Conflict of interest rules for the medical community have been in the spotlight lately, though they typically center around rules that prohibit or restrict physicians from enjoying lunch on behalf of a pharmaceutical company or stocking their office with pens. A new study conducted by researchers from the University of Pittsburgh School of Medicine and published in the British Medical Journal recently decided to look at conflicts of interest from a different perspective: they looked at how many for-profit healthcare company positions were occupied by people with academic affiliations.
These researchers analyzed public disclosures of all publicly traded United States healthcare companies listed in the NASDAQ and NYSE in January 2014 that specialized in pharmaceuticals, biotechnology, medical equipment, and providing healthcare services. The researchers defined an academic medical or research affiliation as “a formal position at a US medical school, affiliated teaching hospital, or health system; overseeing research university; or medical research institute with a medical school partnership” and they further classified individuals with academic affiliations as either leaders, professors, or trustees, as each group holds a different set of responsibilities to their academic institutions that pose unique conflicts with their obligations as for profit company directors.
The study found that 41% of the companies surveyed had one or more academically affiliated board of directors members in 2013. Several of those board of directors members held positions on more than one company’s board of directors: the study found that 279 academically affiliated directors held a total of 309 healthcare directorships, which is less than 10 percent of all total healthcare directorships.
Over half of academically affiliated directorships were held by individuals with clinical training, predominately in internal medicine or related subspecialties, the most common of which were general internal medicine, cardiology, and oncology.
The compensation these academically affiliated board of directors members received for their board of director position varied widely, ranging from zero dollars to over one million dollars, with the median compensation being $193,000. In addition to their monetary compensation, many board of directors members received major stock in their company.
After looking at all of the data, study co-author Timothy Anderson, MD, does not believe that the existence of academically affiliated board of directors members is necessarily a problem in and of itself. Instead, he thinks that it simply poses legitimate questions for initiating a discussion about conflict of interest with academic institutions, healthcare companies, and their interrelationships.
When questioned about the link and possible problems, Dr. Anderson stated, "Our view is not to pass judgment. We wanted to paint that landscape of how diverse these sorts of relationships are. Some may be quite beneficial and some might be quite concerning, but until we really understand what relationships exist, it is hard for the medical and academic community to have a good discussion about what we should do to minimize the risks and maximize the benefits of these collaborations." He continued on, noting that a one-size-fits-all approach will not work to manage all of the relationships, but instead, a more open approach is warranted to avoid losing the public’s trust.
Anderson thinks that the way the Sunshine Act solely focuses on physicians and attempts to expose their minute financial interests might be misguided and results in oversight of academic professionals and their loyalties. The study focused on the fact that academics who sit on the board of a for-profit company have duties of loyalty both to the academic organization that employs them, as well as to the shareholders of the company whose board they sit on. The concern of the study and the researchers behind it are that those loyalties have the opportunity to conflict at times, placing the academic board member in a precarious position.
The study acknowledged that “there is no doubt that collaboration between academic institutions and industry has led to profoundly important clinical trials, drug development, and translational research initiatives, although the role and necessity of academically affiliated directors in facilitating these projects is unclear and undocumented” and that academic institutions can benefit from having their staff members and faculty as representatives in corporate board rooms, forging fundraising or research partnerships.
The study further recognized that one of the difficulties in developing guidelines to monitor the competing interests is that the potential harms vary depending on the individual’s primary academic duties. Certain academics may be in a position, both academically and professionally as a board of director, to balance the potential conflicts of interest and will successfully benefit both organizations with their knowledge and expertise.
However, because the end result of the study advocates for “additional review, regulation, and, in some cases, prohibition when conflicts cannot be reconciled,” it is worth keeping an eye on potential movement in this area. It is likely only a matter of time before someone, or a group of people, speak up and ask for more strict regulation on academics who serve as a member of the board of directors for for-profit companies. This would be unfortunate as both organizations can benefit from the other in expertise and developing much needed cures.