A study led by members of the Massachusetts General Hospital Institute for Health Policy and a University of Michigan bioethicist has found that institutional academic-industry relationships -- financial relationships that companies have with medical schools or teaching hospitals rather than with individual physicians or scientists -- are as common and pervasive as individual relationships.
Their report, the first nationwide look at the extent and impact of these relationships, appears in the Oct. 17 issue of the Journal of the American Medical Association.
"Our data show that institutional relationships are as ubiquitous as individual relationships," says Eric Campbell, PhD, of the MGH-IHP, the study's principal investigator. "As with personal interactions, some institutional relationships likely pose conflicts of interest with the overall missions of academic medical centers. This study is a first step toward compiling information that will be crucial for the development of policies regarding these relationships."
"We wanted to find when these influential medical leaders thought relationships with industry might add to or detract from the independence of medical centers' research and teaching," says Susan Goold, M.D., MHSA, M.A., the study's senior author and director of the Bioethics Program at the University of Michigan Medical School. "Although many respondents felt that relationships with industry could compromise the independence of research or education, such relationships were nonetheless quite common."
To investigate the extent of institutional academic-industry relationships, the researchers conducted a survey of department chairs -- senior members of the academic hierarchy -- at 125 U.S. medical schools and the 15 largest independent teaching hospitals, which conduct more research than do some medical schools.
At each institution the survey was sent to the chairs of Medicine and Psychiatry -- specialties that often receive industry funding for educational activities -- and two randomly selected chairs of other clinical departments. Surveys also were sent to the chairs of Microbiology and one randomly selected non-clinical chair.
The surveys included questions regarding relationships the departments as administrative units had with pharmaceutical companies and medical device manufacturers and about any individual relationships involving the department heads, since those might have an impact on departmental activities.
Respondents were asked about the nature of those relationships and compensation received including direct funding, honoraria, equity or stock options, equipment, royalties and licenses, educational support, personal gifts, travel expenses and food.
They also were asked whether these relationships had positive or negative effects on the activities of their own departments and to generally assess whether particular types of grants or relationships might affect any department's ability to pursue educational efforts or research that was independent and unbiased, terms that were emphasized in the survey itself.
Almost 460 department heads completed and returned the survey, and their responses indicated that 67 percent of departments and 60 percent of department chairs had some type of industry relationships.
The chairs were most likely to act as consultants, members of a scientific advisory board or members of speakers bureaus. Non-clinical departments were most likely to have relationships involving intellectual property.
Relationships between industry and clinical departments were ubiquitous, with four out of five receiving discretionary funds for food and beverages, travel and meetings, or research equipment and supplies.
Relationships involving medical education were quite common, with 65 percent of clinical departments receiving funding for continuing medical education and 37 percent for resident and fellow training. More than half the chairs with industry relationships thought they had a positive effect on their own departments' educational programs.
In their assessment of the impact of industry support on a department's ability to conduct independent research and education, the chairs were more concerned about the effect of restricted grants -- those designated for a specific purpose -- than unrestricted ones. They also viewed larger grants as more likely to have negative effects than smaller gifts. However, the authors point out, other research has shown that even gifts of little or no monetary value can create feelings of obligation in recipients.
Study co-author Joel S. Weissman, PhD, of the MGH-IHP, adds, "We surveyed department chairs because they wield considerable influence over students and the careers of faculty researchers. Given their seniority, the fact that chairs have relationships with private industry may not be surprising, but it could be a cause for concern if there is a negative impact on the conduct of unbiased research and education that takes place under their watch."
The study was funded by the Greenwall Foundation. Additional co-authors are Sowmya Rao, PhD, and Sandra Feibelmann, MPH, of the MGH-IHP; Beverly Moy, MD, MPH, of the MGH Cancer Center; and Susan Ehringhaus, JD, American Association of Medical Colleges.
The U-M Health System was one of the first medical institutions in the country to place strong limitations on the interactions between its clinicians and representatives of companies that make or sell medications, medical devices or other products. UMHS was also one of the first to eliminate the use of drug samples in clinics and hospitals. In May, 2007, UMHS was recognized by the American Medical Student Association as one of only five academic medical centers to receive an "A" for such efforts.
Written by Sue McGreevey, Massachusetts General Hospital