Do We Really Want Our Teaching Hospitals Run or Influenced by Pharmaceutical Industry Fat Cats? — Conflicts of Interest that Our Greed-Based Culture Seems to Take for Granted

© 2014 Peter Free

 

15 April 2015

 

 

Citation — to study

 

Timothy S. Anderson, Shravan Dave, Chester B. Good, and Walid F. Gellad, Academic Medical Center Leadership on Pharmaceutical Company Boards of Directors, JAMA 311(13): 1353-1355, DOI:10.1001/jama.2013.284925 (02 April 2014)

 

 

Citation — to Pro Publica assessment

 

Charles Ornstein, Leaders of Teaching Hospitals Have Close Ties to Drug Companies, Study Shows, Pro Publica (01 April 2014)

 

 

The problem — unalloyed money grubbing in what is supposed to be medical science and service

 

From the Journal of the American Medical Association:

 

 

When AMC [academic medical center] leaders serve on pharmaceutical company boards, they hold a fiduciary responsibility to shareholders to promote the financial success of the company, which may conflict or compete with institutional oversight responsibilities and individual clinical and research practices.

 

© 2014 Timothy S. Anderson, Shravan Dave, Chester B. Good, and Walid F. Gellad, Academic Medical Center Leadership on Pharmaceutical Company Boards of Directors, JAMA 311(13): 1353-1355, DOI:10.1001/jama.2013.284925 (02 April 2014)

 

 

What the investigative team discovered

 

Summarized by Charles Ornstein at Pro Publica:

 

 

A team of researchers at the University of Pittsburgh Medical Center examined the boards of the 50 largest drug companies by global sales (excluding three companies that were not publicly traded). The researchers found that 40 percent — 19 companies — had at least one board member who also held a leadership role at an academic medical center. Sixteen of the 17 companies based in the United States had at least one. Several had more than one.

 

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.

 

© 2014 Charles Ornstein, Leaders of Teaching Hospitals Have Close Ties to Drug Companies, Study Shows, Pro Publica (01 April 2014)

 

 

The JAMA article understates the inevitability of conflict between guiding an academic hospital and owing a fiduciary duty to a profit-seeking medical corporation

 

Cornell University Law School defines fiduciary duty this way:

 

 

A fiduciary duty is a legal duty to act solely in another party's interests.

 

Parties owing this duty are called fiduciaries. The individuals to whom they owe a duty are called principals.

 

Fiduciaries may not profit from their relationship with their principals unless they have the principals' express informed consent.

 

They also have a duty to avoid any conflicts of interest between themselves and their principals or between their principals and the fiduciaries' other clients. A fiduciary duty is the strictest duty of care recognized by the US legal system.

 

© 2014 Legal Information Institute, Fiduciary Duty, Cornell University (visited 15 April 2014) (paragraph split)

 

 

Anyone who thinks that he and she can sort and keep separate the duties they (a) owe corporate shareholders and (b) the purportedly unbiased and scientifically based needs of an academic hospital is either idiot or liar.

 

 

No circumstances in which this dual role is both honorably and ethically possible

 

Consider this:

 

 

Teaching hospitals use an enormous range of medical products.

 

It is highly unlikely that a pharmaceutical corporation does not manufacture a product in one of the drug classes that the academic institution uses or has on its formulary (list of medicines).

 

 

Consequently, there are no circumstances in which someone can, in good conscience, pretend to loyally and fiduciarily serve shareholders in the profit-seeking pharmaceutical corporation and — at the same time — be trusted to avoid the appearance of being influenced by the corporation’s profit motive, while guiding the purportedly evidence-based academic hospital.

 

This is not a case of potential conflict.  It is a case of ineluctable conflict or the appearance thereof.

 

By way of egregious example:

 

 

Among the academic leaders serving as drug-company board members was the dean of the University of Illinois College of Medicine, whose institution was criticized recently when members of its surgery department appeared in an ad for the daVinci surgical robot.

 

© 2014 Charles Ornstein, Leaders of Teaching Hospitals Have Close Ties to Drug Companies, Study Shows, Pro Publica (01 April 2014)

 

 

 

The moral? — Greed tears down the fabric of ethical behavior and produces a corrupt society

 

The fact that we have institutionalized such exceedingly obvious conflicts of interest, without notice or mention, is a reliable indicator of just how corrupt our culture has become.

 

This is also not a problem that can be solved by disclosure:

 

 

Patients go to academic hospitals because they understandably believe that these are the most scientifically advanced and knowledgeable medical institutions on the planet.

 

If the hospital discloses that one of its officers is a board member at Health Forever Enterprises, patients are not likely to discern that this clown’s financial interest legally must take priority over his or her allegiance to the practice of scientifically sound medicine.

 

Why would patients fail to heed the disclosure?

 

They have nowhere else to go.  Not being medical professionals or medical scientists themselves, they have to trust the academic hospital’s claim to stand for science and truth, rather than avarice.

 

By sabotaging the rationality of this trust, we reduce medicine back to the quackery it used to represent.