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President Obama's Plan for Reform
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Where health care policy experts have their say
Sources of Medical Research Funding
January 28, 2010:
In early January, Partners HealthCare (which oversees Massachusetts General and Brigham and Women’s Hospital) released a new conflict of interest policy that limits senior officials’ ability to receive compensation for the work on the boards of biotech and pharmaceutical companies, and prohibits their physician employees from receiving speaker’s fees from drug companies. (See the New York Times article here: Harvard Teaching Hospitals Cap Outside Pay)
Some critics, like Dr. Arnold Relman, think that the policy doesn’t go far enough: “I think that’s a gross conflict of interest for an official of an academic medical center to be on the board of a pharmaceutical company…If it isn’t stopped, I think the academic institutions are going to lose the confidence of the country and the government and they will no longer deserve the tax exemption or anything else. They will be part of the industry itself.”
This criticism, however, ignores the benefits that can accrue from physicians and companies having a better sense of their respective activities, needs, and roles in research and clinical medicine. Does the Partners policy address a real potential for corruption and fraud? Or is it an over-reaction to criticism that may imperil the potential for future innovations?
This edition of our expert panel includes:
Partners HealthCare is a Harvard Medical School offshoot that provides health care and runs two hospitals -- Massachusetts General and Brigham and Women’s -- which themselves are largely staffed by Medical School faculty, so that some 8,000 of Partners employees have Medical School appointments. Faculty meetings are held in the Boston Garden when the Celtics are out of town.
Partners HealthCare recently imposed a ban on faculty speaker fees from pharmaceutical and biotech companies, supplemented by limits (not a ban) on fees for serving on the board of directors of such firms. The goal is to help patients by curtailing conflicts of interest. Whether things will actually work out that way is highly doubtful. Judging by news reports, pharmaceutical companies typically tap high-level Partners employees – such as chief medical officers -- for their boards. People in that kind of position oversee such vastly diverse medical decision-making that it is hard even to imagine why or how they subvert medical care to the interests of the firms on whose boards they serve. After all, they have to protect the reputations that attracted attention in the first place. Of course, they are eager to see new treatments emerge from the formidable research capabilities of the Harvard Medical complex, but the rules of the drug development game leave almost no room for anything beyond the paramount goal of finding out what actually works.
As for speaking fees, these typically go to outstanding faculty whose greatest assets, again, are academic reputations – precisely the reason they are tapped for speaking roles, advisors, and so on. That circumstance greatly diminishes the chances of patient harm. The real problem lies elsewhere, in the role of physician as both decider (you need surgery) and provider (I actually do this kind of surgery a couple of times a week!). The new Partners conflict-of-interest policy does nothing to address this timeless and persuasive conflict of interest.
Jack Calfee is a resident scholar at the American Enterprise Institute and an economist who
studies the pharmaceutical industry and the Food and Drug Administration (FDA), along with the economics of tobacco, tort liability, and patents.
He previously worked at the Federal Trade Commission's Bureau of Economics. He has also taught marketing and consumer behavior at the business
schools of the University of Maryland at College Park and Boston University.
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In 1945 Vannevar Bush (who spearheaded the American scientific initiatives in World War II) prepared a short report, Science The Endless Frontier http://www.nsf.gov/about/history/vbush1945.htm that lay the basis for the huge advances that took place in American science in the post-War era. The key to that development lay in the creation of a strong public sector for science research that lay the foundation for effective commercialization of new advances through the private sector. Cooperation is necessary to secure the rapid and orderly transmission of information across that public/ private divide. Key to that effort must be individuals who work in both camps at the same time. For years, many American scientists have also started their own private companies and worked on boards of larger corporations. Conflicts of interest can arise and must be regulated. But the recent proposals of places like Partners in Health Care to limit across the board the compensation that its members can receive for working on corporate boards represents a strong overreaction to the dangers posed by these collaborations. It makes no more sense to narrow key lines of communications because of an occasional mishap than it does to allow only people over 30 to drive because some younger drivers have accidents. No sound public policy can be formulated by overstating the costs of well-established institutional arrangements while ignoring their benefits.
Richard Epstein is the James Parker Hall Distinguished Service Professor of Law at the University of Chicago, where he has taught since 1972, and the Peter and Kirstin Bedford Senior Fellow at the Hoover Institution. He also is a Manhattan Institute visiting scholar and a visiting professor at NYU Law School.
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Academic-industry relationships are among the most important drivers of medical innovation in the United States. While such relationships have been enormously productive for American medicine, they may also go awry and thus warrant careful handling. It is disappointing that the new Partners Healthcare COI policy follows what is becoming a common pattern among academic medical centers of focusing on appearance rather than substance in seeking to guide such relationships. Partners is taking measures that will visibly remove faculty from certain forms of involvement with industry that are socially useful: work on corporate boards will be discouraged and participation in industry promotion will be prohibited. These restrictions will not aid the academic mission and will predictably interfere with the important academic priorities of producing and disseminating new knowledge. That is a pity.
Thomas Huddle is a clinician-educator in the Division of General Internal Medicine at UAB--The University of Alabama at Birmingham, His research interests include the history of medical education, contemporary issues in medical education, the organization of the medical profession and its practice, clinical and research ethics and the nature and character of clinical knowledge.
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The action taken by Partners HealthCare (in limiting involvement of its senior management in governance of for-profit healthcare companies) is an over-reaction that is potentially damaging to the industry and to academic institutions themselves. As the pace of scientific advances increases, professional education and applied research grow increasingly interdependent. The cost to society of increased compartmentalization is inefficiency—slower development and deployment of life-saving technology. Patient lives literally depend on this collaboration, along with the future competitiveness of the US healthcare industry. Further, at a time hospitals are employing physicians as rapidly as they can, one must ask where such policies, if more broadly implemented, will take us. The attempt to remove ‘temptation’ for the sake of appearances is a reaction to outlier events, and promises to create more harm than good. The underlying assumption that money automatically taints judgment is a belief held in some academic circles reflecting a different, but biased, agenda. Policy makers would do well to bear in mind the first principle of their calling—primum non nocere.
Dr. Rita Numerof, Ph.D., heads up Numerof & Associates, Inc., a management consulting firm with more than 20 years experience working with leading pharmaceutical, medical device, healthcare delivery, and insurance organizations to address strategy, marketing, operational improvement and compliance issues. In addition, she serves as an advisor to members of Congress on both sides of the aisle, providing perspective on healthcare reform proposals and initiatives.
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Dr. Relman labels it “a gross conflict” when an academic medical center official serves on the board of a pharmaceutical company. In doing so, he indulges a popular framing bias that encourages a one-sided view of a relationship which, by terminological fiat, simply cuts off further enquiry whether, after all things are considered, such service may be on-balance good for the medical center, good for the pharmaceutical company and good for the country. He also seriously underestimates the moral capacity of executives, whether from academia or business, to balance multiple competing interests and reliably to show good judgment in doing so. Anecdotes recounting the irresponsible conduct of a few miscreants does not amount to data tending to show that pharmaceutical board members drawn from academia tend to be untrustworthy.
Lance K. Stell is the Samuel E. and Mary West Thatcher Professor of Philosophy and Director of Medical Humanities at Davidson College. He regularly teaches Ethics, Philosophy of Law, and Clinical Ethics. He holds a faculty appointment in the Department of Internal Medicine at Carolinas Medical Center, a teaching hospital in Charlotte with which Davidson College has formal institutional ties. He is also Clinical Professor of Medicine at the UNC-Chapel Hill School of Medicine and at the Translational Science Institute of the Wake Forest School of Medicine.
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On January 3 The New York Times reported that Partners, Harvard Medical School affiliated teaching hospitals, had ruled unacceptable the widespread practice of university presidents and other high academic officials receiving equity and large fees for serving on corporate boards. Justifying the policy was “conflicting roles of some medical leaders” that “have raised questions about bias and the cost and quality of patient care at the nation’s medical institutions.”
No substantive evidence supports these “questions’” validity
A Partners leader disingenuously declared that limiting directorship payments balanced a ban on junior faculty receiving fees for speaking about company products. Institutional officials, who receive far greater and more secure salaries than junior faculty, will simply demand compensation for their directorship restrictions.
The Times quoted the usual anti-industry critics’ demands for elimination of directorships by Partners officials.
Partners already has among the toughest corporate engagement policies in the nation. The Times coverage illustrates the futility of appeasing economically illiterate critics and media who believe medical service, education and innovation should be done by ascetic penitents.
Dr. Thomas Stossel is the Director of Translational Medicine Division at Brigham & Women’s Hospital and American Cancer Society Professor of Medicine at Harvard Medical School. He currently is Editor in Chief of Current Opinion in Hematology and a Trustee of the American Council on Science and Health and co-founder of The Association of Clinical Researchers and Educators.
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The pharmaceutical industry is a powerful innovative force, both in the creation of new life-saving technologies and the underwriting of academic medical research. Yet there is now a sweeping "conflicts of interest" movement aimed squarely at curtailing academic-industry collaboration in biomedical research. Critics, like Dr. Arnold Relman, former editor of the _New England Journal of Medicine_, assert that ties between researchers and industry are unethical. But the campaign to purge industry experts from corporate boards, limit their compensation, or forbid them honoraria chills scientific debate and deprives the public of valuable medical insights.
The conflict-of-interest activists focus entirely on the allegedly biasing effects of money while ignoring how other conflicts can bias scientific interpretation. Why should having served on the Pfizer Board raise questions about hidden agendas -- while being a lifelong member of Greenpeace or Public Citizen does not?
Elizabeth Whelan is President of the American Council on Science and Health (ACSH) and a member of its Board of Trustees. She founded ACSH in 1978. Whelan is a graduate of Connecticut College. She has a Masters in Public Health from the Yale School of Medicine a Master of Science from the Harvard School of Public Health, and a Doctor of Science from the Harvard School of Public Health. Whelan is the author or co-author of twenty-three books on nutrition, smoking, and environmental issues.
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