29 September 2015, British Medical Journal: Gellad et al: Prevalence and compensation of academic leaders, professors, and trustees on publicly traded US healthcare company boards of directors: cross sectional study (PDF)
Academics received $55 million to serve on health-care company boards in 2013
By Carolyn Johnson
September 29, 2015
Craig B. Thompson leads one of the country's most prestigious cancer hospitals, Memorial Sloan Kettering Cancer Center in New York. But noticeably absent from his online biographical sketch is his position as a director of one of the world's biggest pharmaceutical companies, Merck, where over the past four years, he's received more than $1 million to serve on a board charged with the mission "to represent and protect the interests of the Company's shareholders."
A new study shows Thompson is far from alone. Nearly one of every 10 board positions at health-care companies was held by an academic-affiliated person, ranging from medical school deans to hospital heads to professors, according to an analysis of 2013 data published in the British Medical Journal  on Tuesday.
In an age where even relatively small, one-time payments from pharmaceutical companies to doctors have come under intense scrutiny because they may skew prescribing practices or research, the study reveals that some of the most well-paid and influential leaders in medicine are sitting on the boards of publicly traded health-care companies, where they are richly compensated.
"These people who are on boards are among the most famous, the most sought-after academics in the country. At the same time they are making very large incomes, based on their positions, so what they're doing is simply padding their incomes, with a lot of extra money," said Jerome Kassirer, editor in chief emeritus of the New England Journal of Medicine. "I think it's a bad idea, and I think it's widespread."
For years, it's been known that academics served on drug company boards, but the new study chronicled just how prevalent and remunerative these relationships are throughout the health-care industry. The board members received $193,000, on average, and owned more than 50,000 shares of stock. The study found 279 academically affiliated leaders on the boards of 442 companies -- including 17 chief executives of health systems, 11 vice presidents or executive officers, 15 university leaders, and eight medical school deans or presidents. Collectively, they received $55 million in compensation and owned nearly 60 million shares of stock.
"Part of the impetus for this is it's remarkable that my $15 lunch with a pharmaceutical company is on a public Web site, but this information is not. It is publicly available, but you have to do a lot of searching and connecting," said Walid Gellad, an associate professor of medicine at the University of Pittsburgh School of Medicine, who led the study.
A spokeswoman for Memorial Sloan Kettering said Thompson was out of town giving talks and could not be reached, but that his outside activities are reviewed and evaluated by the cancer center's board -- including his board membership with Merck and another company for which he received more than half a million dollars last year, Charles River Laboratories International.
"Although trained as a physician, he does not see patients and does not participate in clinical research or the decisions about which therapeutic agents are included in the hospital formulary," said Avice Meehan, a spokeswoman for Memorial Sloan Kettering.
The study did not show that these conflicting positions led any professor, hospital chief executive or medical school dean to make choices in the interest of a company they worked for on the side. In fact, the study refrained from even naming any individuals at all. Gellad said that was because his team sought instead to map the scope of potential influence that exists at the very highest levels of academic medicine and not to limit the attention to a single case. Among medical schools that receive taxpayer money from the National Institutes of Health, 19 of the top 20 best-funded schools had a leader, professor or trustee represented on a company's board.
Some argue that these relationships can benefit medical schools and hospitals, especially as they increasingly attempt to work more closely with the industry to bridge the "valley of death" -- the gap between basic research and commercial products and drugs.
"Some people will look at this as a good thing, that there's this kind of interaction between industry and academia," Gellad said. "We're talking so much about conflict of interest -- let's talk about all of it, and let's not leave out a certain part because it involves certain people we don't like to talk about, or it's not as easy to figure out if there's something bad about this."
A commentary published in the Journal of the American Medical Association  last year by the dean of the Medical University of South Carolina, the dean of the University of Wisconsin-Madison School of Medicine and Public Health, and the president of Union Graduate College argued that conflicts of interest can grow particularly acute at higher levels of leadership.
"Having a fiduciary responsibility to 2 separate entities is at best a very difficult situation," the three leaders argued. "Will the leader direct business inappropriately to the outside company on whose board he or she sits? Will the leader inappropriately use information about the institution he or she leads to influence decisions by the outside corporation? It is difficult to separate these types of activities and decisions."
Marcia Angell, a former editor of the New England Journal of Medicine and a senior lecturer at Harvard Medical School, said in an e-mail that her only quarrel with the British Medical Journal study was its suggestion these conflicts could "be reconciled" -- instead, she believes the relationships should always be prohibited.
"It puts numbers on a phenomenon that badly needed quantifying. As the study illustrates, academic leaders are now double-agents, serving as the most effective sales force the pharmaceutical and device industries could possibly have," Angell wrote. "And the medical centers themselves are now behaving as junior partners."
Angell and Kassirer both argue that disclosure is not enough, but many medical schools have policies in place to avoid conflicts of interest that tend to lean heavily on disclosure and transparency.
For example, Vanderbilt University Medical Center has had a policy in place since 2009 that requires such relationships to be reviewed by a committee. Gordon Bernard is Vanderbilt's associate vice chancellor of research and chair of the Pharmaceutical and Therapeutic Use committee, which makes decisions about the formulary, the approved list of drugs the hospital uses. He is also on the board of directors of Cumberland Pharmaceuticals.
"These activities were long ago institutionally vetted and approved. Dr. Bernard recuses himself from any institutional matters where there could be a potential conflict of interest," said John Howser, assistant vice chancellor for news and communications.
Cumberland's proxy statement, however, particularly mentions Bernard's expertise in this regard as an asset: "The Board believes Dr. Bernard's medical background is extremely valuable as the Company seeks to continue expanding its pipeline with promising products that offer advancement to patient care and are well-positioned competitively."
At Harvard Medical School, a strict ethics policy exists. An FAQ explaining whether a faculty member can serve on a company's board of directors simply says, "It depends. ... As an individual's authority within HMS ... increases, the scrutiny applied by HMS (and the affiliated institution) will similarly increase in view of the individual's scope of authority."
Elizabeth Nabel, the president of Brigham and Women's Hospital, and a professor of medicine at Harvard Medical School, for example accepted a role on the board of medical device company Medtronic last year. According to the company's proxy statement, she received $71,800, a prorated amount since she started midway through the fiscal year.
Brigham and Women's Hospital "cannot carry out its charitable missions of high quality medicine and leading research and medical education, and of translating scientific advances into improvements in patient care, without interacting with industry," spokeswoman Erin McDonough said in a statement. "Such interactions allow for the exchange of cutting-edge scientific information, the establishment of research collaborations, two-way transmission of scientific expertise, and fostering the seamless transition of the latest scientific and clinical advances into products and services for the ultimate benefit of patients and the public."