Academic Medical Leaders as Corporate Directors

There is yet one more story out of the University of California.

The San Diego Union-Tribune reported that the Chairman of the UC Board of Regents is upset about the number of corporate boards the Chancellor of UC- San Diego sits on. (We had previously posted on this story here.)

UC-SD Chancellor Marye Ann Fox was reported to be on the boards of ten (that's 10) for-profit corporations and not-for-profit organizations. In response, the Union-Tribune reported, "UC Regent Chairman Gerry Parsky said the system needs to ensure chancellors keep the university as their top priority and that any benefits board memberships may bring to the university aren't outweighed by excessive demands on their time." But, "in the past, regents have deferred to UC President Robert Dynes regarding chancellors' compensation and outside activities."

"Fox, 58, an organic chemist, has said she will not step down from any corporate boards because she considers her service a boon to the university."

All things involved in managing and directing and envisioning for corporate entities are virtually the same things you have to do for universities.

In my humble opinion, however, the bigger issue is not how many boards she serves on, but the clear, substantial conflicts of interest entailed by her service as a Director of Boston Scientific, a medical device manufacturer, and of Pharmaceutical Product Development Inc, a pharmaceutical contract research organization.

As a Director, she has a fiduciary responsibility to look out for the interests of each of these companies, and for the financial interests of their stockholders. Yet as the Chancellor of UCSD, to whom the Medical School and the Medical Center report, she has a responsibility to ensure the quality of the patient care, medical teaching and research at those institutions.

Given that the School and Medical Center doubtless use in quantity the sorts of medical devices that Boston Scientific produces, and doubtless do the sort of research that Pharmaceutical Product Development is interested in, how on earth could she make decisions that always conform to these responsibilities?

And what sort of decisions are her subordinates, managers and executives at the medical school and medical center, likely to make about medical devices and about pharmaceutical research, knowing that they report to a Director of Boston Scientific and a Director of Pharmaceutical Product Development Inc?

In summary, any leaders of medical schools or academic centers, or academic leaders to whom they report, who also are directors of a pharmaceutical, medical device, health care IT, contract research, managed care, health insurance, or other health care related corporation havea clear, substantial conflicts of interest.

These sorts of conflict of interest are orders of magnitude more important than those created by physicians accepting the pens and coffee mugs Brennan et al were so worried about in their article in JAMA. (See post here.)
Yet Brennan et al ignored the existence of these conflicts, which, I must admit, have hardly been discussed on the medical and health care literature.

If we are so worried about pens and coffee mugs (and we should we), why aren't we addressing academic medical school leaders who also sit as directors of health care corporations?

Fox is hardly the only one.