a Visicu director and was awarded stock options valued at $90,375 for a total of $96,375, according to Visicu filings. Before Visicu became a public company on April 5, 2006, nonemployee directors such as Altman did not receive any cash compensation. Altman joined the Visicu board in November 2005.
From 1983 to 1996 he was the chairman of the congressionally mandated Prospective Payment Assessment Commission, a predecessor to todays Medicare Payment Advisory Commission.
Altman said his presence on a board doesnt necessarily mean he is an undiscriminating advocate for the company or organization. Ive been berating hospitals for years, he said. I listen to hospitals berating managed-care companies and managed-care companies berating hospitals, and I berate both of them. I dont think there is one villain out there, and I berate people that think there is a magic solution to the problem.
His relationships are disclosed when it is related to what we are doing, he said. His research broadly focuses on the need to cover everyone with health insurance and control healthcare spending, he added, but none of that really has anything to do with Visicu or Lincare. Im not a clinician hawking an intensive-care unit. There is very little overlap. The same with Lincare; I am not talking about oxygen, Altman said.
That said, Altman said he is a proponent of transparency, but I dont think (everything) should be in because you would have to relate everything in your life, he said. But if that were your rules, I would do it.
Campbell agreed that not each and every single relationship is relevant, and the question is: Are the relationships people have in any way related to what researchers write about? There are no clear, defined rules for what people need to do, he said.
The journal Health Affairs, a frequent forum for Altmans scholarship, queries all prospective authors on conflicts of interests, financial or otherwise, that would not be obvious by disclosure of the authors primary employers and funding sources, according to its manuscript guidelines. Authors also are asked if they wish to add an acknowledgement or disclosure statement.
But the Health Affairs policy is very much an honor system, said Donald Metz, the journals executive editor. Coincidentally Health Affairs editorial board has begun reviewing its policy and is examining whether it should be more specific about affiliations, he said. As part of the policy review, Health Affairs is considering whether that is enough or if the journal should take the next step and disclose (the affiliations) to the readership, Metz added.
with Gregg Blesch
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