Leadership of academic medical centers on the boards of directors of pharmaceutical companies | Clinical Pharmacy and Pharmacology | JAMA

Financial relations between the pharmaceutical industry and physicians are under increased scrutiny. Less attention has been paid to the relationship between industry and the management of academic medical centers (CMAs), which exert considerable influence on research, clinical and educational missions.

When AMC executives sit on the board of directors of a pharmaceutical company, they have a fiduciary responsibility to shareholders to promote the financial success of the company, which can conflict or compete with institutional oversight responsibilities and individual clinical and research practices.1 The potential conflict between the responsibilities of those in leadership positions in both industry and academia is worth exploring.

We studied the prevalence of AMC executives on the boards of pharmaceutical companies. Data on board composition and academic positions were collected in January 2013 from the websites of the top 50 pharmaceutical companies based on global sales of prescription drugs in 2012.2 Financial compensation for people who served the entire year 2012 was collected from 2013 corporate proxy statements from the United States Securities and Exchange Commission public database.3 and from the 2012 shareholder reports.

Compensation figures reflect annual compensation for board service, including cash, stock awards, dividends, and charitable matching contributions. We have defined CMAs as the medical schools, health professional schools, teaching hospitals, and health care systems of the United States.1 Leadership positions included CEOs, clinical department chairs, division directors, medical school deans and hospital boards. Given their oversight over medical schools, we also included university presidents and governing boards.

Of the 50 companies examined, 3 private companies lacked public data on governance. Nineteen of 47 companies (40%) had at least 1 board member who simultaneously held a managerial position in an AMC, including 16 of 17 (94%) US companies (Table). Forty-one board members held leadership positions at AMC in 2012, receiving an average financial compensation for their 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 system directors of health and 7 directors of clinical departments or directors of centers. Twenty-five industry board members (5%), including 6 industry executives and 2 who also held clinical positions, held 28 directorships or board members American hospitals, medical schools or universities.

The oversight of potentially intersecting institutional missions, fiduciary responsibility to shareholders, and the breadth of compensation make CMA executive board membership potentially more problematic than other financial relationships between medicine and medicine. ‘industry. Our study builds on the few previous studies on institutional conflicts of interest.4, 5

Association of American Medical College Guidelines1 and most institutional policies require internal disclosure of board members for institutional review. The Physician Payment Sunshine Act will publicize all financial relationships with the industry in 2014. Other management strategies, such as capping industry payments to a daily limit of $ 5,000, have been implemented.6 Others suggested limiting remuneration to a percentage of academic salary,6 which resembles conflict of engagement policies and thus provides a mechanism to ensure that board membership remains secondary to academic appointment.

The severing of ties between companies and CMA leaders could eliminate the potential benefits of collaboration between academia and industry; However, the extent to which individuals in coexisting leadership positions have fostered beneficial partnerships and at what potential cost remains uncertain. Severing fiduciary ties by banning voting board membership would still allow university leaders to serve as consultants.

Our study is limited to one industry and one year; therefore, we cannot comment on time trends. We have relied on information communicated by companies on compensation which cannot be independently verified. We do not draw any conclusions as to whether the specifically identified relationships have led to actual rather than potential conflicts of interest.

However, given the magnitude of competing priorities between academia and pharmaceutical companies, dual leadership roles cannot be simply managed through internal disclosure. These relationships have potentially far-reaching consequences beyond those created when individual physicians consult 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 protected]).

Author contributions: Dr Anderson had full access to all data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study design and design: All the authors.

Data acquisition : Anderson, Dave, Gelad.

Data analysis and interpretation: All the authors.

Drafting of the manuscript: Anderson, good.

Critical review of the manuscript for significant intellectual content: All the authors.

Statistical analyzes: Anderson.

Funding obtained: Gelad.

Administrative, technical and material support: Dave, good, Gelad.

Supervision of studies: Good, Gelad.

Conflict of Interest Disclosures: The authors completed and submitted the ICMJE form for the disclosure of potential conflicts of interest. Dr Anderson said he received a travel reimbursement from the American Medical Student Association for speaking out about conflict of interest topics. Dr Gellad said he received 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 CDA Health Services Research and Development Grant 09-207.

Role of the sponsor: The Department of Veterans Affairs played no role in the design and conduct of the study; data collection, management, analysis and interpretation; preparation, revision or approval of the manuscript; and the decision to submit the manuscript for publication.

Disclaimer: This work represents the views of the authors and does not necessarily represent the views of the Department of Veterans Affairs or the United States government.

United States Securities Commission. Electronic data collection, analysis and recovery system. http://www.sec.gov/edgar.shtml. Accessibility verified on February 27, 2014.
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