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​Ties Between Big Pharma and Leaders of Academic Medical Centers Raise Conflict-of-Interest Questions

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PITTSBURGH, April 1, 2014 – Almost every major U.S.-based pharmaceutical company in 2012 — and nearly 40 percent worldwide — had at least one board member in a leadership position from a U.S. academic medical center, raising potentially problematic conflict-of-interest questions, according to University of Pittsburgh School of Medicine researchers.
The board members were compensated an average of $312,564 by the pharmaceutical companies, while concurrently holding clinical or administrative leadership positions at academic medical centers, the researchers report in the Journal of the American Medical Association (JAMA).
“Board members have a fiduciary responsibility to the shareholders of the pharmaceutical company,” said senior author Walid Gellad, M.D., M.P.H., assistant professor of medicine and co-director of the Center for Pharmaceutical Policy and Prescribing at Pitt and physician in the U.S. Department of Veterans Affairs (VA) Pittsburgh Healthcare System. “However, such responsibility could potentially conflict with the mission of the academic medical center that the board member leads.”
The researchers gathered data on board membership and academic positions from the Web sites of the world’s 50 largest pharmaceutical companies based on 2012 global prescription drug sales and Securities and Exchange Commission (SEC) filings. Only board members who served for an entire year were included.
Of the 50 companies, three private companies lacked public data on governance. Of the remaining 47, 19 had at least one board member who also held a leadership position at a U.S. academic medical center, including 16 of the 17 U.S. companies. Eighteen industry board members, or 3 percent of all board members, held 21 clinical or administrative leadership positions at academic medical centers. These included two university presidents, six deans, six hospital or health system executive officers and seven clinical department chairs or center directors.
“We did not include names of the board members because we wanted to highlight the issue, not the individual,” said lead author Timothy Anderson, M.D., a resident in UPMC’s Department of Internal Medicine. “What they are doing is not illegal and could have benefits. We think the public needs to decide whether potential risks outweigh those benefits.”
Financial relationships between the pharmaceutical industry and physicians have come under increased scrutiny in recent years. The Physician Payment Sunshine Act goes into effect this year and will make all financial relationships with industry public.
Dr. Gellad and his co-authors point out that pharmaceutical industry board membership by academic medical center leaders could lead to a different kind of potential conflict of interest, since academic leaders wield considerably more influence over research, clinical and educational missions than ordinary physicians or staff who may be targeted for gifts by pharmaceutical representatives.
“The public will have to decide whether these non-profit, and in many cases publically funded, academic institutions can manage these potential conflicts with internal policies, or whether additional regulation is needed,” said Dr. Gellad, also an assistant professor of health policy and management at Pitt’s Graduate School of Public Health.
Dr. Gellad has previously received and reported research funding from Express Scripts, a pharmaceutical benefit manager, through the nonprofit think tank RAND Corp., for work unrelated to the JAMA report. Dr. Gellad is supported through a VA Health Services Research & Development grant (CDA09-207).
Additional co-authors on this research are Shravan Dave, B.S., and Chester B. Good, M.D., M.P.H., both of Pitt’s School of Medicine.