Executive Summary
Academics from medical schools and research institutions hold nearly 10% of positions on boards of directors at publicly traded healthcare companies, according to a recent study. Ethicists report the following concerns:
- whether industry dollars should be spent in this manner;
- whether it’s realistic to ask academics to remain neutral;
- how students and other research at the academic institutions are affected.
Academics from medical schools and research institutions hold nearly 10% of positions on boards of directors at publicly traded healthcare companies, according to a recent study.1
“The numbers aren’t surprising for those of us familiar with academia, although they may be surprising for those outside of it,” says Jessica Berg, JD, MPH, professor of law, bioethics, and public health at Case Western Reserve University in Cleveland, OH.
Philip M. Rosoff, MD, MA, professor of pediatrics and medicine at Duke University’s Trent Center for Bioethics, Humanities & History of Medicine in Durham, NC, says, “It is both not surprising and yet deeply disturbing that these sorts of ‘extracurricular’ activities continue to occur at such high rates. This study offers disturbing evidence that there continues to be something rotten in academic medicine.”
Some key findings include the following:
- Directors were affiliated with 85 geographically diverse nonprofit academic institutions, including 19 of the top 20 National Institutes of Health-funded medical schools.
- Of 442 healthcare companies with publicly accessible disclosures on their boards of directors, 180 had one or more academically affiliated directors.
- The median individual compensation to academically affiliated directors for their services to companies was $193,000.
“The lines between academic medicine and the medical industry have become more and more blurred over the years,” says Berg. “The potential for conflicts of interest on both sides should be grounds for concern.”
Berg says ethical concerns stem from both the influence of the gift, and whether industry dollars should be spent in this manner. “Is it realistic to ask academics to remain neutral in these contexts?” she asks. “Should we be concerned about the effect of these agreements on students, and on other research being done at the academic institution?”
Money is motivator
Rosoff says that the first issue to examine is why companies feel it is in their interest to employ academic medical leaders as members of their boards. “It’s reasonable to presume that their motivation is similar to that of pharmaceutical companies which pay physician ‘thought leaders’ to serve as consultants or spokespeople,” says Rosoff. Companies expect a return on their investment that will provide a direct monetary benefit.
“What’s in it for the academics who serve as directors? The simple answer provided by this study is money — and lots of it,” says Rosoff. He notes that well-known academics are also quite well-compensated by their home institutions.
“Industry has long sought prominent academics to serve on their boards. Academics may view these favorably for a variety of reasons,” says Berg. These include real-world insight, prestige, and financial benefit.
Berg sees high levels of compensation as a central ethical concern. “We used to have direct gifts to physicians, which have fallen out of favor,” she says. “Now these ‘gifts’ often come as consulting agreements and board positions.”
The study authors acknowledge the benefits that have accrued due to collaboration between industry and academia. “However, it is unclear that these kinds of relationships can be plausibly said to make these sorts of positive contributions,” says Rosoff. “These academics work first for their institutions.”
Rosoff argues that it is incumbent upon academics “to engage in outside activities that enhance, rather than detract or conflict with, their primary fiduciary duties.”
Increased regulation possible
Berg says it’s clear that these arrangements “are not going away. The question is how they should be regulated.”
A 2008 report issued by the Association of American Medical Colleges and the Association of American Universities called for medical schools and major research universities to develop and implement institutional conflict of interest policies within the next two years, and to refine standards for addressing individual financial conflicts of interest. (The complete report can be viewed at http://bit.ly/1HxmlIU.)
Most conflict of interest policies are based on traditional disclosure and monitoring and do not set financial limits, notes Berg. “In the absence of additional professional or even industry self-regulation, we might see efforts at external regulation,” she says.
Disclosure won’t alleviate all ethical concerns, however. “We might want to consider restrictions on some of these arrangements, and also restrictions on the amount of compensation,” Berg says.
REFERENCE
- Anderson TS, Good CB, Gellad WF. Prevalence and compensation of academic leaders, professors, and trustees on publicly traded US healthcare company boards of directors: cross sectional study. BMJ 2015; 351:h4826.
SOURCES
- Jessica Berg, JD, MPH, Professor of Bioethics & Public Health, Case Western Reserve University, Cleveland, OH. Phone: (216) 368-6363. Fax: (216) 368-2086. Email: [email protected].
- Philip M. Rosoff, MD, MA, Professor of Pediatrics & Medicine, Trent Center for Bioethics, Humanities & History of Medicine, Duke University, Durham, NC. Phone: (919) 668-9025. Fax: (919) 668-1789. Email: [email protected].
Academics from medical schools and research institutions hold nearly 10% of positions on boards of directors at publicly traded healthcare companies, according to a recent study.
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