Dozens of physicians from Brigham and Women’s Hospital, Massachusetts General Hospital, and other Harvard-affiliated medical centers have signed a petition calling for stronger ethics rules to prohibit top executives from working on corporate boards, outside jobs that can earn them millions of dollars but create conflicts of interest.
The petition — delivered July 27 to officials at the hospitals and at Harvard Medical School — is signed by more than 100 physicians, researchers, residents, and medical students from an array of specialties. Its text references findings from a Globe Spotlight Team report in April showing that Boston is an outlier among major cities in the large number of hospital chiefs who accept lucrative outside board work, mostly for drug makers and other health care companies.
“As an individual physician, I don’t even take a pen from a pharma company,” said Dr. Walter O’Donnell, a critical care physician at Mass. General who signed the petition, referring to hospital ethics rules governing regular clinicians. “Yet we have our hospital leaders take millions of dollars? It’s just improper.”
O’Donnell said some of his intensive care unit colleagues are also disheartened by these relationships between hospital leaders and companies. “I am a full-time doctor and teacher, and everything we do, our behavior and values, sends a message. What’s the message here to our patients, students, trainees, and colleagues?’' he said.
Dr. Jack Meyer, a retired Brigham radiologist and an emeritus professor at Harvard Medical School and a recent member of its admissions committee, said he has paused his donations to the Brigham over this issue. Hospital presidents, he said, should be “100 percent dedicated to the mission of the hospital.”
It is not unheard of for Boston’s hospital chiefs to work on multiple corporate boards at once. Dr. Elizabeth Nabel, who earned $2.4 million a year as Brigham president before stepping down in March, sat on the boards of two publicly traded companies and a group of investment funds at one point. Her outside work required her to attend, either remotely or in person, 30 to 40 board and committee meetings in 2019, according to the Spotlight Team report.
Last summer, Nabel resigned as a director for one of the companies, Moderna, amid concerns that her outside job could influence a nationwide clinical trial that Brigham researchers were helping lead on the company’s COVID-19 vaccine. She sold what turned out to be $8.5 million of Moderna stock before the trial concluded, and some Harvard physicians and staff were deeply upset by the extent of her profit.
At Dana-Farber Cancer Institute, chief executive Dr. Laurie Glimcher, who earns $1.8 million a year, is a director for both Analog Devices and GlaxoSmithKline, for which she earned $320,000 total in cash and stock last year.
The petition signers included Harvard faculty physicians who work at Mass. General, the Brigham, Beth Israel Deaconess Medical Center, Boston Children’s Hospital, and Dana-Farber Cancer Institute.
Dr. Carolyn Becker, a Brigham endocrinologist and co-author of the petition who e-mailed it to medical school and hospital leaders, said the action was born out of frustration and anger.
In a letter accompanying the petition, she wrote that the close relationships between hospital presidents and health care companies “have been damaging to the reputation of Harvard and have eroded the trust of our patients, employees, trainees and faculty in the integrity of our academic healthcare institutions.”
Yet, she told the Globe, leaders seemed slow to grasp the impact and importance of this issue. While Harvard Medical School and Mass General Brigham, the parent organization of the two hospitals, said they are reviewing their conflict of interest policies, the process has gone on for months and officials have shared little with doctors about their deliberations. Both hospitals are searching for new presidents, but won’t say if the new executives will be allowed to join outside boards.
“No one is asking us for input or ideas,” said Becker, an associate professor at the medical school. “No one is saying let’s talk about this.’’
Harvard Medical School Dean Dr. George Daley declined to comment on the petition. Ekaterina Pesheva, a spokeswoman for the medical school, said in an e-mail that “the dean has received and is aware of the concerns raised in the petition. He has asked the Harvard Medical School Standing Committee on Conflicts of Interest to consider the range and nature of possible conflicts and their potential impact on the medical school, its faculty, and its mission.’’
Rich Copp, a spokesman for Mass General Brigham, said the organization “is in the process of reviewing our policy on this topic.” The other hospitals declined to comment.
A handful of senior physicians agreed to talk to the Globe about why they signed the petition, but other doctors, especially those early in their careers, were reportedly worried that speaking out could damage them professionally. One of the most prominent physicians to lend his support was cardiologist Dr. Eugene Braunwald, a former chair of medicine at the Brigham and chief of cardiology at the National Heart, Lung, and Blood Institute. When asked to elaborate, he indicated the petition speaks for itself.
The petition calls for prohibiting those in “executive leadership positions’' at Harvard teaching hospitals from taking paid positions on the boards of publicly-traded companies. They did not include private companies because public companies routinely reward board members with valuable stock, which “is an extra way companies can influence our hospital leaders,’’ Becker said.
The petitioners argue that these outside corporate positions create multiple opportunities for conflicts between what is best for a hospital and its patients versus what is best for a pharmaceutical or for-profit company for which a hospital executive is a board member.
An example cited by medical ethicists is that a drug company may want high drug prices that can increase profits, but that burdens patients and sometimes providers.
“These goals are not aligned at all,” said Dr. Nancy Keating, an internist at the Brigham and a professor of health care policy at the medical school. Keating said it was an easy decision for her to sign onto the petition, as she has made it a practice to decline speaking engagements and other industry-paid work that could create an appearance of conflict.
Signers of the petition said hospital executive jobs are demanding and “very well-compensated,’’ requiring “undivided attention, commitment, and loyalty.’’
Boston hospital chiefs are outliers compared with their peers in the rest of the country, according to a Spotlight survey earlier this year. Until recently, six out of seven presidents worked as paid board members for pharmaceutical, biotech, and other health care companies.
The Spotlight Team analyzed 120 large teaching hospitals, children’s hospitals, and cancer centers outside of Boston, and found only eight were headed by chiefs who also work as directors for a publicly traded company. Even in a city as vast as New York, none of the 13 hospitals included in the Spotlight analysis this spring was run by presidents or CEOs who also moonlighted on corporate boards.
Boston hospital presidents and trustees — who typically make the final decision about whether hospital chiefs can join outside boards — declined the Globe’s requests for interviews in April.
But they defended the practice in written statements, saying outside directorships increase medical center collaboration with the critical bioscience sector that produces important drugs and devices. The risk of conflicting interests, they asserted, can be avoided with proper safeguards, such as prohibiting a hospital president who sits on a corporate board from participating in discussions about hospital business or clinical trials with that company.
But the petition is likely to increase pressure on Harvard Medical School and its affiliated institutions to curtail the practice. Harvard Medical School and its teaching hospitals all have separate, though similar, conflict-of-interest policies, and generally the medical school does not have authority over hospital executives. But if a hospital president is a physician who is also on the medical school faculty, then the school policy as well as the hospital policy could apply.
The Brigham’s interim president, Dr. Sunil Eappen, does not sit on an outside for-profit board. Dr. Peter Slavin, president of Mass. General, sits on the board of Amwell, a telemedicine firm, and earlier this year made $1.2 million selling stock paid to him for his board work. Slavin, who earns $2.4 million to run the hospital, also is planning to step down soon as hospital president.
Aside from Eappen, Beth Israel Deaconess president Peter Healy is the only chief of a major Boston teaching hospital who is not a director for a for-profit company. The hospital does not have a written policy prohibiting executives from outside board work but officials said the longtime practice is to not allow top executives to sit on for-profit health care company boards.
The chiefs of Tufts Medical Center and Boston Medical Center, who are not affiliated with Harvard Medical School, also hold positions on outside boards.
Becker said she hopes hospital and Harvard officials promptly address the issues raised in the petition. “This is a call to action that we start talking about these things openly,’' she said.
Liz Kowalczyk can be reached at firstname.lastname@example.org.