Over the past several years, and particularly over the past several months, physician relationships with the pharmaceutical and medical device industry have come under a microscope. Critics of the relationships, who frequently do not address the benefits such collaboration bring, often believe that payments from industry to physicians create a potential for bias or conflict of interest. However, to combat this problem, numerous academic medical centers (AMCs) have instituted transparency and disclosure policies so that faculty reports such relationships and payments. Additionally, numerous companies also publish such payments.
Despite the clear benefits that patients receive from physician-industry collaboration—newer devices and treatments, better training and education for physicians—critics continue to attack these relationships. In fact, the “belief that consulting fees and other remunerations from industry can adversely affect the educational activities of medical school faculty has led many such teaching institutions to require the disclosure and management of faculty members’ relationships with private companies.”
However, as a recent opinion piece in Nature Medicine titled Intramural conflicts of interest warrant scrutiny, too pointed out, “the financial incentives offered by medical schools have gone largely unnoticed.” Specifically, “people have taken little, if any, notice of the financial incentives provided by medical schools themselves.” In fact, as Matthew Movsesian, a professor of internal medicine and pharmacology at the University of Utah School of Medicine, pointed out, “these intramural incentives are far more prevalent than those from industry and have an even greater ability to influence the activities of medical school faculty.”
Consequently, Dr. Movsesian explained that, “part of the problem may be a failure to appreciate that US medical schools have evolved into big businesses that derive most of their income by providing healthcare services and securing extramural research grants. In 2009, for example, 53% of medical school revenues came from clinical services and 29% from extramural grants. By comparison, less than 4% came from tuition.
As a result, Dr. Movsesian pointed out that academic medical centers are now vying for clinical market share through direct-to-consumer advertising. “To increase referrals, they offer free continuing medical education programs that boost the visibility of their more profitable services to community providers and executives at these teaching institutions are paid industry-level salaries.” He also noted how “schools regularly patent the discoveries by faculty members that have the potential to develop into profitable products, and they strive to partner with industry by licensing out the related intellectual property.”
Based on these trends, Dr. Movsesian noted how medical schools now frequently view faculty members for their potential revenue-generating activities. For example, he pointed to a recent survey of faculty at US medical schools, in which 51% of respondents agreed that, “the administration is only interested in me for the revenue I generate.”
Nevertheless, the influence medical schools exert on faculty with regard clinical and research revenue generated from clinical “is usually overlooked.” For example, Dr. Movsesian pointed to “a recent study of clinical guidelines from the American Heart Association and American College of Cardiology, which noted that 56% of the authors of the guidelines received money or owned stock in companies that might benefit from the recommendations; the accompanying opinion suggested banning most of these relationships to eliminate conflicts of interest.”
However, as Dr. Movsesian noted, “the faculty who serve on such guideline committees—arrhythmia specialists who write guidelines for pacemaker implantation, for example—are likely to be compensated by their universities in relation to the number of procedures performed.” Accordingly, he recognized that, “this gives them an economic incentive to favor these procedures in their recommendations, regardless of their individual financial relationships with industry.” And Dr. Movsesian provided an example of a speaker at an annual conference he attended, which showed that, “the incentives medical schools offer to encourage revenue generation are fundamentally similar to those affecting faculty members lecturing on a product while being paid by its manufacturer, and the breadth of their influence is greater.”
Ultimately, Dr. Movsesian noted that, “there is no reason to think that faculty members who can be swayed by payments from industry are immune to the pressures of institutional incentives.” As a result, he recommended that “a consistent standard should be applied to both.”
In particular, he explained that, “if disclosure and management of relationships with industry are desirable, comparable expectations should apply to all potentially influential sources and mechanisms of compensation, including those from faculty members’ own institutions.”