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Hospitals need a stronger prescription for keeping the public’s trust

Policies for conflict of interest should be updated so that patients don't have to question the loyalty of hospital executives.

The fact that Elizabeth Nabel was on the Moderna board doesn’t mean she did anything unethical regarding the vaccine trial, but her resignation signals that the appearance posed enough of a problem in the court of public opinion.David L. Ryan/Globe Staff/file

Dr. Elizabeth Nabel, the president of Brigham and Women’s hospital, broke no hospital rules when she took a seat on the board of Moderna, a Cambridge biotech firm. Still, the fact that she held the position — from which she recently resigned — has bred mistrust and outrage from patients and her own employees. That’s why the rules that allowed it need to be changed.

“A physician leader is different than another leader,” said Dr. Charles Binkley, director of bioethics at the Markkula Center for Applied Ethics at Santa Clara University. “A hospital leader has different moral obligations.” It’s impossible to meet those moral obligations, said Binkley, when you are also a board member “with a fiduciary responsibility to propel the profits of a company” — not to mention the opportunity to enrich yourself from those company profits.


Nabel joined the Moderna board in 2015, and her position was approved in accordance with hospital policies. More safeguards were put in place after the hospital undertook a major role in a nationwide study of an experimental vaccine for COVID-19, which is being developed by Moderna and the National Institute of Allergy and Infectious Diseases. In May, Nabel sold about $8.5 million worth of stock in Moderna. After the Globe asked hospital officials whether Nabel’s position at the biotech firm conflicted with her hospital’s work in the clinical trial, she resigned from the Moderna board. It’s worth noting that the fact that she was on the Moderna board doesn’t mean she did anything unethical regarding the vaccine trial, but her resignation signals that the appearance posed enough of a problem in the court of public opinion. The stock sales also angered employees, because at the time Nabel was cashing in her shares, the parent company, Mass General Brigham, reduced or froze salaries and suspended contributions to retirement benefits.

Relationships like this between hospital executives and biotech and pharmaceutical firms are common. In 2014, the Journal of the American Medical Association published a paper that found that about 40 percent of pharmaceutical company boards of directors had at least one member who held a leadership position at an academic medical center. The paper, co-authored by Dr. Walid F. Gellad, director of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh, explored the potential for conflict of interest problems, but did not reach a conclusion about any actual conflicts.


In 2018, the risks became more than hypothetical when The New York Times, in collaboration with ProPublica, reported that top hospital executives at Memorial Sloan-Kettering Cancer Center in New York profited from relationships with drug companies, outside research ventures, and corporate board memberships. The disclosures led to the resignation of the hospital’s CEO from the corporate board of Merck & Co. and drew “new attention to the opaque web of connections between pharmaceutical companies and nonprofit health systems at the highest levels of power,” reported biopharmadive.com, an online industry newsletter. In the embarrassing aftermath, Memorial Sloan-Kettering announced it would bar its top executives from serving on corporate boards of drug and health care companies.

Arguments in favor of allowing these relationships include the contention that it helps hospitals to recruit the best talent, if executives are also allowed to accept lucrative board positions. There are also benefits to the institution from such collaboration. Hospital leaders can learn about the latest research in a given field and help shape the direction taken by these companies. Yet the potential risk is considerable in terms of maintaining the public’s and employees’ trust. For example, for those working on a clinical study at a hospital, people can raise the question: how much does knowing of their boss’s financial stake in an outcome influence their thinking? For employees, said Binkley, “What people see is a physician leader making a lot of money ... while freezing and cutting salaries at their institution. Meanwhile, a patient may rightly wonder, ‘Is what I’m being prescribed, treated with, benefiting me or the person prescribing it?‘”


Hospitals are special places, and their leaders have special obligations. One of those obligations is absolute, undiluted loyalty to the community they lead and serve. That includes patients and their families, along with the entire universe of hospital employees — from doctors, nurses and nurse’s aides to cleaning crews and cafeteria staff.

Allowing executives to serve on corporate or biotech boards while the hospitals they lead are conducting research on their products could undermine that loyalty and compromise trust in the hospital itself. It’s a practice that hospitals should rein in for their own sake.

Editorials represent the views of the Boston Globe Editorial Board. Follow us on Twitter at @GlobeOpinion.