Boston hospitals warn doctors to disclose industry ties
Amid an unfolding ethics crisis at a prominent New York cancer center, Boston hospitals are warning doctors that they must publicly disclose all their financial relationships with pharmaceutical and device companies.
Dana-Farber Cancer Institute said it also plans to review the outside positions held by physicians, including its chief executive, Dr. Laurie Glimcher, who sits on the boards of drug giant GlaxoSmithKline and another public company.
The hospitals’ actions were triggered by a series of lapses at Memorial Sloan Kettering Cancer Center in New York City, including the failure of its chief medical officer to disclose millions of dollars in payments from pharmaceutical and other companies. Dr. Jose Baselga, a respected breast cancer researcher who was being paid to help develop drugs, stepped down from his hospital post last month following a report about the lapses by The New York Times and ProPublica.
Later, Memorial Sloan Kettering’s chief executive, Dr. Craig Thompson, resigned his highly compensated seats on the boards of drug makers Charles River Laboratories, based in Massachusetts, and Merck, saying he plans to focus more intently on hospital priorities.
The upheaval in New York prompted a strongly worded memo from a Partners HealthCare lawyer to physicians and researchers at Massachusetts General and Brigham and Women’s hospitals, the provider network’s Boston founders.
The lawyer, Christopher Clark, said that academics usually get in trouble because they’ve failed to disclose their relationships with industry, not because of the relationships themselves.
“These situations create a stain on the reputation of the individual involved that can never be erased; often the result is career-altering and sometimes career-ending,’’ Clark, director of Partners’ Office for Interactions with Industry, wrote late last month. “They also generally reflect badly on the institution involved.’’
Boston Children’s Hospital, Beth Israel Deaconess Medical Center, and Dana-Farber also advised physicians to carefully review their submissions to medical journals and their public presentations to make sure they accurately divulge all payments they receive from outside companies.
“Failing to do so,’’ said Beth Israel’s chief executive, Dr. Kevin Tabb, “can undermine confidence in the important work we all do.’’
Many executives at teaching hospitals and researchers believe that collaborating with deep-pocketed companies is the best way to turn discoveries made in academic labs into marketable drugs to treat patients, an expensive and time-consuming process. But, as Glimcher pointed out in a letter to staff late last month, “collaborations are also fraught with the potential for conflict of interest that can undermine public confidence in our work.’’
Those who favor these relationships believe transparency is one way to mitigate bias, Clark said in an interview. When researchers disclose financial ties to companies, colleagues and the public can take that information into account and look out for favoritism toward a particular product.
But disclosure does not always happen. A study published in JAMA Surgery in August found that 100 doctors who are highly paid by device makers divulged their relationships in medical journals 37 percent of the time.
Many academic medical centers do not monitor physician compliance with journal disclosure rules. Glimcher seemed to go further in her letter, saying Dana-Farber will strengthen reporting requirements and review researchers’ reporting practices.
Asked if Glimcher would give up her board seats, hospital spokeswoman Ellen Berlin said in an e-mail that “the Institute will be reviewing its policies around the overall issues of board memberships and consulting.’’ She declined to provide further details.
Glimcher was on the board of Bristol-Myers Squibb until July 2017, when she stepped down and joined GlaxoSmithKline’s board. The company pays her roughly $150,000 a year, at least 25 percent of it in the form of stock, “to enhance the link’’ with shareholders, according to a company statement.
Waters Corp., based in Milford, pays Glimcher $285,000 in stock and cash to sit on its board.
She took over as the chief executive of Dana-Farber in September 2016 and earned about $900,000 for the remainder of that year, according to hospital reports.
It is not uncommon for drug and device companies to recruit the heads of prestigious teaching hospitals to sit on their boards.
Dr. Elizabeth Nabel, chief executive of the Brigham, earns $175,000 annually, plus stock, as a director of the Dublin-based technology company Medtronic, and a confidential fee as a director of the Cambridge biotechnology company Moderna Therapeutics.
Eric Campbell, a bioethics professor at the University of Colorado, said that “drug companies have a right to the knowledge these people have,’’ but hospital chief executives should not be paid extra to serve on boards. “It takes away one component to the conflict,’’ he said.
Dr. Roy Poses, a Brown University professor and outspoken critic of industry influence on doctors, said there is an inherent conflict when hospital heads become directors of drug companies. As a company board member, their duty is to stockholders.
“You are very interested in heavily marketing your drugs and keeping your prices high and supporting research that makes your company look good,’’ Poses said.
Running an academic medical center, on the other hand, means “creating research that is unbiased and doesn’t favor anyone’s product,” he added. “You want to give the best possible care to the most patients, and you want to keep your costs as low as possible.’’