Tuesday, November 01, 2011

If a Medical School is Just Part of the "Biomedical Industry," Who Will Do Medical Education?

A little while ago, we discussed questions raised by the pre-existing financial relationships of Dr Laurie Glimcher, the new incoming Dean of Weill Cornell Medical School. Dr Glimcher is also the longest serving director of Bristol-Myers-Squibb, and has a number of other financial relationships with drug and device companies.

A new interview with Dr Glimcher suggested that what is most interesting about the coverage of her ascension to the Cornell Deanship is what it did not mention, especially whether she has any goals other than promote relationships with and do product development for corporate health care.

So let me review what has been made public about the interests and goals of Weill Cornell Medical College's new Dean.

The New York Times: To Develop "Research Capacity" and a "New High-Tech Campus"

The New York Times article focused on the new Dean's conflicts of interests, but found no doubts about these conflicts among the university leadership to whom the new Dean would report. Instead,
Cornell University’s president, Dr. David J. Skorton, said he believed Dr. Glimcher had the skills to carry out the medical school’s plan to double its research capacity and to help the university compete to develop a new high-tech campus proposed by the Bloomberg administration.

However, while it emphasized how university leaders defended Dr Glimcher's conflicts of interest, the New York Times article said nothing about the university leadership's educational or clinical expectations for Dr Glimcher.

The Cornell Sun: To "Strengthen its Relationship with Biotechnology and Pharmaceutical Companies"

Similarly, according to the Cornell Daily Sun, the university leadership regarded the new Dean's relationships with industry as strengths, not weaknesses,
As the longest-standing member of the corporate board of biopharmaceutical company Bristol-Myers Squibb, [Dr Laurie] Glimcher has 'extensive experience' in corporate finance, governance and management, according to a University press release.

Under Glimcher’s leadership, Weill hopes to strengthen its relationship with biotechnology and pharmaceutical companies, develop innovative cures and bolster research, the University stated.

The Sun did briefly note,
In a press release, [Cornell University President David J] Skorton said he was 'honored and delighted' that Glimcher accepted the position.

'Her passion for accomplishment and her many research and clinical strengths make her ideally suited to build on Tony Gotto’s strong foundation and lead Weill Cornell’s bright future in clinical care, education and translational research,' Skorton said.

However, there were no further details about what Dr Glimcher would do for clinical care or education.

The Cornell Press Release: To Achieve "Preeminence in the Biomedical Sciences"

This press release emphasized Dr Glimcher's corporate skills even more than did the Times or Sun articles,
Her service with the biopharmaceutical company Bristol-Myers Squibb, where she is the longest-standing member of the corporate board of directors and of its audit committee, has afforded her extensive experience in management oversight, corporate governance, corporate finance, accountability, leadership and the practical aspects of running a business and bringing therapeutics to the marketplace.

'This is great news for the medical school and for the city,' said Sanford I. Weill, chairman of the medical college's board of overseers and a member of the board of trustees of Cornell University. 'With her thorough appreciation of the management and financial challenges of complex organizations, I am confident she will lead the college with the same creativity and acumen she demonstrated when she pioneered the establishment of Bristol-Myers' science and technology committee, which is widely credited for transforming its stake in research. With a state-of-the-art biomedical research facility under construction and Dr. Glimcher at the helm, Weill Cornell and New York are on course to achieve a preeminence in the biomedical sciences that has already been achieved in clinical medicine and first-rate medical education.'

However, it said nothing substantive about Dr Glimcher's educational or clinical goals or interests. (Perhaps, because Mr Weill thought that the school had already achieved preeminence in these areas, he also thought no further goals in these areas are needed.)

Crain's New York Business: "Critical that the Pharmaceutical Industry has Input from the Biomedical Industry"

Now Crain's New York Business just published an interview with Dr Laurie Glimcher, the Dean to be of the Weill Cornell Medical College with a singular emphasis.  It introduced Dr Glimcher thus,
She is the longest-serving member of the board at Bristol-Myers Squibb and has been a big earner from her work with drug companies. Snaring Dr. Glimcher is a coup for Cornell University, which is using her status to bolster its proposal to build a science and engineering campus on Roosevelt Island.

The interviewer asked, can New York become "a more competitive research hub?"  Dr Glimcher opined,
I think New York City is going to be the next greatest center for biomedical research.

Then, with an instructive tilt, why are you so comfortable taking research funding from drug makers?  Her answer included the usual rationale, but with a twist:
I think it's critical that the pharmaceutical industry has input from the biomedical industry. I believe it is essential to have partnerships to accomplish our goals.
The implication, and the twist is that she apparently sees herself as leading not a medical college, but an entity within the "biomedical industry."

The next question was, does this mean that more collaboration with drug companies are ahead for Weill Cornell?  Her answer was no surprise,
Harvard probably has more ties to pharmaceutical companies than Weill Cornell, but Weill Cornell definitely has connections that I hope we can leverage.

At this point, it should be no surprise that this interview of this erstwhile leader of "biomedical industry" mentioned nothing substantive about clinical care or medical education.

Summary: Education and Patient Care Disappear into the Maw of the "Biomedical Industry"

In summary, so far, all the hoopla about the new Dean of Weill Cornell Medical College has been about her anticipated ability to align the school with the pharmaceutical and biotechnology industry. Amidst the hoopla, neither the new Dean nor anyone within the Cornell leadership has said anything about her interests, goals, or positions relevant to education or clinical care. Yet education is the most fundamental mission of a medical school and of academic medicine. Instead, on one occasion, the new Dean suggested that she would be leading not a medical school, but part of the "biomedical industry."

So it appears that the brave new version of the Weill Cornell Medical College is not merely more focused on doing product development for industry than on its traditional mission of education, research more broadly defined, (e.g., which also may include basic biomedical research, clinical research, and epidemiological and public health research), and patient care. It appears that applied research for product development has become its only important goal. How else should one interpret what the new Dean and her supervisors have said? Not one of them has said anything about education or patient care other than to acknowledge that these endeavors exist.  (Also, not one of them discussed the other kinds of research that medical schools and academic medical centers have traditionally done.)

If Cornell's Board Chairman, President, and Medical College Dean are only interested in being part of the "biomedical industry," why should anyone want to attend what is still called their "Medical College?" Why should anyone want to serve as a house officer in one of the "Medical College's" hospitals? Why should anyone want to attend one of the "Medical College's" continuing medical education courses? If Cornell's Board Chairman, President, and Medical College Dean are only interested in being part of the "biomedical industry," that is, doing applied research for product development, why would any patient want to go to their hospital,s clinics, and other facilities?

We now see not merely academic medical leadership chosen because of, not despite their conflicts of interest with health care corporations. We now also see academic medical leadership who appear only interested in corporate product development, and not even interested in talking about education or patient care (or traditional biomedical, clinical, and epidemiological research.)

Of course, all this discussion is based only what has been published so far about the new leadership of Weill Cornell. Maybe the publications have been woefully incomplete and full of errors. I eagerly hope that to be the case (nooffense intended to the journalists involved.) But I fear that we are seeing the final common pathway for the corporate academic medical center, its transformation into the "Biomedical Industry."

If academic medical leaders no longer care about education or patient care, the downward spiral of our health care system has only just begun.


Afraid said...

Spot on Roy. Same has happened elsewhere already, these folks are just following the herd. The 'leadership' of this change comes from the big city medical schools and their huge academic medical centers.

Anonymous said...

Perhaps you are just being intellectually lazy as per this in KevinMD: http://www.kevinmd.com/blog/2011/10/judging-guideline-financial-interest-intellectually-lazy.html

Roy M. Poses MD said...


Brilliant, a nearly pure ad hominem attack in only 12 words plus one URL.

And your evidence that I am intellectually lazy would be?

By the way, the relevance of the post above to conflicts of interest affecting clinical practice guidelines would be?

Steve Lucas said...

Shades of UCSF.

During half time at a recent Ohio State football game President Gordon Gee spoke in glowing terms of soon having all freshman enter school with passports in hand and being required to not only spend a semester overseas, but also participating in a research project.

Ohio State is a land grant college whose main purpose is suppose to be providing educational opportunities to the citizens of the State. Instead we find a few years ago tuition was raised so more students qualify for loans. The statement was made that those who do not qualify for a scholarship, or are able to secure a loan, will just have to go to the community colleges, but it still going to cost more to attend Ohio State.

This is a far cry from providing broad based educational opportunities to the general public.

OSU has also pushed the City of Columbus to end the low cost housing options that use to surround the university. The stated desire is a “Harvard” atmosphere. My lawyer wife was only able to attend Harvard’s CLE program for a week at a time in the past due to cost, and that was using all of her educational money from her State job.

Our educational institution’s seems to have lost their way and in many cases reflect ethics not acceptable in the general business world.

Steve Lucas

MB said...

Unfortunately, the entire medical industry (from school to professionals to drug reps to insurance) is a giant conflict of interest right now. I truly believe that nobody (okay, maybe a few) means to behave unethically, but we definitely have a system that incentivizes that to occur.

Anonymous said...

Rather than arguing the science you simply point out negative characteristics of physicians who collaborate and work with industry. So you argue that because such physicians work with industry, any work they produce must be biased or conflicted or not evidence-based. There is no evidence or scientific proof to even suggest that relationships with industry harm patients or produce negative outcomes.

Indeed outcomes are often ignored by those who attack doctors working with industry because outcomes better than the norm for docs who work with industry do not fit the proposed narrative.

Roy M. Poses MD said...


My main point was that the publicity surrounding the new Dean of a prestigious medical school ignored major aspects of the traditional medical school mission, (education, clinical and public health research, and patient care), while emphasizing a medical school activity that is not part of that mission, commercial drug development.
The icing on the cake was the new Dean's apparent reference to the medical school as part of the "biomedical industry." It used to be that medical schools were considered non-profit academic institutions.

By the way, I have nothing against commercial drug and device development. I do not see, however, why it should become the primary mission of medical schools. If it does become their primary mission, who is supposed to teach medical students, and to do clinical research?

PS - Much of the comment seems to be irrelevant to this specific post.

I challenge "Anonymous" to cite a single example in my post above of any assertions about "negative characteristics of physicians who collaborate with industry."

Furthermore, his or her discussion of conflicts of interest does not seem relevant to this post.

If he or she wants to argue about what aspects of physician-industry "collaboration" may be more or less likely to produce good results for patients, public health, or society, he or she should at least pick such an argument about a relevant post.