JAMA Letter: Many Academic Medical Leaders are also on Pharmaceutical Boards

A research letter published in the Journal of the American Medical Association (JAMA) explores the financial ties between academic medical centers and pharmaceutical companies by discussing individuals who both serve on company boards and hold leadership roles in an academic medical center. The letter, which was published online Wednesday, points out that nearly 40 percent of drug makers worldwide, including almost every US pharmaceutical manufacturer, have at least one board member who also holds a leadership position in academic medical centers.

Johnson & Johnson, Gilead Sciences and Pfizer have company boards with the largest represented proportion of academic medical centers.

According to the JAMA paper, 19 out of the 50 largest drug makers have at least one board member who also holds a leadership role at a US academic medical center, including 16 out of 17 US companies. Furthermore, the authors found that three percent of all board members (18 individuals) held 21 clinical or administrative leadership positions at centers.

The researchers who authored the letter say that the dual-role can be problematic because “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.” Company board members were paid an average of $312,564 in 2012.

According to the Wall Street Journal, the matter is being explored at a time when the US government is beginning to require pharmaceutical companies to disclose financial relationships with physicians. The U.S. Physician Payment Sunshine Act, which takes effect this year, is enforcing this.

Walid Gellad, an assistant professor of medicine at the University of Pittsburgh and co-author of the letter, says “There are a number of decisions these individuals may make about where resources are placed, the policies and regulations, what is taught, that are critical,” the Wall Street Journal reports.  “So any time we talk about a potential conflict, we need to consider these scenarios where the role at one institution may affect the role at the other institution. The possibilities [for conflicts] are real.”

Gellad and the two other researchers who authored the letter posed the question “Having a fiduciary responsibility to two separate entities is, at best, a very difficult situation. Will the leader direct business inappropriately to the outside company on whose board he or she sits? Will the leaders inappropriately use information about the institution he or she leads to influence decisions by the outside corporation?

The issues raised in the JAMA letter are not completely new. In 2007, JAMA published a study showing that 60 percent of department chairs at academic medical centers and university hospitals had some type of relationship with industry.

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