A New Species of Conflict of Interest

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When prominent academic figures are on corporate payrolls, and when corporations finance groups whose mission is to end childhood obesity, alarm bells ring in the minds of vigilant observers — in some cases, alarm bells that have tolled very many times before.

For Forbes, reporter Larry Husten takes a trip down memory lane to a previous article in which he questioned the extracurricular activities of Victor Dzau, MD. Up until recently, Dr. Dzau, a cardiologist, was CEO of Duke University’s Health System as well as that institution’s chancellor for health affairs. While filling those posts, he also sat on the boards of several corporations — Alnylam Pharmaceuticals, Genzyme (biotech), Medtronics (medical devices), and PepsiCo.

His official Duke U. bio at the time, which Husten characterizes as “less than forthcoming about fully disclosing Dzau’s board memberships,” only mentioned one of those four rather significant affiliations. Husten wrote:

[I]n 2009, Dr. Dzau received $1,081,073 in compensation to be a director of these four companies. In 2009, Dr. Dzau owned stock or equivalent in these four companies valued at $7,854,090.

That’s just short of $8 million, along with the million-plus for a year of multiple board-sitting, on top of the $2.2 million annual academic salary. Although he still has the same relationship with at least three of those companies, the current version of the bio mentions none of them. It merely states a generality, that as a preeminent health leader, the doctor “advises governments, businesses and universities worldwide, serving on advisory councils and boards of directors.”

Why does any of this matter? On July 1, Dr. Dzau will begin his new job, a six-year term as president of the Institute of Medicine. Although it is one of the United States National Academies, the IOM is described as a non-governmental and nonprofit organization, independent and staffed by volunteers. Here is the IOM in its own words:

Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely…. Many of the studies that the IOM undertakes begin as specific mandates from Congress; still others are requested by federal agencies and independent organizations.

We are talking about Influence with a capital I. It goes without saying that the information given out by the Institute is supposed to be not only authoritative and evidence-based, but unbiased. Why is this a problem? Roy M. Poses, MD, explains:

Dr Dzau’s service on the board of each of these companies means he has fiduciary duties to each company, and is supposed to show unyielding loyalty to the companies’ stockholders…
Even in the best case, showing unyielding loyalties to the stockholders of companies that make drugs, medical devices, and sugary drinks seems to be likely to influence a leader of an academic medical institution in ways that risk degrading the leader’s responsibilities to uphold the institution’s mission, i.e., to create severe conflicts of interest.

The phrase “a new species of conflict of interest” was first used by Dr. Poses in 2006.

Your responses and feedback are welcome!

Source: “Newly Elected President Of Institute of Medicine Is On The Pepsico Board Of Directors,” Forbes.com, 02/19/14
Source: “About the IOM,” IOM.edu, undated
Source: “Duke Divinity Students Protest Pay of Chancellor for Health Affairs,” HCRenewal.Blogspot.com, 12/06/10
Source: “A New Species of Conflict of Interest in Health Care,” HCRenewal.blogspot.com, 03/29/06
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