1 Boring Old Man

Improving Health With Partnerships Between Academia and Industry

JAMA: Internal Medicine
Viewpoint

by Susan Desmond-Hellmann, MD, MPH
June 24, 2013

AT A TIME WHEN JOBS seem scarce, one role seems to have multiplied: the pundit; never at a loss for a provocative, deeply held view or opinion. And, one of the rapidly expanding punditry themes is focused on the purported “evils” of the pharmaceutical industry and the potential for an associated corrupting influence of money on innovation in health. In his new book, Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients, Ben Goldacre, BA, MBBS, MA, MRCPsych, a British physician and writer, says

Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques which are flawed by design, in such a way that they exaggerate the benefits of treatments.

This kind of hyperbole ignores remarkable advances in medicine, such as in human immunodeficiency virus/AIDS and cancer care, that are directly attributable to the work done in the pharmaceutical and biotechnology industries. But repetitive negative publicity has had an impact; a recent randomized study of 503 internists showed that industry sponsorship of clinical trials negatively influences physician perception of methodologic quality and reduces their willingness to believe and act on trial findings, independently of the trial’s rigor and quality. So why did I accept the invitation to write an article regarding the role of the pharmaceutical and biotechnology industries in innovation [and risk an attempt at punditry myself]?…

• Desmond-Hellmann joined Genentech in 1995 as a clinical scientist, and she was named chief medical officer in 1996. In 1999, Desmond-Hellmann was named executive vice president of development and product operations.
• Prior to joining Genentech, Desmond-Hellmann was associate director of clinical cancer research at Bristol-Myers Squibb Pharmaceutical Research Institute. While at Bristol-Myers Squibb, she was the project team leader for Taxol.
• Desmond-Hellmann also has served as associate adjunct professor of epidemiology and biostatistics at UCSF. During her tenure at UCSF, Desmond-Hellmann spent two years as visiting faculty at the Uganda Cancer Institute, studying AIDS and cancer. She also spent two years in private practice before returning to clinical research.
• In April 2012, Desmond-Hellmann was honored with the Commonwealth Club of California’s 2012 Distinguished Citizen Award for her leadership at UCSF and Genentech.
• In October 2010, she was elected a member of the Institute of Medicine and inducted into the American Academy of Arts and Sciences.
• In January 2009, Desmond-Hellmann joined the Federal Reserve Bank of San Francisco’s Economic Advisory Council for a three-year term.
• She was named UCSF’s first woman chancellor and took the helm of the graduate health sciences university in August, 2009.
• In July 2008, Desmond-Hellmann was appointed to the California Academy of Sciences Board of Trustees.
• She was named to the Biotech Hall of Fame in 2007 and Healthcare Businesswomen’s Association Woman of the Year for 2006. Desmond-Hellmann was listed among Fortune magazine’s Top 50 Most Powerful Women in Business in 2001 and from 2003 to 2008. From 2004 to 2006, the Wall Street Journal listed Desmond-Hellmann as one of its Women to Watch.

So, on one hand, Dr Desmond-Hellmann, to be charitable, does not have much of an academic track record, at best approximating that of a very junior medical faculty member. She also certainly has no experience in academic administration. In general, people who lead academic medicine often have substantial track records in academics and in academic administration. So, in some sense, Dr. Desmond-Hellmann’s appointment seems to based on the theory of the generic manager. That is, the popular notion in the business world managers can manage anything, any organization, with any mission, in any context. Managing in the complex health care context, especially managing large, complex academic medical institutions, may not be easy for those used to managing elsewhere, even in the health care corporate world. Furthermore, the complex mission of academic medicine, which includes providing excellent care of individual patients, while discovering and disseminating the truth in a spirit of free enquiry, is very different from the mission of a for-profit biotechnology company. How well someone used to the bottom-line mentality of the corporate world would uphold the academic mission is not clear…

^{But, while Dr Desmond-Hellmann was defending pricing drugs that at more than $55,000 a year, and complaining about low industry profits, she was pocketing lavish rewards. According to Genentech’s 2008 proxy statement, [the last available, since the company has been bought out by Roche], her total compensation was $8,361,348 in 2007 and $7,820,142 in 2006. In 2007, her total compensation was equal to 0.3% of the firm’s total net income, and the top five company executives’ total compensation was equal to about 1.5% of the firm’s total revenues. In 2007, the firm’s stock price declined from 91.30 on 6 January 2007 to 66.38 on 4 January, 2008, or 27%, according to Google Finance. In 2007, she held 1,616,383 shares of stock, or stock options exercisable within 60 days of January 31, 2008. In 2007 she exercised 170,000 stock options, realizing $11,556,663. So perhaps those high drug prices were needed not only to pay for research, but to make top executives, including Dr Desmond-Hellmann, very rich…}

Desmond-Hellmann told the Regents she expects one of the working group’s tasks to be exploring alternative governance strategies that would allow UCSF to benefit from the region’s considerable expertise in health care, biotech industry and business. During her nearly three-year tenure as UCSF chancellor, Desmond-Hellmann has championed forging new industry partnerships to more quickly translate research discoveries for the benefit of patients. In recent years, UCSF has connected growing numbers of scientists with the resources and expertise of pharmaceutical, biotech and high-tech companies to move science and inventions closer to becoming drugs, therapeutics or products to improve health.
In the future, UCSF could find new revenue streams through efforts such as spinning off successful biotech companies, creating a joint venture for an outpatient pharmacy with a for-profit pharmaceutical company and exploring new opportunities on the technology transfer front. The chancellor noted that Genentech, Chiron and other biotech companies were created based on science that came from UCSF. “Company creation and innovation are part of our DNA,” she told the Regents.

Given the challenge of effectively innovating to improve health, we must resist measures that would increase the barriers to effective industry-academic partnerships. Academic faculty members are the very individuals who can best add rigor to the research process, help to make study results more transparent, and facilitate better feedback to all stakeholders. These activities should increase confidence in medical innovations. In addition, we must ensure that communication of research findings is robust and clear. Communications should explain the inherent uncertainty of novel therapeutic approaches, the strengths and limitations of findings as new data emerge, and how new data that contradict earlier data affect best clinical practices. To improve health, increasing industry-academic interactions is vitally important…

^{She cited the University’s remarkable progress in achieving its three-fold mission of training the next generation of health sciences leaders, leading scientific discovery as one of the top biomedical research institutions in the world and advancing health care as one of the top-10 medical centers in the nation. UCSF received $532.8 million in funding from the National Institutes of Health in 2011, once again garnering the most funds among public institutions in the United States, second overall after private Johns Hopkins University.}

^{The chancellor also explained that UCSF is significantly different from its sister campuses in the UC system since it is the only University dedicated solely to graduate-level programs in the tuition increases an impractical financial solution for UCSF. The chancellor already is working on other fronts – including making a personal contribution of $1 million – to increase financial support to both graduate students and students enrolled in its four professional schools of dentistry, medicine, nursing and pharmacy health sciences… Revenue sources for UCSF’s $3.86-billion budget come primarily from the clinical enterprise [50 percent] and grants to the research enterprise [29 percent], she explained. “UCSF is heavily dependent on two funding sources: our medical center and grants,” Desmond-Hellmann said. “Eighty percent of our revenue comes from these two sources, which both exist in an extremely competitive landscape.”}

Perhaps on Susan Desmond-Hellmann’s side of the rainbow, industry-academic partnerships might bear some relationship to improved health. And maybe in Oz, the corporate management of Community Hospitals cuts medical costs and improves care [the modern robber barons…]. It might be even be true in Munchkin-land that adding academic key opinion leaders to industry funded and authored clinical trial reports improves their scientific clarity and validity [seroquel: good to the last drop…, rest my case…]. But here in Kansas, those are hypotheticals rarely if ever realized – rather they contribute to soaring medical costs, misrepresented efficacy, undeclared adverse effect burdens, and obscene corporate profitability, not to mention the palpable erosion of our medical ethic.

In many ways, psychiatry currently stands as a testimony to what’s at the end of this yellow brick road. After three decades of generously supporting departments of psychiatry with the fruits of Desmond-Hellmann’s kind of academic-industrial partnerships, the reputation of academic psychiatry is all but spent and the pharmaceutical industry is in full flight. It was a Faustian bargain, not a dream that could be conveniently exited in a State Fair balloon – more like the nightmare you can’t wake up from.