Financial And Health Care Relations
In recent years, the financial relationships that take place between industry and health care have drawn increasing controversy. For the most part, these relationships have appeared to involve physicians working for drug companies and device makers; however, the trend appears to involve those with deeper influences.
Now, research suggests that even greater money is paid to the bosses of these physicians, including those people who run medical schools and hospitals and who serve on drug maker boards. These relationships, at all levels, say critics, may create conflicts of interest that disproportionately impact research findings and prescribing practices. The relationships may also lead to situations in which patients are no longer the primary focus in health care decisions.
Researchers found, when reviewing the world’s 50 largest drug firms, that 40 percent had at least one board member who held a leadership role at a United States academic medical center, according to The Wall Street Journal. This includes medical school deans, chief executive officers, university presidents, and department chair-people. Annual compensation from the drug firms averaged about $313,000, according to the paper just published in the Journal of the American Medical Association (JAMA). “These relationships present potentially far-reaching consequences beyond those created when individual physicians consult with industry or receive gifts,” the researchers wrote.
“It is a potential conflict of interest that is not often discussed,” said senior author Walid Gellad, a physician with the VA Pittsburgh Healthcare System and an assistant professor of medicine at the University of Pittsburgh. “If a pen or a $150 dinner presents a conflict for a doctor, what does it mean if you get $300,000? I would say this is just the tip of the iceberg,” The Wall Street Journal reported.
Critics have said that this financially beneficial work should not be conducted by university leaders who oversee independent research or the teaching of medical practitioners. “I don’t know how they can manage a conflict like that,” said Susan Chimonas, an expert on conflicts of interest in medicine. “My gosh, there is so much money they are making for a little side job.” Chimonas notes that serving in these types of dual roles raises enormous potential conflicts; it would be smarter to eliminate the roles, wrote The Wall Street Journal. Chimonas is an associate director of research for Columbia University’s Center on Medicine as a Profession.
According to Paul Levy, former president and CEO of Beth Israel Deaconess Medical Center in Boston, Massachusetts (2002-2011), the key leaders of academic medical institutions are involved in business decisions and corporate partnerships, The Wall Street Journal reported. Beth Israel Deaconess is affiliated with Harvard University. These decisions and partnerships may involve conducting clinical trials for drug companies, permitting drug samples to be distributed in hospitals and clinics, allowing doctors to be part of drug company promotional speaking engagements, endorsing and offering drug company-funded continuing medical education, and choosing which drugs to allow on a hospital’s formulary, said Levy. “You cannot serve two masters, even if you are highly intelligent,” said Levy, who blogs about the health industry and is the senior adviser at Lax Sebenius LLC, of Concord, Massachusetts. “In fact, if you are highly intelligent, you will rationalize the problems away by saying that you cannot be personally corrupted.”
The JAMA paper did not name individuals, but did list medical schools, universities, and academic hospitals whose officials served on drug company boards of directors, and also lists drug companies, such as Pfizer, Merck, GlaxoSmithKline, and Johnson & Johnson. The review looked at 2012 and Gellad noted that this research only involved drug companies and did not include medical device companies and health insurance firms.