Home > Medical/Health Commentary > The UCSF-Altria imbroglio

The UCSF-Altria imbroglio

As the New York Times, its Prescriptions blog, and the San Francisco Chronicle have been reporting, there’s been a scandal of slightly more-than-minor size involving the UCSF Chancellor’s stock holdings.  Dr. Susan Desmond-Hellmann — the oncologist at the head of UCSF’ — disclosed shareholdings in the area of $100,000 in Altria, the company formerly known as Phillip Morris that makes most of its money from tobacco-related products.  Since that disclosure, followed promptly by divestment, Dr. Desmond-Hellmann’s holdings in health products/pharmaceutical companies and fast food companies — this time to the tune of millions of dollars — have come to light.  The investments were apparently made by a third-party financial advisor without her knowledge, and this advisor has since been instructed to purge her shareholdings in alcohol, tobacco, and firearms manufacturers.

Reading these articles prompted me to consider one of my earliest posts here, in which I argued that there is nothing unethical, unseemly, or untoward about life/health insurance companies holding shares in fast food companies.  Does the same argument apply to Dr. Desmond-Hellmann’s holdings?

Yes and no.

In my mind, the most problematic of her stocks are the pharmaceutical and health products companies.  These firms are probably vendors or research sponsors at UCSF, or have the potential to be.  The Chancellor’s shareholdings in these firms are substantial, and the potential for a conflict of interest is definitely present.  As one of the ethicists quoted by the Chronicle points out, recusal from decisions that would trigger this conflict may be all that is required, but continuing to hold the shares certainly creates the appearance of impropriety.  While some have pointed out that physician-industry relationships aren’t always eeevvvilll, as others would have us believe, there is a difference between productive collaboration of the sort Dr. Rich discusses and passive shareholding of the sort at question here.

I personally find her other shareholdings to be less objectionable.  Alcohol, firearms, soft drinks, and fast food are all legal products that can be used or abused, depending on who is doing the ab/using.  I see nothing intrinsically “evil” about them that should force medical leaders to steer clear.  Many of these firms (McDonalds, Pepsi, etc.) are also components of major equity indices, and as such may well have been chosen for that reason.  It’s highly unlikely that they will be directly involved with UCSF as vendors, donors, or sponsors, though I could be wrong about this.  Tobacco, however, doesn’t pass the smell test with me, especially not when we’re discussing an oncologist.  Arguably, it’s the only one of the products in question that is inescapably harmful regardless of how it’s used.  Of course, I would be remiss if I didn’t point out that there are lots of anti-smoking groups out there who have let their love for tax revenue outweigh their desire to reduce smoking.  This doesn’t make Dr. Desmond-Hellmann’s Altria holdings more palatable, in my view.  It just places them in the context of “how worse could it be/what company is she in.”

There is a growing obsession with rooting out conflicts of interest in healthcare, often under the rubric of reducing “waste and fraud.”  Much of this is a good thing, though as people like Dr. Rich point out, this obsession comes with a risk of harmful side effects.  More and more attention seems to be paid to “who owns which shares.”  Given that companies like McDonalds, Pepsi, and Altria are major blue-chip companies that are components of the DJIA/S&P 500 — thus likely to be held by many people and institutions — and targets for public health activists, it will be interesting to see how this plays out in the future, and where the line will be drawn for medical professionals who want to be perceived as “ethical investors.”

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  1. December 13, 2010 at 12:52

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