So what if I use letterhead when I am consulting for a 3rd party, such as a corporation, or a labour union as in the UM case? Well, it depends on 1) what my role or expertise is (professor?) that is being contracted, and 2) the norms of my institution about doing consulting alongside my academic responsibilities. In the UM case, Mr. Fred Feinstein, an adjunct professor at the School of Public Policy, wrote a letter in the context of a labour dispute, and provided an expert judgment based on his capacity as a lawyer (he had also been a paid consultant for one of the parties involved in the dispute).

“Mr. Feinstein violated university procedures by improperly using university letterhead in the course of his outside work,” Donald F. Kettl, dean of the School of Public Policy, said in a statement. “This activity was wholly unrelated to his work at the University of Maryland, which has no involvement or stake in this outside matter. He should not have written the material on university letterhead nor invoked his title as a university employee. In addition, he should have disclosed the payment he received from one of the parties in the issue on which he commented.”

The conflict arises because Mr Feinstein implied, through the use of institutional letterhead, that he was commenting in his capacity as a professor, and thus also in a sense involving the institution. Now this may seem like a bit of a stretch. Surely academic liberty allows professors to make all sorts of comments, sign petitions, be active in political debates, etc., and use the public credibility given to them by being professors? Maybe, but I think it depends on the context, whether the role (as professor, as academic) is reasonably related to the activity in question, and how the institution is being involved (directly or indirectly).

With the privilege of academic liberty that is provided by my institution, also comes the responsibility to be professional in my behaviour. I can be critical of my own and other institutions, but I should also use good judgment, and think carefully about where my role as academic (professor, public thinker) ends and my personal space begins…

Conflict of Interest and Textbooks

The issue here is about profs using their own textbooks in classes they teach. The COI is a financial one, because in choosing one’s own textbook, the prof receives royalties on the sale of the book. In the context of large Intro classes with hundreds of students, the royalties (e.g., 3-5% per text, on a $100 book, for a few hundred students) could be in the order of thousands of dollars. The concern then is that this not insubstantial interest could bias the judgment and choice of text for the class. There’s also the indirect interest of having students read the prof’s own textbook (good for the ego!), and the fact that this may stymie freedom on the part of students to critique or critically engage with the text, undermining another important element of the university learning environment. So the challenge, like with many COI, is twofold. 1) Determine the extent and magnitude of harm, and 2) Decide what to do about the situation.

1. Potential Harm: bias in choice of text (maybe not the best), loss of critical judgment on the part of the class. Clearly this will vary based on factors such as the size of class (a large Intro class vs a small advanced undergrad or grad class), and also maybe the subject – we can imagine that in some areas there simply aren’t many texts to choose from, or the contrary, that there’s so much choice that one text is as good as another. In both cases, this factors may reduce our perception that there’s a real bias at play.
2. What to do? Eliminating such COI by banning a prof’s right to choose their own teaching material seems like an extreme measure, and also an undue restriction on academic freedom. After all, if I’m hired to teach a course, surely there should at least be the presumption of confidence in my ability to choose appropriate material. And an extreme measure such as prohibition also undermines the possible positive impact of disclosure of the COI to the class, debate about the issue (a great learning opportunity!), and the development of innovative solutions to separate the interest such as deciding (together with the class) that royalties from sales of the text will go to fund research, for extra resources or opportunities for the class (a trip, a party, etc.), or to a charity.

This story brings to our attention the fact that COI can occur outside the bioscience lab, in the classroom, and thus should also be a concern for scholars in the humanities and social sciences. It also leads us to think about appropriate responses to COI, and in particular, question the scope and magnitude of harms and possible appropriate (and innovative) mechanisms to deal with the conflict.

Thanks to Chris MacDonald of the BusinessEthicsBlog for discussions on this subject and thinking through possible responses…

Bryn

1) Journal editor gets royalties as articles favor devices (Dec. 24)

• This story continues with the ongoing debate about publishing and COI, but sheds light on a little examined area – that is COI encountered by journal editors. The gist of the issue that lots of focus has gone into building disclosure mechanisms for authors and reviewers, but very little to address issues associated with the editors, the ultimate arbiter of journal content and quality.
• See also this analysis by Nancy Walton at the Research Ethics Blog

2) Harvard Teaching Hospitals Cap Outside Pay (Jan 2)

• Two Harvard affiliated hospitals have implemented policies to limit the amount of pay for outside consulting on the part of senior administrators. “Senior officials…must limit their pay for serving as outside directors to what the policy calls “a level befitting an academic role” — no more than $5,000 a day for actual work for the board. Some had been receiving more than $200,000 a year. Also, they may no longer accept stock.”
• The issue here is ensuring that senior managers are 1) not being influenced by outside consulting (e.g., from pharma, medical device manufacturers) in their strategic planning, purchasing choices, etc., and 2) actually spending sufficient time in their primary job as administrators (which are already well paid): also called “conflict of commitment”. But one has to wonder if hospital officials should “ever” be on corporate boards? Even if they’re not doing much work or are only being moderately recompensed, isn’t the apparent COI sufficiently worrisome as to threaten the trust on the part of hospital staff and patients? (P.S. Feb 20: Partners’ Conflict of Interest Policy’s Reach Concerns Docs)

3) University of Michigan Medical School’s conflict of interest policies will likely improve in 2010 (Jan 4)

• There’s been a lot of coverage of Michigan’s COI policy development over the last year. Its good to see here that they’re moving the discussion outside the policy making environment of senior administrators, into the hallways and getting faculty, staff and students involved. Also good to note that, from the associate-dean, “I think most places have policies in place to deal with research and that’s in part driven by the fact that (National Institutes of Health) and others expect that,” Hutchinson said. “I think the conflict of interest piece with respect to clinical care and educational activities (in the health care realm) is less well developed, but places are rolling out policies like Stanford and (Washington University) and St. Louis, and we’re coming up with ours.” [Its worth reading the whole interview]

4) Faculty group urges UW provost to quit Nike board (Jan 5)

• Continuing with the thread of academic administrators and corporate involvement (see also my Dec blog post about Canadian funding agencies), this story about the Provost of the University of Washington joining the Nike corporate board raises issues about the responsibility and reputation of senior administrators.
• Beyond the issue of financial COI linked to personal remuneration (the Provost stands to add another $100-200K to her $500K university salary), the situation is further muddied by the fact that the “UW athletic department in 2008 signed an exclusive 10-year contract with Nike, worth at least $35 million to the university” and that Nike’s been the subject of a number of very public allegations about systemic poor labour standards (sweat-shops and such in early 2000; although maybe this situation has turned around). So there is a real concern on the part of faculty that the Provost’s appoint to the Nike corporate board could have “a “chilling effect” on future research about labor violations that implicates Nike, and that it isn’t in the best interests of the UW for top administrators to “offer up knowledge about the institution” to corporations — especially when the administrator stands to personally benefit.” — a serious institutional COI.

It has resulted in a nationwide petition (to date, almost 4000 signatories – including me), organised by Bioethics Professor Francoise Baylis and colleagues at Dalhousie university, on the grounds that the appointment of Prigent “represents a significant threat to the integrity of CIHR by entrenching an intractable structural conflict of interest.” This has lead to a flurry of news stories, initially reported by the CBC in late November, then in the Canadian Medical Association Journal (here and here), in opinion piece by Professor Baylis, and most recently on CBC Radio’s The Current.

There is a very real concern — which I share — that the appointment of a Pfizer VP to the CIHR GC further entrenches a particular commercial perspective in the upper direction of CIHR; that is, that the role of this funding agency should be more about actively promoting knowledge transfer and commercialization than supporting academic training and research in the basic and applied health sciences. Yet the appointment of a member of industry is in one sense not surprising: governing boards of universities and other public institutions very often have members from outside the local (academic) community to help provide a broader range of expertise and perspectives, networking and fund raising, etc. At CIHR, 5 of the 17 members of the GC do not have current university appointments, so the “commercial perspective” might not seem that dominant. Moreover, given that the mandate of the GC includes “developing strategic directions, goals and policies” and “evaluating the agency’s overall performance”, not to mention supporting innovation and knowledge transfer, the appointment of someone from the health industry, such as Prignent, might seem completely reasonable.

But concerns about COI remain, even at this high level of governance. The interests of a pharma are pretty apparent, and may well diverge from the interests of Canadian researchers who benefit from CIHR funding, that the Canadian public that pays for it. And Pfizer does not have a very good reputation at this moment. Yet as Chris MacDonald clearly explains in his Research Ethics Blog entry on this subject,

“Divergence of interests’ between a company’s shareholders and the public isn’t sufficient reason to exclude executives from that company. Nobody’s interests are perfectly aligned with the public’s. What matters is whether the divergence is sufficient to render an individual’s advice suspect in a way that cannot be remedied through standard mechanisms used to mitigate the effects of conflict of interest (mechanisms such as disclosure and recusal). So simply working for industry doesn’t strike me as an insurmountable flaw, particularly if (if!) the governing council’s role makes an intimate understanding of the drug industry useful. But the main point remains: it’s very hard to support the inclusion of an executive from this pharmaceutical company on the governing council of Canada’s most important health-research-funding organization.”

And, as Steven Lewis notes,

“There are excellent reasons to exclude people actively engaged in health care commerce from the GC table to save the institution, and themselves, from the appearance and reality of conflict-of-interest.  Canada would do well to take a lesson from the United States, which is moving in the opposite direction by removing registered lobbyists from advisory boards.”

P.S. (Feb 3, 2010): See this follow-on article by Steven Lewis in Open Medicine : Neoliberalism, conflict of interest, and the governance of health research in Canada