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zoom RSS ハーバード大提携病院で外部からの報酬を規制/米国医療事情

<<   作成日時 : 2010/01/13 00:51   >>

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 ハーバード・メディカル・スクールと提携している2つの研究病院のオーナーは、製薬・バイオ企業取締役に座っている20人の上級役員の外部からの収入に制限を課した。産学癒着への批判が高まり、制限を設ける。
 製薬企業からの収入を制限する他のメディカルセンターより、Partners HealthCareでの利害の不一致規則が厳しくされるべきと医療専門家は考えている。金曜日に実施された規則では特に国内大企業を動かすような外部取締役に対しての制限を課している。
 取締役会の実際の仕事で「学究的な役割に釣り合うレベル」1日5,000ドル以下に制限する。年に20万ドル以上を受け取っていたものが数人いるという。株も受け取れなくなる。
 最近数年の議会調査や訴訟、報道を通して、医学会のリーダーが矛盾した役割を持っていたことが暴露されることが増えてきており、現行医療制度下での治療のコストと質とに関する問題への提起となった。ハーバードは特にGrassley上院議員が中心となり議会調査をしてきた。Partners HealthCareは、8,000人のハーバード職員に対して、製薬企業からの講演報酬を禁止している。他の医学校でも、製品についての講演での製薬企業からの報酬を禁止するという同様の措置をとった。しかし、どの学究的なメディカルセンターも取締役会への参加を規制しなかった。
 MGHの診療部長でファイザーの取締役ともなっているAusiello博士は昨年22万ドル以上を受け取っている。
 新方針では、取締役会議での適切な報酬は時給500ドルで10時間と算出されたという。
 善意で行うリーダーの仕事への制限が厳しすぎるという意見もあれば、企業監督者が研究の監督をしたり教育プログラムを管理したり患者治療の決定に関わるべきでなく利害対立のコントロールには不充分とする意見もある。
 学究的なメディカル・センターの役員が製薬会社の取締役会にも出ることは総体として矛盾していると、NEMJ前編集長でハーバード名誉教授のArnold S. Relman博士は言う。こうした矛盾は国中いたるところでおきているとも言う。
 米国医科大学連盟Ann C. Bonhamは、他の学究的なセンターが1日に10,000ドルまでに役員への報酬制限を考慮しているという。
 企業の金銭的利益に注意することが企業役員の義務であるので、病院と製薬企業の両方の役員をすることは危険であり、ハーバードでは特に企業と不釣り合いな関係にある。1994年にSamuel O. Thier博士がメルクの取締役になった時に、Partnersの会長もしていた。1997年から2007年までハーバード・メディカル・スクールの学部長だったJoseph B. Martin博士は、2002年にBaxterの取締役となった。両氏とも年に20万ドル以上を受け取っている。Daniel K. Podolsky博士はGlaxoSmithKlineの役員として年に191,000ドルを受け取りながら、2007年にPartners policy commissionの委員長であった。その後を引き継いだDr. Braunwaldは、20年前にAstra 製薬の役員であり、最近では少なくとも6つの会社の科学アドバイザーをしている。
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ハーバード・メディカル・スクールの倫理的苦境/米国医療事情
http://kurie.at.webry.info/200903/article_8.html
小児向精神薬治療研究での問題/米国
http://kurie.at.webry.info/200806/article_17.html
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Harvard Teaching Hospitals Cap Outside Pay
http://www.nytimes.com/2010/01/03/health/research/03hospital.html
By DUFF WILSON
Published: January 2, 2010

The owner of two research hospitals affiliated with the Harvard Medical School has imposed restrictions on outside pay for two dozen senior officials who also sit on the boards of pharmaceutical or biotechnology companies. The limits come in the wake of growing criticism of the ties between industry and academia.

画像Mark Ostow for The New York Times
Dr. Dennis Ausiello said he would continue at Partners HealthCare and on Pfizer’s board.

Medical experts say they believe the conflict-of-interest rules at the institution, Partners HealthCare, go further than those of any other academic medical center in restricting outside pay from drug companies. The rules, which became effective on Friday, impose limits specifically on outside directors who guide some of the nation’s biggest companies.

Senior officials at the two hospitals, Massachusetts General and Brigham and Women’s Hospitals in Boston, 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.

Criticism has been mounting in recent years as the conflicting roles of some medical leaders have been disclosed through Congressional investigations, lawsuits and reports in the news media. Those disclosures have raised questions about bias and the cost and quality of patient care at the nation’s medical institutions.

Harvard, in particular, has come under scrutiny from Senator Charles E. Grassley of Iowa, a leader of Congressional inquiries into the influence of money in medicine.

Partners HealthCare is also forbidding speaker’s fees from drug companies for any employee, including nearly 8,000 with Harvard faculty appointments. Some other medical schools have taken similar actions in prohibiting faculty members from being paid by drug companies to speak about their products.

But no other academic medical centers have so restricted participation in boards of directors.

“We’re the first to go in this deep, and we’re still into it only up to our knees,” said Dr. Eugene Braunwald, a Harvard professor and former Partners chief academic officer who was chairman of the policy-writing group. He said the group had “a very spirited debate” before announcing its compromise in general terms in April, much of it effective in 2010.

“We thought it was a very good idea to have institutional officials serve on boards, but we did not want to have personal enrichment,” Dr. Braunwald said.

The ban on speaking fees was one reason Partners wanted to take a strong stand on the issue of directors, he added. It would seem unfair, Dr. Braunwald said, to restrict outside pay of junior faculty but not senior leaders.

Among the senior officials affected by the policy is Dr. Dennis A. Ausiello, chief of medicine since 1996 at Massachusetts General and the Partners chief scientific officer, who serves on Pfizer’s board. He was paid more than $220,000 by the company last year. Dr. Ausiello said he would continue in both roles.

Dr. Ausiello said Pfizer and other companies were crucial to translate academic research into drugs that benefit patients. At Partners, he has oversight of a research, ventures and licensing office that seeks to commercialize the hospitals’ intellectual property.

“I’m very proud of my board work,” he said. “I’m not there to make money. I certainly think I should be compensated fairly and symmetrically with my fellow board members, but if my institutions rule otherwise, as they have, I will continue to serve on the board.”

The proper pay for time spent on board meetings under the new policy was calculated at $500 an hour for a 10-hour day, said Christopher Clark, a senior lawyer at Partners and director of a new office for interactions with industry. Stock and options were banned because they tie the director’s fortunes to company profits.

Some say the restrictions are too tough on well-meaning hospital leaders. Others say they are too weak to control conflicts of interest, arguing that corporate directors should not be overseeing research, managing educational programs or determining elements of patient care.

“I think that’s a gross conflict for an official of an academic medical center to be on the board of a pharmaceutical company,” said Dr. Arnold S. Relman, former editor of The New England Journal of Medicine and Harvard professor emeritus who has written about conflicts of interest.

“It’s happening more and more around the country,” he added. “If it isn’t stopped, I think the academic institutions are going to lose the confidence of the country and the government and they will no longer deserve the tax exemption or anything else. They will be part of industry itself.”

Ann C. Bonham, chief scientific officer for the Association of American Medical Colleges, said other academic centers were considering restrictions on director pay from zero to $10,000 a day. “They’re all taking this very seriously and moving as quickly as they can,” she said.

Thomas Donaldson, a professor of business ethics at the Wharton School of the University of Pennsylvania, said: “It strikes me as a breath of fresh air in a room that’s getting progressively more stale. I hope this will set a standard for others ― hospitals, medical schools.”

Professor Donaldson, who advises large companies on corporate governance, said dual roles in a hospital and at a drug maker were “dicey at best” because a director’s duty is to look out for the corporation’s financial interests.

Senior faculty in leading teaching hospitals are in high demand on medical product boards, but corporate filings show that Partners and Harvard Medical have a disproportionate share.

For instance, Dr. Samuel O. Thier was president of Partners when he was named to the Merck board in 1994. He is now retired from Partners.

Dr. Joseph B. Martin, dean of the Harvard Medical School from 1997 to 2007, was named to the board for Baxter International in 2002. Dr. Thier and Dr. Martin each receive over $200,000 a year from the corporate boards.

Dr. Martin, a professor of neurobiology, declined to comment. Dr. Thier did not return calls seeking comment.

Dr. Daniel K. Podolsky was the original chairman of the Partners policy commission in 2007, when he was the chief academic officer at Partners and a $191,000-a-year board member at GlaxoSmithKline, the pharmaceutical company based in London.

Dr. Podolsky, who left in 2008 to become president of the University of Texas Southwestern Medical Center in Dallas, said: “It is possible to find an approach that separates the potentially distorting effects of the personal benefit, but more importantly the perception of that, and still work in a constructive way as a board member.”

Dr. Braunwald, who succeeded him as chairman, also had industry ties, as a director of Astra Pharmaceuticals 20 years ago and as a science adviser to at least six companies more recently.

“In all fairness,” he said, “what was O.K. three years ago is not O.K. now.”

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