Double Duty: Academic Leaders, Corporate Boards, And The Harvard Connection

A large and potentially disturbing number of leading academic figures serve on the board of directors of public healthcare companies, according to a new study published in BMJ.

“These kind of industry relationships have not been front and center in most debates about conflict of interest (COI),” David Rothman, PhD, a medical historian at Columbia University, noted in an accompanying BMJ editorial.

“Previously, most COI discussions have involved thinking about ‘doctors with their prescription pads’ being influenced by industry,” he wrote. “This paper opens up an area we haven’t much thought about.”

Researchers at the University of Pittsburgh, led by Walid F. Gellad, MD, MPH, analyzed available data from nearly all publicly owned U.S. healthcare corporations. Among their findings:

• 41% of companies (180 of 442) had at least one academic board member
• 9% (309 of 3,434) of company board members came from academia
• 19 of the top 20 NIH-funded schools had at least one faculty member serving on a company board
• All of the top 17 U.S. News & World Report hospitals had at least one board member
• Total compensation to academic board members was $55 million
• Median compensation was $193,000
• Academic board members beneficially owned 60 million shares of corporate stock, atop direct compensation

The new study went beyond earlier work that looked at COIs involving insurers, pharmaceutical benefit managers, and other non-pharmaceutical or device oriented companies. However, this new study did not include any information about private companies or companies based outside the U.S.

The authors noted that

“unlike consultants who are compensated to provide expertise on a specific issue, directors are subject to a fiduciary responsibility to company shareholders to advance the general interests of the company and increase profits. Secondly, directors are reimbursed both through larger cash fees than typical consulting contracts and through stock options, the value of which is directly tied to the financial success of the company. Serving as a director has largely been unaddressed in professional society guidelines.”

They concluded:

“Dual obligations to for profit company shareholders and non-profit clinical and educational institutions pose considerable personal, financial, and institutional conflicts of interest beyond that of simple consulting relationships. These conflicts have not been fully addressed by professional societies or academic institutions and deserve additional review, regulation, and, in some cases, prohibition when conflicts cannot be reconciled.”

In his editorial, Rothman wrote that “although it may seem radical, excluding leaders from directorships is the only credible policy. Critics insist directorships promote cooperation and progress; but obviously many ways exist for sharing knowledge without joining a board.”

Joseph Ross, MD, of Yale University, offered the following comment on the study:

“The presence and substantial compensation of academic medical center faculty and leaders on the Board of Directors of publicly traded healthcare companies raises important concerns about the dual obligation to both promote the profitability and sustainability of the company while ensuring the commitment and ideals of the academic medical center to education, patient care, service and discovery. At times, an individual’s role will put one obligation in conflict with another. Clear guidelines for professional society and academic medical center review and oversight over these relationships are needed.”

The Harvard connection

Harvard University has more faculty, administrators, and trustees who serve on corporate boards than any other institution. According to the BMJ study, Harvard has 29 faculty members, leaders, and trustees who are directors of public corporations in the US. Cornell, in second place, has 20 board members.

The BMJ article does not name individual directors because the authors chose to “highlight the topic, rather than focus on individuals.” But it is not difficult to find out who some of these individuals are. Two examples, both at Harvard, raise important additional questions about the issue of board membership.

Katherine Baicker is a professor of health economics at the Harvard University School of Public Health. She has been described as “arguably the most acclaimed health policy researcher” in the country. Since December 2011 Baicker has also served on the board of directors of Eli Lilly. Baicker has one additional conflict: she is a commissioner of MedPAC, which is “a nonpartisan legislative branch agency that provides the US Congress with analysis and policy advice on” Medicare.

The authors of the BMJ study point to “the dual obligations to industry and academia” that may diverge when individuals try to serve both those interests at the same time. It seems clear that serving yet another interest– in this case, an important advisory role to congress– adds yet another level of difficulty to this already hard problem.

Peter Zimetbaum is an associate professor of medicine at Harvard Medical School and the director of the coronary care unit and clinical cardiology at Beth Israel Deaconess Medical Center. As I have previously reported, Zimetbaum also serves on the board of Forest Laboratories. According to the Open Payment database, between August 2013 and December 2014 Zimetbaum received $657,000 from industry, almost all of it from Forest Laboratories, where he serves on the board of directors. In addition to compensation for his board duties, it appears that he also receives significant sums from the company for promotional talks and consulting.

But there’s an extra layer to Zimetbaum’s conflicts. Zimetbaum also serves on Harvard Medical School’s conflict of interest committee. According to Forest, this “provides Forest with important insights on the ethics of healthcare.”

Perhaps it bears repeating: a Harvard professor who received nearly two-thirds of a million dollars from industry over 17 months serves on the committee that determines the school’s conflict of interest policy.

Here’s a perspective from one thoughtful observer who wished to remain anonymous: “Being on a COI panel is a good strategy to make sure the panel does not adopt any policies that would affect your bottom line. Or you get to influence policies and even give the appearance of being a watchdog. But that allows you to selectively support some regulations or establish precedents that have the least impact on you. For example, you could push for management that is not really meaningful, like disclosure for dollar amounts that fall above what you make. People are self-interested in their actions and their rationalizations for their actions. It is an unconscious bias. The literature shows it.”

I have requested comments from Baicker and Zimetbaum, as well as from Harvard Medical School, the Harvard School of Public Health, and MedPAC. I will update this story with any responses I receive. Harvard Medical School did provide me with a link to the HMS COI policy statement, which includes this FAQ about board membership:

“Q: Can faculty members serve on a company’s the fiduciary board of directors?

A: It depends. Participation on the fiduciary board of a for-profit company engaged in commercial or research activities of a biomedical nature will now, effective January 1, 2011, be subject to periodic review by HMS (and its affiliated institutions, as applicable) in order to evaluate whether the arrangement gives rise to a conflict of interest requiring management and/or elimination. As an individual’s authority within HMS (and/or the individual’s affiliated institution, as applicable) increases, the scrutiny applied by HMS (and the affiliated institution) will similarly increase in view of the individual’s scope of authority. Assessment of these relationships will occur in connection with the HMS annual disclosure process.”

As it happens, according to the Boston Globe, Harvard is currently engaging in a wholesale reevaluation of their conflict of interest policies. According to the article, many in the Harvard community believe that the current guidelines are too strict. One Harvard professor states that “If there were conflict-of-interest policies so that Thomas Edison couldn’t be involved in the company he formed to create the electric light, we’d still have gas lamps.”

From the comments section:

James Stein (University of Wisconsin): When fiduciary responsibilities coincide the conflicts are dramatic. Patients and the health care system suffer. Boards of Directors provide the veneer of status and prestige but in the end are simply ways to exert economic control. Doctors and researchers seem so naive in this regard. That we are calling for no interaction with industry is a red herring. We want ethical interactions and transparency. Where your treasure is, there your heart shall be. An old maxim – still true.