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The Role of Academic Health Centers
in Health Care Reform
2006 Annual Meeting
San Antonio, Texas
Research: Leading or Coexisting in a New System?
Jennifer Washburn, Fellow, New America Foundation; Philip A. Pizzo, MD, dean, School of Medicine, Stanford University; Shannon Brownlee, Bernard L. Schwartz Senior Fellow, New America Foundation
To address how research should or could be incorporated into any health reform plan, speakers focused on institutional and public perceptions and issues that first need to be addressed.
Academic relationships with industry and their impact on public trust is the most pressing research problem, according to Washburn. Stricter regulations on industry's dealings with academic institutions are required to rebuild public trust, said Washburn, suggesting that academic health centers band together to take the lead.
"A growing reliance on industry funding sources and pervasive conflicts of interest has dangerously compromised the prestige and credibility of academic health centers."
A growing reliance on industry funding sources and pervasive conflicts of interest (which are not being adequately regulated) has dangerously compromised the prestige and credibility of academic health centers, according to Washburn. Universities are losing their autonomy and ceding too much power to pharmaceutical companies, especially when it comes to clinical drug research design and the reporting of research results. In effect, academic health centers have been trying to compete by behaving much like any other for-profit contract research organization. In the process, they are losing the very foundation of their public trust.
Academic health centers—and Stanford University in particular—have been proactive in addressing conflicts of interest, according to Pizzo, who pointed to public confusion and misperceptions about what is or is not a conflict. Stanford recently banned all gifts from industry to university faculty. Under current regulations, faculty members are banned from publishing ghostwritten materials.
Marketing representatives and salesmen are prohibited from entering the medical center without an appointment, and Stanford does not accept any gifts that support endowed activities.
"Academic health centers have been proactive in addressing conflicts of interest."
Stanford has long had a policy which requires all faculty to report any outside relationship that involves the exchange of money. Unquestionably partnerships with industry have led to scientific breakthroughs that are expected and needed by the public, said Pizzo. However, the current financial and regulatory environments are straining the capabilities of academic health centers. Pizzo also pointed out that academic health centers only accrue about 40% of the cost of education through tuition. Revenue derived from research helps to sustain education costs.
Academic health centers are constantly examining and remaking relationships with industry, said Pizzo. Stanford is currently redesigning how the university works with industry by examining conflict of interest and clinical disclosure polices.
University-industry relationships can compromise the university's reputation, said Brownlee, who believes the nation's research agenda is driven by industry's willingness to invest in new projects rather than what the country needs. Large research areas are being ignored, such as comparative drug researchcost-effectiveness research and researchon quality of care. Consulting contracts between academic health center physicians and pharmaceutical companies have had a negative effect on the integrity of research. Peer-reviewed medical literature has also been called into question because of false claims and scandals resulting from a lack of full disclosure and mischaracterization of research data.
Academic health centers should set clearly defined boundaries with industry, and reassert control over research data and the research agenda, said Brownlee.
"Academic health centers should set clearly defined boundaries with industry."