Medical Professors See Threat in Corporate Influence on Research
At an AAUP conference, they talk of academic freedom and conflicts of interest By KATHERINE S. MANGAN
Boston - When Kate Bronfenbrenner spoke publicly about alleged labor-law violations at a chain of nursing homes, she had no idea of the price she would pay.
The company that owned the nursing homes, Beverly Enterprises, sued the Cornell University researcher for defamation, ordered her to turn over her research, and tried to persuade Cornell's president to fire her. The company dropped its lawsuit in 1998, but her battle scars remain.
"I've had numerous calls from people who are afraid to do research analyzing corporate behavior because they don't want to end up in jail," said Ms. Bronfenbrenner, director of labor-education research at Cornell University's School of Industrial and Labor Relations. "The experience was frightening and stressful" (The Chronicle, December 18, 1998).
Her story and others like it were recounted at a national meeting in May organized by the American Association of University Professors. Some 130 professors and researchers gathered to discuss what they see as the growing influence of corporations on academic research in medicine.
With government support for medical education failing to keep up with the demand for research dollars, medical schools are relying more than ever on corporate funds. Teaching hospitals are reeling from sharp cuts in Medicare payments and intense competition for patients. In order to stay in business, some medical schools are demanding that professors win more grants, often tying their salaries to their ability to bring in money.
Corporate dollars, professors here said, come with too many strings attached. Too often, they said, the sponsors decide what will be studied, how the research will be conducted, and how and whether the findings will be published.
The result is a growing threat to academic freedom in the nation's medical schools, according to professors at the meeting and leaders of the A.A.U.P. To counter that threat, the association has drafted a statement aimed at protecting medical professors from exploitation and abuse.
The statement, which is expected to be approved by the A.A.U.P.'s full membership this month, reads in part: "The freedom to pursue research and the correlative right to transmit the fruits of inquiry to the wider community -- without limitations from corporate or political interests and without prior restraint or fear of subsequent punishment -- are essential to the advancement of knowledge."
Association leaders called on medical schools to endorse those principles. Many professors in medical research are idealists, said Mary A. Burgan, general secretary of the A.A.U.P. "They got into their profession to help train the next generation of doctors. Now, both the income and time to do this are being eroded. They're being told this is a new world, and if we don't make money, we're out of business."
Among the most prominent speakers at the conference were two researchers who were fired from academic positions after they published findings that angered their corporate sponsors. David G. Kern, an associate professor of medicine at Brown University, and Nancy Olivieri, a medical researcher at the University of Toronto, were hailed as "heroes" who had refused to be silenced even though it would cost them their jobs. Dr. Olivieri was later reinstated, but Dr. Kern was not (The Chronicle, April 9).
A spokesman for Brown said the university had done what it could to support Dr. Kern's right to publish the information, but stressed that Dr. Kern was employed by one of the university's affiliated hospitals, and not directly by Brown.
Brown officials were also troubled by a confidentiality agreement Dr. Kern signed before he began his research for Microfibres, a textile manufacturer in Rhode Island. The terms of his agreement are in dispute. The research was arranged between the hospital and the company and didn't involve Brown. Dr. Kern says the confidentiality agreement applied only to an initial visit to the company's plant in Pawtucket, R.I., not to his subsequent research, which found clusters of work-related lung disease at the factory.
"I knew that publishing the information would create havoc for me, but I never thought I'd be forced to leave my job," he said. He plans to leave academe when his contract expires this month.
"I have ambivalent feelings about leaving," he said. "I enjoy teaching medical students and residents, but I don't want to end up in a situation like this again."
While many medical researchers place the blame for such conflicts squarely on the corporate sponsors of research, others warn that professors should be more careful before signing agreements.
Sheldon Krimsky, a professor of urban and environmental policy at Tufts University, has studied conflicts of interest that arise when research is commercialized. In an interview, he said he wasn't familiar with the details of Dr. Kern's contract. But he said: "Anyone who is a serious scholar or academic would be foolish to sign any clause that inhibits their ability to publish the results of their research."
Faculty members also have a responsibility to disclose conflicts of interest that might taint their research, he added. In fact, many profit handsomely from ties with corporate sponsors. "They're not exactly indentured servants," Mr. Krimsky said. "Many faculty members are perfectly satisfied with these arrangements."
One conference participant questioned whether the A.A.U.P. should do more to punish professors who make money from corporate research grants and don't divulge that information. The arrangements vary: Professors serve as consultants, are paid by companies to perform clinical trials on potential drugs, or are given stock in the companies. A professor might also have a financial stake in a patent on a product being marketed by a company.
Ms. Burgan, the A.A.U.P.'s general secretary, said that the group had issued guidelines on corporate-sponsored research, but that it could not police members to insure compliance with the rules.
The pressure to spend more time bringing in grants and less time teaching is taking its toll on the professoriate in other ways, said Leon Eisenberg, a professor of social medicine and psychiatry at Harvard Medical School who helped organize the conference.
"Faculty find themselves overburdened and constantly busy at paperwork," he said. "Morale at teaching hospitals is lower than I can recall during my 50 years in academic medicine."
In the related realm of medical practice, John McKinlay, a sociologist with the New England Research Institute, said physicians were being forced to participate in "assembly-line medicine" and had little control over their professional lives.
Among the factors that are slowly eroding the status of the medical profession, he said, are the loss of clinical autonomy as physicians are pressured to abandon private practices and join group plans. Physicians have also been hurt by growing competition from other health-care workers, such as nurse practitioners and physician assistants, he said. Add to that trend the oversupply of physicians nationally, and the waning power of the American Medical Association, which lobbies on the profession's behalf -- only about a third of all physicians belong to the A.M.A. -- and it's no wonder physicians are feeling beleaguered, Mr. McKinlay said.
The speakers, who used words like "proletarian" to describe their new position, conceded that the public was not likely to shed many tears for physicians who are earning more than $100,000 a year. The problem isn't how much they're earning, they said, but how little input they have into their working conditions.
Several speakers chided their colleagues for not doing more to resist the encroaching corporate influence in medicine. "Some colleagues see nothing wrong with a market economy in medical care," Dr. Eisenberg said. "They have become as adept at referring to 'covered lives,' 'consumers,' and 'providers' as my generation was at using the quaint terminology of 'patients' and 'doctors.' Words matter." Health-care "providers," he noted, are adept at the "art of pay"; physicians are adept at the art of medicine.
One of the problems, speakers noted, is that many academic physicians work in isolation from their peers. "Doctors are still like cats. You can't herd them," said Arnold S. Relman, a professor emeritus of medicine at Harvard Medical School and editor in chief emeritus of The New England Journal of Medicine.
One of the purposes of the A.A.U.P. gathering was to coax more medical professors out of their labs and up to the bargaining table. The rhetoric reached a feverish pitch at times. Researchers who refused to be silenced were described as heroes, and the villains were meddling corporate sponsors and managed-care executives, who were compared to used-car salesmen, crooks, and even Mafia bosses. "People are beginning to realize they're being exploited, and they're going to mobilize," Mr. McKinlay said.
Dr. Relman said he believed that the "corporatization" of medicine may die out on its own. "I think many of the industrial trends we're seeing in health care have sown the seeds of their own destruction," he said. "The interests of patients are fundamentally different from the interests of the corporate suppliers of health care. I don't see how it can last."
As evidence, he pointed to an article in The Boston Globe in May reporting that all the health insurers in Massachusetts, including its six major health-maintenance organizations, lost money during the first three months of the year.
Donald B. White, a spokesman for the American Association of Health Plans, said the criticism of managed care, and its influence on medical research, was unfair. Surveys show that patients are happier and the quality of care is at least as high under managed care as under fee-for-service plans, he said. The association represents more than 1,000 H.M.O.'s and other network-based plans. "We're all going through a period of turmoil, and it will be apparent soon that we need to buckle down and work together," he said in an interview.
For the time being, the uncomfortable alliance between medical professors and the corporate world is an inescapable part of their jobs. James S. Wilson, an associate professor of medicine at Howard University, said he welcomed his institution's recent efforts to focus attention on research. He said he worried, though, what changes might be in store for faculty members, like him, who see themselves first and foremost as teachers.
"Medical education at its best is a mentoring system that provides students with lots of personal attention," he said. "With the pressures faculty are facing today, that kind of system is disappearing."