Institutional Academic Industry Relationships Eric G. Campbell; Joe! S. Weissman; Susan Ehringhaus; et al. JAMA. 2007.298(15)1779-1786 (dok'10.1001jama 298.185.1779) Online article and related content (Sanant as oF Fahey 18, 2000 btip:jama.amavassn orglegi/contontMull29815/1778 Correction ‘Contact me this article is comectnd, Citations This article has been cited 16 times, Contact me when this aril is ced Topic collections ‘Medical Practice; Academic Medical Centers; Conflict of interest, Medical Ethics; ‘Drug Therapy; Drug Therapy, Other Contact me when new articles are published in these topic areas: ‘Subscribe Email Alerts itp sjama conv'subscrbe ‘iip:/jamaarchoves.comiaierts Permissions Roprints/E-prints missions @armna-assn omy Fepnnts@ama-assn.org pubs ama. aech orpmescipermessions et ‘Downloaded from wv ama com by guast on February 15, 2000Institutional Academic-Industry Relationships Fic 6 Campbell PAD Jock S. Weissmann, PhD ‘Susan Elringhaus, ID Sowmya ft Rao, PRD try relationships (IAIRs) exist when. academic institutions, or any of their senior officials, have a finan relationship with or financial in- fetests in a public or private com- pany.! For example, a series of case ‘studies conducted in 003 at institu tions showed that all had received ‘money from companies atthe insitu- tional level and 3 had received several million dollars a year over 5 or more years to support research and educa- tion on campus Similar to relationships between in- dividual faculty members ana indus ty." relationships between aca- ‘demic institutions ana indusiry, when they conflict—or have the appearance ‘of conflicting—with the core mis sions of academic medical centers cre> ‘ale an institutional conflict of intet= ‘est. which exists when a department ‘chair supervises faculty who conduct research for companies with which the ‘chair hasa personal financial relation~ ship.” In the face of these and other in~ ‘stiutional conflicts of interest, there have been calls forthe establishment of policies and practices for disclosure, ‘evaluation, and management of AIRS." However, no national data ‘exist that might describe the extent of AIR and inform the development of policy ‘Context institutional acadersc—industr relationships have the potential of creating insbtutiona confits of interest. To date there are no empirical data to support the establishment and evaluation of institutional ples and practices related to manag, ing these relationships Objective To conduct a national survey of department chairs about the nature, ex: tet and consequences of insttuttanal academic industry relitorships for mecca chooks and teaching hospital. Design, Setting, and Participants National survey of department chairs in the 125 accredited allopathic medical schools and the 15 largest independent teaching hospitals in the United States, administered between February 2006 and October 2006. ‘Main Outcome Measure Types of relationships with industry Results A total of 459 of 688 eligible department chavs completed the survey, yield- ing an overall response rate of 67%, Almost two-thrds (60%) of department chairs had some form of personal relationship with industry, including serving as a consul tant 27%). member of a scienbitic advisory board (27%). a pad speaker (14%), an oficer (7%), a founder (9%), or a member of the board of directors (11%). Two- thirds (672%) of departments as administrate units had relatonshins with industry Cinical departments were more likely than nonclinical departments to receive re- search equipment (17% vs 10%, P= 04), unrestricted funds (19% vs 3%, P= 001), residency oF fellowship taining support 87% v5 2%, P< 001), and continuing me- dal edcation support (65% v5 3%, P<.001), However, nonclinical departments were ‘mare lel to receive funding from nteectual property Kcensing 27% vs 16%, P= 01). ‘More than two-thirds of chasrs perceived that having a relationship with industry had ro effect an ther professional actives, 72% viewed a chars engaging in more than ‘Vindusty-related activity Gubstantl role m start-up company. consulting, at serv: ing on a company’s board) as having. a negative impact ona department's aby to Conduct independent unbiased research. Conclusion Overal, institutional academic-industy relationships are highly preva- lent and underscore the need for thei active dsdosure and managernent {AMA 2007 298(0511779:1796, wacom The purpose ofthisstudy wastode- resources, and wield considerable in- scribe the nature, extent, and conse- fluence over the content of medical edu (quences of IAIRS by conducting a ma- cation and the carers of department onal survey of medical schoo! members. Thus, the views ad experi- department chairs, The attudes and eneesol these leaders in academic medi- experiences of department chais are cineareboth elevantand should be in Stgnifiant because they manage the pre a aa mary organizational structure ol medi- jaderaitadons wasacvonts Grea roa Cal schools and teaching hospitals, Sven Carp tao hoy nena an Hence, they are an important st of Mt obama Urey of Mm foe stakeholders and informants in any dis- lanes (Ms Etvingnaa). cussion of medical school budgets and abr c G. Camb. FO, rats Sher reat Pty 30 Sed on MA ‘mission, control significant amounts of Git scampi rp ©2007 American Medical Auociaion All igs reserved (epee WMA Ct 17, 2007—Vol 298, No AS ATID Downloaded fromm wvw sora com By guast on February 15, 2000:[ACADEMICINDUSTRY RELATIONSHIPS structive in developing principles and [practices for addressing IAIRS and for evaluating their consequencesom sated ‘institutional missions ‘METHODS Population and Sampling ‘The source ofthe data for this study was national survey of department chairs Inthe 125 accredited allopathic medt- calschoolsand the | lent teaching hosp States. The 15 independ hospitals were those that received the Aargest amount of funding fom the Na- tonal Institutes of Health in 2004, We ‘ncladed these independent teaching hospitals because they often conduct more research than many medical schools. A otal of 40 institutions were tncluded in the study ‘At cach institution, we sampled 4 nical department chairs (medicine, paychiatry, and 2 randomly sclected portant role in supporting some as- pextsof the education al research ms- sions of academic medical centers. |Mowever, 1AIRS are a cause for ‘ceri thcy havea negative elect on the ability of medical mstitutions to offer unbiased educational experiences for faculty and trainees* Our results sug- gest that department chairs consider both the size ofa git and whether tis restricted when judging the possible detrimental influence on independent ‘education and training, Almost 20% of ‘hairs deemed a restricted grant from industry of less than $10 000 detrimen- adepariment’sabilty wo offer im jependent unbiased meclical educa tion and training. while 4% responded this way for resricted grants between $10000 and $100000. When asked about unrestricted gifts, however. only ‘Ph considered a pil of ss than $1000 detrimental and 21% considered an un- restricted gift between $10000 and 100000 detrimental “These findings illustrate the com: ‘mon misconceptions that smal gifts are Jess influential than larger gts and that lumrestricted gifts are less influential than restricted gifts. However, te- search in human behavior has shown that even small gifs and ones without restrictions can influence actions with- ‘out being tied to explicit demands.” The belief that the benefits af unre~ stricted and/or small gifts tend (0 out ‘weigh the detriments may unintenion- ally make medical school leaders less vigilant about ensuring independent unbiased curricula andl research, For in- stance. one of the most frequett forms of IAIRs involved elinical depart- ments receiving aiseretionary Funds to purchase food and beverages. Increas- ingly. medical educators have recog- nized that even these inal gifts come atthe expense of real or perceived in- dependence from industry influ- (©2007 American Medical Auociaion. AM rights reserved nce." The finding that more than, half of department chairs with relation ships berween their department as an administrative entity and industry felt that these relationships had no effet on. their departmental finances, their abil- ity to recruit of retain faculty. oF tose ‘cure resources from their institution is puzzling. Ifthe majority of VAIRS have ‘ng effect on these important funetions of departments, then why do they ex- -ACADEMIC-INDUSTRY RELATIONSHIPS ist? Ins possible that these LAIRs have effects that we did not measure oF that chairs may be unwilling to admit that ‘industry funding exerts any effect that ‘could be construed as influence ‘This study has several limitations First, social desirability bias may eause some individuals to underreport that ‘hich may be viewed as negative: thus. ‘our data on the frequency of relation ‘hips key underestimates the tre fe= ee ame = oe See aor a ee nemo wry da 0 fon ransom 3- Respondents Views of Chan Peronal Reston Wath ncusty on rowan Unbiaied Reseuch Siesta omen oe 9s 08) ‘Be soe Seve boost a” ow rapes SAMA. Ouse 17,297 W298 No ts a8 ‘Downloaded from wi jana com by quest on February 15, 2009rere ACADEMIC: INDUSTRY RELATIONSHIPS ‘queney of LAIR in medical schools and teaching hospitals, Findings related the perceived consequences of 1AIRS ‘may be subject to this bias as well, in that chairs may be urwilling to report hat UAIRS had negative effects (or ever any effect) on their behavior or that of their department, Second, besides s0- ‘ial desirability, the wording of survey ‘tems may have influenced responses. For instance, “restricted” and “unre- stricted” grants were not further de- fined andl may have beer interpreted ‘variably, Because the survey was anony= ‘mous in nature—an important sirat~ ety for maximising response rates—ve ‘were unable to link department re sponses to individual schools and, as 1 result, were unable to conduct insi- "utional-specific analyses Third, we did not collect data om AIRS tht occur at the level of the ‘medical school, hospital, or university as organizational entities, nor did we ‘study the personal industry relation- ships of other institutional officials Zational entities and institutional fi ‘clals as they are at the department level, the potential for institutional ‘conflicts interest ikey t0 be subs stantial, Additional research should address this issue. Finally we found that 52% of the chairs in ou sample ‘were from public institutions and 48% ‘were from private institutions, This disirHbutlon among nonrespondents ‘was similar (46% public and 54% pri- ‘vate. This data suggests that chairs in private institutions responded at a Slightly lower rate than thei represen tation in the sample, However, clinical and nonclinical department chairs responded at almost identical rates is unclear what inapoct, any, this has ‘on out findings. This study presents the first empiri- ‘cal data showing that IATRs are fre- «quent in medical schools and teaching Fhospttals and thus deserving of alien ton. Future research is needed t bet ‘er understand the impact of 1AIRS on. the independent unbiased pertor- mance of the education and research ‘missions of medical schools, the man- agement and disclosure of these rela- tionships a the institutional level, and the impact of institutional poicis. 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