JAMA - Institutional Academic- Industry Relationships (fwd)

[Guest guest]

Today's issue of *Journal of the American Medical Association* (Vol.

298 No. 15, October 17, 2007) includes a study: " Institutional

Academic- Industry Relationships. "

The article is by G. , PhD; S. Weissman, PhD;

Ehringhaus, JD; Sowmya R. Rao, PhD; Beverly Moy, MD;

Feibelmann, MPH; Dorr Goold, MD, MHSA, MA.

PLEASE NOTE: One of the interesting findings in this study led the

authors to include this statement in the Discussion section: " These

findings illustrate the common misconceptions that small gifts are

less influential than larger gifts and that unrestricted gifts are

less influential than restricted gifts. However, research in human

behavior has shown that even small gifts and ones without

restrictions can influence actions without being tied to explicit

demands.19 The belief that the benefits of unrestricted and/or small

gifts tend to outweigh the detriments may unintentionally make

medical school leaders less vigilant about ensuring independent

unbiased curricula and research.

For instance, one of the most frequent forms of IAIRs involved

clinical departments receiving discretionary funds to purchase food

and beverages. Increasingly, medical educators have recognized that

even these small gifts come at the expense of real or perceived

independence from industry influence.5, 14-15 The finding that more

than half of department chairs with relationships between their

department as an administrative entity and industry felt that these

relationships had no effect on their departmental finances, their

ability to recruit or retain faculty, or to secure resources from

their institution is puzzling. If the majority of IAIRs have no

effect on these important functions of departments, then why do they

exist? "

Here's how the article begins:

[begin excerpt]

Institutional academic-industry relationships (IAIRs) exist when

academic institutions, or any of their senior officials, have a

financial relationship with or financial interests in a public or

private company.1-4 For example, a series of case studies conducted in

2003 at 4 institutions showed that all had received money from

companies at the institutional level and 3 had received several

million dollars a year over 5 or more years to support research and

education on campus.5

Similar to relationships between individual faculty members and industry,

6-13 relationships between academic institutions and industry, when

they conflict--or have the appearance of conflicting--with the core

missions of academic medical centers create an institutional conflict

of interest,

1-2 which exists when a department chair supervises faculty who

conduct research for companies with which the chair has a personal

financial

relationship.5 In the face of these and other institutional conflicts

of interest, there have been calls for the establishment of policies

and practices for disclosure, evaluation, and management of

IAIRs.1-2,14 However, no national data exist that might describe the

extent of IAIRs and inform the development of policy.

The purpose of this study was to describe the nature, extent, and

consequences of IAIRs by conducting a national survey of medical

school department chairs. The attitudes and experiences of department

chairs are significant because they manage the primary organizational

structure of medical schools and teaching hospitals. Hence, they are

an important set of stakeholders and informants in any discussion of

medical school budgets and mission, control significant amounts of

resources, and wield considerable influence over the content of

medical education and the careers of department members. Thus, the

views and experiences of these leaders in academic medicine are both

relevant and should be instructive in developing principles and

practices for addressing IAIRs and for evaluating their consequences

on stated institutional missions.

[end excerpt]

Here's how the Discussion section starts:

[start excerpt]

The study provides, to our knowledge, the first comprehensive

empirical portrait of department-level IAIRs in academic medical

centers in the United States. Overall, these data suggest that IAIRs

are highly prevalent, with 67% of departments and 60% of department

chairs having relationships with industry.

Chairs with individual relationships most often served on speakers'

bureaus and as industry consultants. These findings likely reflect

companies' desire to establish relationships with individuals who

have substantial expertise or professional status in their fields of

research and patient care. Still, a wide variety of relationships,

including equity, royalties, and travel expenses, was evident. Given

that department chairs hold faculty appointments these relationships

are likely subject to the annual faculty disclosure processes

mandated by the federal government for federally funded research and

thus are likely to be known and reviewed by the institution.

Relationships between industry and departments as administrative

entities differed for clinical and nonclinical departments. Industry

appears more likely to gain access to scientific resources controlled

by nonclinical departments since nonclinical departments were more

likely to receive money from licensing, the transfer of intellectual

property, products, and services developed by researchers in their

departments.

These revenues, which are usually negotiated in advance (and

sometimes by a technology transfer office with little input from a

department) and require no deliverable beyond what is included in the

agreement, pose potential conflicts of interest only if department

personnel continue to engage in research that could add value to the

product.

Certain types of relationships between clinical departments and

industry appear to be far more extensive than between nonclinical

departments and industry. Clinical departments are significantly more

likely than nonclinical departments to receive discretionary funding

to purchase research equipment and money to support departmental

operations, research seminars, graduate medical education, and

continuing medical education. Although we did not ask about the

amount of money departments receive for these uses (because in

pretesting we found chairs were unable to give reliable estimates),

the prevalence of these relationships among clinical departments in

medical schools suggests that departments may rely on such support.

Such reliance, in turn, may influence a department's willingness to

engage in research or educational activities that could be harmful

the industry partner.

The frequency of relationships between departments and industry

around medical education is worthy of emphasis. The finding that 65%

of clinical departments receive industry funds for continuing medical

education and 37% for residency and fellowship training suggest that

industry has made substantial inroads into graduate and continuing

medical education in the United States. This finding is not

surprising given that two-thirds of the costs of continuing medical

education in medical schools and teaching hospitals is paid for by

drug and medical device companies.17 Furthermore, more than half of

chairs whose departments have relationships with industry believe

these types of IAIRs have an overall positive effect on their ability

to provide educational offerings in their department suggesting that

IAIRs likely play an important role in supporting some aspects of the

education and research missions of academic medical centers.

However, IAIRs are a cause for concern if they have a negative effect

on the ability of medical institutions to offer unbiased educational

experiences for faculty and trainees.18 Our results suggest that

department chairs consider both the size of a gift and whether it is

restricted when judging the possible detrimental influence on

independent education and training. Almost 20% of chairs deemed a

restricted grant from industry of less than $10 000 detrimental to a

department's ability to offer independent unbiased medical education

and training, while 42% responded this way for restricted grants

between $10 000 and $100 000. When asked about unrestricted gifts,

however, only 6% considered a gift of less than $10 000 detrimental

and 21% considered an unrestricted gift between $10 000 and $100 000

detrimental.

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