This one case suggested how pervasive are conflicts of interest affecting the people at the top of health care leadership in the US, and also how such conflicts may be associated with problems for all the organizations involved. The story originally came to my attention because students were demonstrating against the lavish compensation given the health sciences leader at a time of university cutbacks, suggesting that university leaders were paying more attention to their own enrichment than to the mission of the university. At the same time, one of the corporations which he was stewarding (Genzyme) had to shut down a factory because the extremely expensive drug it was producing was found to be impure and adulterated, while its CEO continued to be compensated lavishly. The other corporation (Medtronic) had to settle litigation accusing it of manufacturing defective products for hundreds of millions of dollars, while its CEO again continued to be compensated lavishly.
So I thought it might be interesting to see who are the other stewards of these troubled corporations. I consulted the official biographies of their board members from their 2010 proxy statements (Genzyme here, Medtronic here). I looked for board members who also held leadership positions in other health care organizations whose interests may not be aligned with the two corporations of interest. I also looked for those who held leadership positions in the discredited financial services corporation who helped usher in the global financial collapse.
The specifics of what I found follow.
Genzyme had 10 directors in 2010. The following directors had relationships of interest:
- Douglas A Berthiaume is "Chairman of the Children's Hospital (Boston) Trust Board, a member of the Children's Hospital board of trustees, and a Trustee of the University of Massachusetts Amherst Foundation." Children's Hospital is a teaching hospital. The University of Massachusetts includes a medical school.
- Robert J Bertolini "retired from Schering-Plough Corp following its merger with Merck & Co in November, 2009." Schering-Plough was a large pharmaceutical company now combined with Merck to form an even larger company.
- Gail K Boudreaux "has served since May 2008 as an Executive Vice President of United Health Group Incorporated." Also, "she serves on the board of directors of America's Health Insurance Plans...." UnitedHealth is one of the US' largest health insurance/ managed care corporations. Incidentally,it has frequently misbehaved, as can be seen in this set of posts. AHIP is the health insurance corporations' trade associations.
- Robert J Carpenter "is Chairman of Hydra Biosciences Inc... He is also a trustee of the Immune Disease Institute, a non-profit institute affiliated with Children's Hospital in Boston...."
- Charles L Cooney "is a director of India-based Biocon Limited, a biotechnology healthcare company."
- Victor J Dzau MD (discussed in the earlier post) is "Chancellor for Health Affairs and President and Chief Executive Officer of Duke University Health System...." He "sits on the board of directors of Pepsico Inc, Anylam Inc, Medtronic Inc, and the Duke University Health System."
- Senator Connie Mack III is "Chairman Emeritus of the parent board of the H. Lee Moffitt Cancer Center and Research Institute...." He also is director of "EXACT Sciences Corporation and Moody's Corp." EXACT Sciences is a biotechnology company that develops diagnostic test technology. Moody's Corp is a financial ratings agency whose lax ratings of financial derivatives, perhaps arising from conflicts of interest produced by payments from the producers of the derivatives, have been implicated as a major cause of the global financial collapse.
- Richard E Syron was from "January 2004 to September 8, 2008 ... Chairman and Chief Executive Officer of the Federal Home Loan Mortgage Corporation, commonly referred to as Freddie Mac...." Freddie Mac as bailed out and taken over by the US government when he departed, or was forced out. Freddie Mac, was a "government-sponsored enterprise," (GSE) one of another group of companies whose enthusiastic participation in securitizing dubious mortgages was implicated as a major cause of the global financial collapse.
- Henri A Termeer (CEO of Genzyme) is a "director of Massachusetts General Hospital, a board member of Partners HealthCare, and a member of the board of fellows of Harvard Medical School."
So the box score for Genzyme's 10 directors: six have leadership positions at teaching hospitals, academic medical centers, medical schools or their parent universities (some such institutions are lead by more than one Genzyme director). Seven have leadership positions in other drug, device or biotechnology corporations. One have leadership positions in health insurance/ managed care corporations. Two had or have leadership positions in discredited financial services corporations that were implicated in the global financial collapse.
Medtronic had 11 directors in 2010. The following directors had relationships of interest:
- Richard H Anderson "was Executive Vice President of UnitedHealth Group Incorporated." As above, UnitedHealth is a health insurance/ managed care corporation.
- Victor J Dzau (see above) is "Chancellor for Health Affairs at Duke University and President and Chief Executive Officer of the Duke University Health System." He is "a director of Alnylam Pharmaceuticals Inc, ... PepsiCo Inc, and Genzyme Corporation." (See discussion above.)
- James T Lenahan "served as President of Johnson & Johnson from 2002 until June 2004...." He is "director of Telecris Biotherapeutics Inc, Alton Pharma Inc and Imacor Inc." Johnson & Johnson is a large drug, device, and biotechnology company. Telecris, and Alton Pharma are biotechnology pharmaceutical companies. Imacor is a medical device company.
- Denise M O'Leary "is a director of Lucille Packard Children's Hospital and Stanford Hospitals and Clinics." Also, "she was a member of the Stanford University Board of Trustees from 1996 through 2006, where she chaired the Committee of the Medical Center...."
- Robert C Pozen is "an advisor to Gelesis Inc." Gelesis is a biotechnology company.
- Jack W Schuler "has been a director of Stericycle Inc since March 1990...." He is a "director of Quidel Corporation and Elan Corporation plc...." Stericycle company disposes of medical waste, including that produced by medical devices. Quidel is a biotechnology and (medical diagnostic) device company. Elan is an multinational biotechnology and pharmaceutical company.
So the box score for Genzyme's 11 directors is: Two have leadership positions at teaching hospitals, academic medical centers, medical schools or their parent universities (some such institutions are lead by more than one Genzyme director). Ten have leadership positions in other drug, device or biotechnology corporations. One has a leadership position in health insurance/ managed care corporations. None had or have leadership positions in discredited financial services corporations that were implicated in the global financial collapse.
Just to summarize the sorts of conflicting interests these relationships suggest.
Teaching hospitals and medical schools are supposed to provide unbiased teaching, including about issues relevant to drug and device corporations, such as choice of diagnostic strategies and treatments, and relevant health policy. They are supposed to perform unbiased research, including research that evaluates drugs and devices. They are supposed to provide the best possible patient care at a reasonable cost, which relates to choices of and prices paid for drugs and devices.
Other drug, device, and biotechnology corporations may be producing, or developing products that compete with those of the index corporations.
Health insurance companies ostensibly try to control costs and improve quality in part by reducing excess utilization and bargaining down prices of drugs and devices.
So this limited case study of the boards of directors, that is, the ostensible stewards of two health care corporations, selected because they have a common member who is the leader of a large medical school and academic medical center, and which both have histories of poor management or ethical missteps showed - that the leadership of health care organizations is incredibly interrelated, interlocked, incestuous.
This gave an example of how pervasive are the conflicts of interest that affect all kinds of health care organizations. Companies that ought to be competing have interlocked directors. Companies that ought to be negotiating at arms length have interlocked directors. Not-for-profit academic medical institutions have leaders who are also directors of companies whose drugs their patients may take, whose devices their patients may receive, whose insurance their patients may buy, and whose products and services they may teach about and evaluate through clinical research and policy research.
This also gives an example of how the failed culture of finance may be linked to the culture of medicine and health care. Some of the stewards of health care organizations were also the stewards of financial services corporations whose reckless, if not arrogant, greedy and amoral leadership is widely believed to have caused the global financial collapse and our ongoing economic problems.
Finally, this suggests how top leaders of various health care organizations may be more familiar with and identify more with each other than with their organizations, their organizations' missions, and their organizations' professionals, staff, students, clients, and patients.
What is to be done?
I strongly believe that there needs to be much more investigation, academic, journalistic, and perhaps legal, of the identity, nature, and culture of the leaders of health care, and their relationships. A few bloggers cannot do it all. Obviously, the anechoic effect mitigates against medical and health care academics looking into their own leaders. However, failing to understand who is leading our march to the brink of health care failure ought not to be something such academics would want on their conscience.
Finally, and obviously, health care organizations need leaders that uphold the core values of health care, and focus on and are accountable for the mission, not on secondary responsibilities that conflict with these values and their mission, and not on self-enrichment. Leaders ought to be rewarded reasonably, but not lavishly, for doing what ultimately improves patient care, or when applicable, good education and good research.
If we do not fix the severe problems affecting the leadership and governance of health care, and do not increase accountability, integrity and transparency of health care leadership and governance, we will be as much to blame as the leaders when the system collapses.