Financial relationships between the pharmaceutical industry and physicians have come under increased scrutiny. Less attention has been paid to relationships between industry and the leadership of academic medical centers (AMCs), who wield considerable influence over research, clinical, and educational missions.
When AMC 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.1 The potential conflict between responsibilities of individuals who hold leadership roles in both industry and academia deserves exploration.
We studied the prevalence of AMC leaders on pharmaceutical company boards of directors. Data on board composition and academic positions were collected in January 2013 from the websites of the 50 largest pharmaceutical companies based on 2012 global prescription drug sales.2 Financial compensation for individuals who served the entirety of 2012 was collected from 2013 company proxy statements from the US Securities and Exchange Commission’s public database3 and from 2012 shareholder reports.
Compensation figures reflect annual compensation for services on boards including cash, stock awards, dividends, and charitable contribution matching. We defined AMCs as US medical schools, health professional schools, teaching hospitals, and health care systems.1 Leadership positions included CEOs, clinical department chairs, division directors, medical school deans, and hospital boards of directors. Given their oversight over medical schools, we also included university presidents and boards of directors.
Of the 50 companies examined, 3 private companies lacked public data on governance. Nineteen of 47 (40%) companies had at least 1 board member who concurrently held a leadership position at an AMC, including 16 of 17 (94%) US companies (Table). Forty-one board members held AMC leadership positions in 2012, receiving a mean financial compensation for board membership of $312 564 (excluding the 6 industry executives).
Eighteen industry board members (3% of all board members) held 21 clinical or administrative leadership positions including 2 university presidents, 6 deans, 6 hospital or health system executive officers, and 7 clinical department chairs or center directors. Twenty-five industry board members (5%), including 6 industry executives and 2 who also held clinical positions, held 28 positions as trustees or board members of US hospitals, medical schools, or universities.
Oversight of potentially intersecting institutional missions, fiduciary responsibility to shareholders, and the magnitude of compensation make board membership by AMC leaders potentially more problematic than other financial relationships between medicine and industry. Our study builds on the few prior studies of institutional conflicts of interest.4,5
Association of American Medical College guidelines1 and most institutional policies require internal disclosure of board membership for institutional review. The Physician Payment Sunshine Act will make all financial relationships with industry public in 2014. Further management strategies, such as capping industry payment to a $5000 daily limit, have been implemented.6 Others have suggested limiting compensation to a percentage of academic salary,6 which bears similarity to conflict of commitment policies and thus provides a mechanism to ensure that board membership remains secondary to the academic appointment.
Severing ties between companies and AMC leaders might eliminate the potential benefits of academic-industry collaboration; however, the extent to which individuals who hold coexisting leadership positions have fostered beneficial partnerships and at what potential cost remains unclear. Severing the fiduciary ties by banning voting board membership would still allow academic leaders to serve as consultants.
Our study is limited to a single industry and a single year; thus we cannot comment on temporal trends. We relied on company disclosures of compensation that cannot be independently verified. We do not make any conclusions about whether specifically identified relationships led to actual, rather than potential, conflicts of interest.
However, given the magnitude of competing priorities between academic institutions and pharmaceutical companies, dual leadership roles cannot simply be managed by internal disclosure. These relationships present potentially far-reaching consequences beyond those created when individual physicians consult with industry or receive gifts.
Corresponding Author: Walid F. Gellad, MD, MPH, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, 151C University Dr, Pittsburgh, PA 15240 (email@example.com).
Author Contributions: Dr Anderson had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: All authors.
Acquisition of data: Anderson, Dave, Gellad.
Analysis and interpretation of data: All authors.
Drafting of the manuscript: Anderson, Good.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Anderson.
Obtained funding: Gellad.
Administrative, technical, and material support: Dave, Good, Gellad.
Study supervision: Good, Gellad.
Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Anderson reported receiving travel reimbursement from the American Medical Student Association for speaking on conflict of interest topics. Dr Gellad reported receiving research funding through RAND from Express Scripts for work unrelated to the current article. No other disclosures were reported.
Funding/Support: Dr Gellad is supported by VA Health Services Research and Development grant CDA 09-207.
Role of the Sponsor: The Department of Veterans Affairs had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Disclaimer: This work represents the opinions of the authors and does not necessarily represent the views of the Department of Veterans Affairs or the US government.
US Securities and Exchange Commission. Electronic data gathering, analysis, and retrieval system. http://www.sec.gov/edgar.shtml
. Accessibility verified February 27, 2014.
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