Tag Archives: Conflict of interest

Conflicts of interest in research leadership (Part I)

Family & Friends

This is the first in a series of pieces I am writing on research leadership. The first in the series is a couple of articles devoted to conflicts of interest. I also want to explore ideas of organisational strategy, gender, who can lead, and with my interest in the global south, on funding, collaboration, and global leadership.

When I started to think about writing this series, I remembered one of the best books I had ever read on leadership, Be in Charge: A Leadership Manual. It was written by Alexander Margulis. During his career, Margulis was Professor of Radiology at Cornell, Chair of Radiology at UCSF, and an accomplished scientist. His book is, unusually in the leadership literature, relevant to the research environment. I read it early in my career, the year it was first published, at a time when I was trying to overcome management issues with a large multi-country study I was conducting. It helped to crystallise in my mind basic ideas of successful leadership.

When the book was first published, its language and tone were already a little dated (and while he struggled against it, sexist). Re-reading it, it reminds me of the comfy slippers worn by the sage, bachelor uncle in a 1960s, US family, TV drama. I recommend that you push past all that; read it for its common-sense advice, and ignore it for its anachronisms. One of the things he reflects on, not in great detail, is the issue of conflicts of interest associated with family and friends in the workplace. To start off, I have extracted three short ideas:

Close friendships are a handicap except with clearly non-competing equals.

Do not have favorites.

Do not ever employ members of your family in your unit … If for some reason one of your family members has to be employed in your unit, you should not have any supervisory or controlling responsibilities for his or her performance.

For my entire career in Global Health, I have collaborated with my wife, and the question of conflicts of interest would occasionally raise its head. Global health has, in fact, had some great husband and wife teams. One of the most successful, and frankly, one of the most important for health globally was that of Ruth Bonita and Robert Beaglehole. There was never a hint of a conflict of interest, and the benefits of that collaboration were enormous.

The salvation for my wife and I was that we were never each other’s boss. We were either working in different institutions or, when we were at the same institution, we occupied parallel positions. We could work together, but we could not offer favours to each other. Monash University was so concerned about the potential for conflicts of interest that they stopped us co-supervising PhD students — something I thought was a particularly stupid interpretation of a conflict of interest that ignored where the real benefit of our collaboration lay for students. Nonetheless, we complied, and that perceived conflict went away without even a hushed whisper.

When my wife moved to take over the Director position of a United Nations policy institute, we briefly discussed whether we could continue the collaboration and whether I could seek a position in the same institute. In our heads, we could see how to navigate it, but the reality of the conflict of interest was too strong and the rules unequivocal — No! It is easy to see why the answer is, no: “Do not have favourites”. Couples can be more or less emotionally mature but, unless there is indifference between them, it is probably quite tricky not to favour the person you love over others. Even if that can be managed, it is probably difficult for the no-longer-favoured to understand why. At the very least, you each know your partner’s needs, desires, and handicaps more deeply than you do others. In that greater understanding, opportunities are created for perfectly rational moments in which help can be offered. The help that is not offered to others because you do not understand them as well. That loss of opportunity for others is simply unfair, and the kind of thing that gnaws away at organisational harmony.

For the Head of a Research Organisation, to have a family member working within the organisation will always be a challenge. If the family member is very junior, it may appear, at first, to make little difference. A helping hand from above would be so overt and so distasteful that it likely would not occur. However, the supervisor of the family member may believe that doing small (or large) favours for Junior will play well with the boss: a favourable appraisal, an opportunity to attend a conference, a room with a view. Even if the Head and the Supervisor are both completely honest, the perception of a conflict of interest, however unjustified, may arise. And perceived conflicts of interest can undermine the trust and confidence in the organisation.

If the family member is not junior, but quite senior, the risks of a conflict of interest are even more pronounced. Senior Scientists need to negotiate with their supervisor or their supervisor’s supervisor (who may well be the Head of the Research Organisation) for resources to support their team. A new piece of equipment is needed, extra space, or a new hire. None of these is an issue except, as is always the case, when others are competing for the same resources. Only the other team wants the resources for a new vehicle, $50,000 of cloud computing, or a staff retreat.

Margulis has a blanket rule. Don’t do it. The reality may be more difficult. If my wife and I progressed in the same organisation and she applied for a senior position, should I resign? Should she be precluded from consideration for higher office? Should there be a process based on the Russian aphorism, Trust but Verify (Доверя́й, но проверя́й). Set up some oversight role that can monitor conflicts of interest arising between the Head of the Research Organisation and their lover. It doesn’t merely sound distasteful, it can’t work because any process operating from within the organisation can be subverted by the boss. The inherent power of the Head of the Research Organisation provides ample opportunities to offer favours and promotion to the Guards — and there is no one to Guard the Guards. Again, even if the Head is completely honest, perception creates the potential for conflict of interest.

Margulis focused on potential conflicts of interest where a more organisationally senior family member offered (or was perceived to offer) favours or advantage to a more junior family member. In organisational leadership, however, there is also a potential for lateral conflicts of interest to arise, from family members occupying ostensibly parallel but influential positions.

In a commercial organisation, family members holding parallel posts may not be an issue and may, in fact, be a significant “value add” for the organisation. If you are a member of the Murdoch family then having family members on the Board, others holding senior positions elsewhere in the company, others working in an entwined parallel organisation, need not be a conflict of interest. The whole family is focused on maximising the value of their holdings, and therefore (probably) supporting the maximisation of the value for all the shareholders. That at least would be the argument I would make, and if the majority of shareholders buy the argument, it is a non-issue. In a private, family-owned company, it is even less of an issue.

This is not so in your typical not-for-profit research organisation or university. A family member who is a Chair of Geology and another who is a Chair of English Literature are unlikely to create conflicts of interest within the organisation. They are not simply in parallel units, they are in parallel universes of academic and research engagement, and they are highly unlikely to have an opportunity to interact with each other in a compromising professional manner. This would not be the case, however, if one family member was, say, the Director of Purchasing and the other was the Director of Finance. Here, there would be ample opportunity for fraud. It would be equally challenging to avoid a conflict of interest if one family member were on the University Council, another was a senior executive in the university, and a third was the steward of the university’s union, representing academic staff. They might argue that, as with the Murdochs, this level of intertwining is an advantage for the organisation because it creates efficiencies and synergies. Nonetheless, it would create an unequivocal perception of a conflict of interest that the university’s Vice-Chancellor or President would inevitably have to confront.

There is an interesting twist to this notion of parallel units. A married couple were simultaneously Vice-Chancellors (Presidents) of two of Australia’s top universities. Each appointment was a testament to the extraordinary qualities of the individuals. In combination, it could also have created a perception of a potential conflict of interest. The Australian newspaper described them as wielding “vast influence as the vice-chancellors of two of Australia’s largest, most highly ranked and esteemed universities”.

Two notorious, rival institutions, constantly competing with each other over a larger slice of a diminishing pot of funding — and also sometimes successfully collaborating — were led by a married couple. The universities could have their internal strategies, strengths or weaknesses exposed by their leaders (the two people who were supposed to have their respective institutions’ best interests at heart) over a shared cup of coffee, a walk in the park, or a more active and intentional trade. For four years the couple simultaneously held these two university CEO positions (with a combined salary in 2018 of AUD$2.7 Million), and to my knowledge, there was never a hint of a realised conflict of interest. It must, nonetheless, stand out as a bizarre exception to the rule. It is impossible to imagine that close a familial relationship would be countenanced between the CEOs of Alphabet and Amazon or Microsoft and Apple.

It may be that a Research Organisation would permit (potentially) conflicted relationships to arise in its leaders — and not simply allow them but countenance and endorse them. This action would require clear acknowledgement, clear justification, and clear guidelines for ensuring that it neither damaged the internal nor external working relationships of the organisation. The costs and benefits of permitting such a conflict would need to be carefully weighed and balanced. If it arose inadvertently it could have even greater reputational damage because it would bring the quality of governance into question.

Play with Big Tobacco and you will be tarred

Philip Morris International (PMI), profits by selling the world’s leading cause of preventable death — tobacco. The Foundation for a Smoke-Free World (FSFW) recently handed PMI a public relations coup by accepting a $1 Billion donation. Who now could credibly work with FSFW?

PMI is the world’s largest, international tobacco company. It is quite explicitly not interested in a tobacco-free world and it works hard and secretly to subvert tobacco control. Its raison d’être is the sale of tobacco products, and the “smoke-free world” cover provided by FSFW looks like a Big Tobacco tactic in a long line of them.

There is little doubt that FSFW as an organisation has placed itself in moral jeopardy by accepting PMI’s money: “Moral jeopardy occurs when a person or an organisation attempts to do good using resources from a source that involves harm.” And here is the rub. One of FSFW’s stated goals is to support global research through the support of “Centers of Excellence”. Any research group, however, that accepts FSFW money is exposing itself to moral jeopardy. And like other health and medical research outputs from conflicted industry sources, the results cannot be trusted — no matter how genuine the researchers are in their belief of independence.

PMI’s money laundering scheme for researchers may provide a scent of freshness, but the tobacco tar will stick.

Beware of Big Tobacco bearing gifts

Two days ago it was announced to much fanfare that the international tobacco giant, Philip Morris International (PMI) pledged $1bn over the next 12 years to the Foundation for a Smoke-Free World (FSFW) to fund scientific research designed to eliminate the use of smoked tobacco around the globe. The Lancet editor, Richard Horton tweeted a challenge to the health community: how should we respond? My tweeted response is shown below, but the challenge drew a range of (usually negative) responses, and the whole announcement is worthy of further unpacking and analysis.

First, it is worth pondering PMI’s motivation. Would turkeys vote for Christmas? Would tobacco companies vote for a world without tobacco? And the answer is no, they wouldn’t.

The announcement of the funding was picked up by, among other media outlets, Bloomberg, the Guardian, the Financial Times, Fortune, and CNBC. Most of the headlines start with two words, “Philip Morris”, which means the corporate social responsibility team at PMI can expect a big elephant stamp on their performance appraisals and an end-of-year bonus. This kind of positive publicity for a tobacco company is extraordinary and under other circumstances I would have said they couldn’t buy it, but apparently they can.

If you visit the PMI corporate web-site you will be presented with a glossy video of talking heads with overlaid text that PMI is “Designing a smoke-free future”. Some time in the future PMI will be out of (less reliant on) their cigarette business — not their tobacco business, but their cigarette business.

We’re dedicated to doing something very dramatic – replacing cigarettes with the smoke-free products that we’re developing and selling. That’s why we have a total of over 400 dedicated scientists, engineers, and technicians developing less harmful alternatives to cigarettes at our two Research & Development sites in Switzerland and Singapore. It’s the biggest shift in our history. And it’s the right one for our consumers, our company, our shareholders, and society.

That is clearer. PMI is still deeply committed to the manufacture and sale of an addictive, harmful substance, but in the future they hope it will be less harmful. The level of PMI’s commitment to the shift away from smoked tobacco can be gauged by the allocation of 400 of their 80,000 staff to the innovation of smoke-free products, or about 0.5% of their workforce. It should also be noted that when countries have attempted to interfere with PMI’s capacity to trade in a lethal product, it has fought those measures vigorously. This means that PMI will fight extremely hard (as is required by its fiduciary duty to investors) to maintain its profitability even at the expense of the life and health of its consumers. If PMI can develop a range of successful proprietary tobaccos products/technology that are smoke free, it is entirely in PMI’s interest to throw its weight behind anti-smoking initiatives, because competitors will be forced to use PMI technology under license.

Having got a sense of PMI, I will shift focus, more directly to the funding for FSFW. In the light of the PMI pro-tobacco, smoke free agenda, ponder the name of FSFW. This is a foundation dedicated to a smoke-free, but not a tobacco-free world. This is consistent with the commercial goals of PMI. For some, the argument is one of harm reduction. If the world moves to smoke free products, harm will be reduced. The fact that PMI is funding it, is proof of the excellence of public-private-partnership models.

Would it reduce harms? Yes. The harms, however, may not be reduced to the extent that might be hoped. There are some indications that the use of smoke-free products carry an increased risk of mortality over non-smoking, non-use of smoke-free products. Nonetheless, for those who would have become smokers, or switch from smoke to smoke-free products, harm will be reduced over being a smoker.

Does FSFW have a conflict of interest? They say, no.

Importantly, as established in the Foundation’s bylaws, PMI and the tobacco industry are precluded from having any influence over how the Foundation spends its funds or focuses its activities. Independence and transparency are core principles of the Foundation and all activities will be conducted with full transparency, free of tobacco industry influence. The Foundation has, constituted in its bylaws, an independent research agenda, independent governance, ownership of its data, freedom to publish, and protection against conflict of interest. Furthermore, strict rules of engagement will be put into place to ensure any interactions with the tobacco industry are fully transparent and publicly reported.

This is naive.

PMI has pledged about $80 Million per year over 12 years. this represents about 0.11% of of PMIs annual net revenue. The money is not paid up-front or held in an escrow-type account, and the continued payment will be decided up by PMI — presumably factoring in PMI’s satisfaction with FSFW’s activities. And $80 Million buys a lot of loyalty.

The loyalty that funding from corporate giants garners was well illustrated recently by the New America Foundation (NAF). “New America is a think tank and civic enterprise committed to renewing American politics, prosperity, and purpose in the Digital Age. We generate big ideas, bridge the gap between technology and policy, and curate broad public conversation.” Like FSFW they also boldly proclaim their independence from funders, stating under their Gift Guidelines:

New America steadfastly adheres to its mission of developing independent, non-partisan analysis and recommendations reflective of rigorous scholarship and promoting those ideas through broad public discourse. New America maintains full authority regarding project agendas, events, budgets, editorial content, and personnel decisions.

NAF receives substantial funding from Google. One of the NAF Fellows commented (as part of his work) positively about a decision by a European Union antitrust regulator that went against Google. The employee was subsequently fired by NAF, after Eric Schmidt the Executive Chairman of Alphabet, Google’s parent company, spoke with the head of NAF and made his displeasure known. This is instructive for two reasons, first Google was famous for its internal corporate motto “Don’t be evil” and later in Alphabet, “Do the right thing”. If a company that had “do the right thing” as an explicit part of its self image can’t leave independent foundations to be independent, what hope does a tobacco company have? Second, companies react negatively to things that they perceive as a threat to profit, without regard to the legitimacy or moral rectitude of the threat.

One would have to be foolish or naive to believe that one could be independent of the hand that feeds them. Even if someone at FSFW felt truly unshackled and unconstrained, the invisible thread of funding would moderate the independence of judgment.

Mitch Zeller the director of the Center for Tobacco Products at the US Federal Drug Administration regards this approach to harm reduction as a positive step forward, because Public Health has been “stunningly unsuccessful“, at selling harm reduction thus far. Unfortunately, government and industry are often tightly bound, ensuring that harm reduction does not work unless, as in this case, the industry can continue to make money from a (less) harmful addiction.

If government wants harm reduction to be successful, then government needs to get serious about tobacco control. Ban all forms of tobacco advertising. Ban the sale of cigarettes in locations frequented by children. Enforce uniform, plain packaging. Ban smoking in public places. Tax the product heavily. Place all taxation revenue from tobacco products into health promotion, quit campaigns, interventions, and tobacco related research.