Chapter 18: Conflict of Interest, MD Anderson Leadership, and Protection for the Institution and Patients
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Description
Dr. Levin reflects on conflicts of interest (which have plagued three of the four MD Anderson presidents), taking first the perspective of a patient and then the viewpoint of the faculty. Patients, Dr. Levin says, must know there is not financial motive behind their treatment, though that does not necessarily mean that innovative and productive individuals have no connections to the pharmaceutical industry. He then observes that the average faculty member or employee must also be protected so his/her choices of research/clinical approach or equipment are only governed by pure motives. Transparency is fundamental to these matters, and academic leaders will increasingly have connections to biotech companies, but there must be mechanisms, such as blind trusts, for insuring that these links do not govern day to day decisions. He notes that he would not want to see the presidents sitting on decision-making boards of biotech companies and that there must be a mechanism for top administrators moving into different roles within MD Anderson, should their external responsibilities reach a certain point. Dr. Levin closes this Chapter with some observations about nepotism.
Identifier
LevinB_02_20130208_C18
Publication Date
2-8-2013
City
Houston, Texas
Interview Session
Bernard Levin, MD, Oral History Interview, February 08, 2013
Topics Covered
The University of Texas MD Anderson Cancer Center - OverviewEthics Patients Character, Values, Beliefs The Administrator Institutional Mission and Values MD Anderson Culture Industry Partnerships Leadership On Leadership Ethics On Pharmaceutical Companies and Industry
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey Ann Rosolowski, PhD:
All three of these presidents have been plagued with difficulties with connections with industry. Understand the spirit in which I’m raising this issue. I had an interesting conversation interviewing Leon Leach when the issue came up, and he said that it might be time for a real paradigm shift—thinking about conflict of interest—given the way medical research, particularly the importance of drug research, proceeds right now. I was wondering if you had any thoughts about that. What can—I mean first of all, what do these sorts of public revelations have on the leadership of an individual who is so key, obviously, to an institution, and what is your impression of how, perhaps, the arena in which these things are judged has to be relooked at?
Bernard Levin, MD:
Well, it’s a very complex area. That’s obvious. If I put myself in the shoes of two different individuals, I would have a more elaborate answer to give you. If I put myself in the shoes of the patient who comes to MD Anderson, I want to be sure that if I’m being offered a treatment that there isn’t behind the scenes some financial motive for the specific choice. Either the president or some other individual are gaining financially or even, perhaps, academically, without it being made very clear to me that, perhaps, there is a choice that I may wish to exercise over what I am being offered. That is not to say that individuals who are innovative, productive, well connected, don’t often have the connections with the pharmaceutical industry. But I think those connections have to be extraordinarily explicit, and there can be no doubt in the mind of the patient as to what’s involved. The second example I would say is of the average faculty member or employee at MD Anderson who isn’t, perhaps, part of such financially or academically beneficial interactions. That individual too has to be protected and has to be assured that their actions are in no way motivated by some other third party conflicts and that the choice of approaches, treatment—whatever—use of equipment is being governed by as pure motives as are possible. So having said that, I think there is in my mind no substitute for transparency in these matters. Academic leaders will probably increasingly have personal or family connections to the biotech industry or the pharmaceutical industry by the very nature of the work and research that’s going on at MD Anderson. But there has to be some mechanism where such interests are placed in a blind trust where personal day-to-day decisions cannot be in any way related to the fate of that particular company or institution. I think that is the way I would see the best outcome. I would not want to see the president or the executive vice presidents sit on decision making boards of companies because I believe that even subconsciously their decision making could be influenced and their motives questionable. Whether the paradigm shift means that these relationships are allowed and encouraged—nevertheless—I don’t believe there is room for slippage when it comes to transparency, and I would personally favor some mechanism such as blind trust—blind ownership—and as many as the president or executive vice president want. It doesn’t matter how many there are as long as there are no direct relationships, and of course, provided that these do not become in some ways a consumer of that individual’s time. It’s one thing to hire at a very highly paid level executives and whatever the market demands, but it’s entirely another to have their attention being diverted much of the time, because I don’t believe that when there is a financial interest, particularly a direct one, that it is possible to ignore the requirements for membership for rendering opinions, attendance at events. I could see how that could become extremely divisive.
Tacey Ann Rosolowski, PhD:
Uh-hunh (affirmative).
Bernard Levin, MD:
That’s a long sermon.
Tacey Ann Rosolowski, PhD:
No, it’s not. No. I am grateful for you answering the question so completely. It’s obviously very much a topic of discussion. It also—I mean, you’ve provided another facet to that discussion about leadership that we were having earlier too. It’s a transparency question, and how does one give oneself 125 percent to a leadership role of an institution or a department or a division—all of those things. Everyone that I’ve spoken with has talked about the enormous time demand that MD Anderson requires, and they’re happy to give it. But it’s just a reality.
Bernard Levin, MD:
I think that in instances of which I’m aware where there have become conflicts where an individual has developed a significant outside interest it’s appropriate to—of course—declare that. Then, perhaps, transition into a part-time role or a non-leadership role—to the extent that can be managed. Where there isn’t transparency, there is always going to be some doubt. Another example of that is, of course, the whole area of nepotism. It’s very—it’s essential, again, that there not be any confusion as to whether one’s spouse or one’s child or whether one’s parent—in that unlikely situation—is somehow being judged and rewarded by a mechanism other than that which is available to anyone else. I believe as one goes higher up the ranks the UT system—the executive vice chancellor and chancellor—need to be extremely clear both in the initial recruitment process but in subsequent phases of an individual’s career that those kinds of transparent relationships are a core value and must be enforced irrespective of the consequences.
Tacey Ann Rosolowski, PhD:
Well, thank you for answering that. I wanted to pause just for a second because I wanted to kind of strategize with you about where we go from here if you don’t mind.
Tacey Ann Rosolowski, PhD:
(The recorder is paused.) All right. We’ve turned the recorder back on a 10:22.
Recommended Citation
Levin, Bernard MD and Rosolowski, Tacey A. PhD, "Chapter 18: Conflict of Interest, MD Anderson Leadership, and Protection for the Institution and Patients" (2013). Interview Chapters. 1354.
https://openworks.mdanderson.org/mchv_interviewchapters/1354
Conditions Governing Access
Open
