Corporate Funding for Schools of Public Health: Confronting the Ethical and Economic Challenges

Abstract

We discuss the public and private sponsoring of university research and the issues it raises in a context of diminished federal funding. We consider research funding at schools of public health and why these schools have historically had weaker links to industry than have other academic units.

We argue that the possibility of enhanced links with industry at schools of public health may raise specific concerns beyond those facing universities generally.

Six issues should be considered before entering into these relationships: (1) the effects on research orientation, (2) unacceptability of some funders, (3) potential threats to objectivity and academic freedom, (4) effects on academic standards, (5) the effects on dissemination of knowledge, and (6) reputational risks.

“As federal funds get tight, and institutions have built up capacity during the heady days of the doubling of the NIH budget, I think it’s inevitable that they’re going to turn more and more to industry to amortize their investments in people and buildings. I don’t think that industry funds anything that isn’t part of their business. It may be very near term or it may be a little longer term, but they’re not philanthropic.”

—David Korn, senior vice president, Association of American Medical Colleges, and former dean, Stanford University School of Medicine^1(p38)

In an era when federal funds are increasingly scarce, should schools of public health (SPH) consider more actively seeking corporate funding for their research and teaching activities?

University–industry relationships have a long history in the United States. They have taken numerous forms, including cooperative research projects and programs, research consortia, procurement of services from universities, work for hire arrangements, and more unrestricted industrial funding of individual departments and training programs. Previous research suggests that these relationships have generated benefits for both sectors and for society. In addition to financial benefits, such relationships have facilitated the translation of academic research into practice, generated new research questions, enhanced university training, created employment opportunities for graduates, and increased academic access to cutting-edge research tools and techniques.²

Some have viewed such links as having the potential to corrupt the academic mission and undermine the unique roles universities should play in American society.³ The controversy over the potential impacts of university–industry relationships will almost certainly be amplified at SPH, which have typically been committed to population health, robust conceptions of equity, and the broad dissemination of knowledge and have had an ethics that has at times viewed corporate interests as antagonistic to the very heart of public health.

We provide a context for the discussion that we believe should occur in SPH and the questions that should guide faculty debates about the prospects of increased corporate support for research and training.

SPONSORED RESEARCH AT UNIVERSITIES

Before World War II, the federal government did not actively support academic research in any field except agriculture.² Industry and foundation funding was more common. However, the success of the wartime research and development effort created political backing for federal academic research financing during peacetime. The growth of this form of sponsored research raised concerns. Scientists feared that with reliance on federal support academics would become “intellectual slaves of the state.”^4(p10)

As a result of federal funding growth, especially after “the golden age of science” that followed the US response to the 1957 launch of Sputnik, the industry share of academic research and development funding shrank from about 10.0% in the late 1950s to a low of 2.7% by 1970.²

Leading science policy scholar Donald Price observed that by the 1970s scientists had “become addicted to federal support” and had generally forgotten their pre–World War II ambivalence toward federal funds. The era “when the leaders of the National Academy of Sciences objected on principle to letting private universities accept government funds” was but a distant memory.^5(p76) University–industry relationships saw a resurgence beginning in the mid-1970s as a result of several forces, including a decline in federal funding, a growth in academic research interesting to industry, and changes in federal policy encouraging academic patenting and licensing. Since the 1970s, the industry share of funding for academic research has grown sharply, reaching a peak of about 7% by 1998.²

The recent growth in university–industry interactions has also triggered a range of concerns. Because the growth has been most pronounced in the life sciences, it is not surprising that concerns about commercialism have been most vocally expressed in this field.^2,3 However, these relationships appear to have been relatively rare at SPH.

SCHOOLS OF PUBLIC HEALTH

SPH in the United States emerged early in the 20th century. The Rockefeller Foundation was an important early source of funding and helped institutionalize the form. From the very beginning, their focus was applied and emphasized controlling disease and promoting population health, focusing heavily on training the public health workforce.^6,7

Like other institutions, SPH benefited from the postwar expansion of science funding, in particular funding from the National Institutes of Health (NIH).^6,7 Federal funding also became a more important source of funds because foundation support had declined by the 1950s.⁷ During the 1950s and 1960s SPH started to rely on federal research grants to fund research and subsidize teaching activities. Although they benefited from steady growth of NIH funding over this period, public health faculty were not always well positioned to compete for funds in a system that powerful medical school faculty dominated.⁷

There has been longstanding concern that public health research has been subservient to the popularity of topics at the NIH. Reliance on the NIH created a system that worked well for some disciplines within the schools (laboratory sciences, epidemiology, and biostatistics) but other areas (field research, public health practice, public health administration, social sciences, history, politics, ethics and law) were more difficult to support.^7(p284) As early as 1976, the Milbank Memorial Fund had asked whether SPH were too dependent on federal funding, whether “their policies and programs are determined by the dollars available and they no longer control their own destiny?”^7(p258)

To be sure, there were non-NIH public funding sources that have provided important support. In the 1950s and 1960s, the Hill–Rhodes Act provided a range of training, faculty development, and construction grants.⁷ Following the passage of Medicare and Medicaid, the US Public Health Service provided funding for schools developing courses in health service administration.⁷ Additionally, many foundations, most notably the Robert Wood Johnson Foundation, have been important funders of public health research that the NIH would not support.

Over the past quarter century, federal support for SPH has grown in absolute terms. Funding associated with the AIDS epidemic in the 1980s and 1990s and bioterrorism in the 2000s, together with a rapidly expanding NIH budget, has led SPH to grow rapidly since the late 1990s.

Unfortunately, the standard sources of academic research and development data, including the National Science Foundation’s various surveys of academic research and development, do not separately report funding by school and source. Our sense is that beyond broad funding from philanthropists and the foundations they have created (including the Rockefeller Foundation, the Robert Wood Johnson Foundation, the Bloomberg Foundation, and the Gates Foundation), private support in the form of research projects underwritten by industry has been more limited at SPH than at other university components, for example, medical, business, and engineering schools.

There are exceptions to this, of course, and variation across departments, but in general, public health faculty members have had only limited direct interaction with industry. The fact that SPH researchers have a much lower propensity to apply for patents than do academics in other units of academic medical centers is an imperfect indicator of limited commercial links.⁸

This lack of industry interaction in public health reflects several things. Most public health research has the characteristic of a public good with low excludability; no individual funder can easily appropriate this.⁹ This could limit private sector incentives to support such work. In addition, it is unclear that much of the output of public health research is directly useful to any individual firm, as compared with, say, research on new molecules or research techniques. Moreover, public health institutions have longstanding antipathy to restricting access to knowledge, for example, through patents and restrictive licenses.² To the extent that a desire for research that can be privately appropriated drives industry funding, public health researchers may be viewed as unlikely collaborators.

Another cultural norm that may limit relationships in SPH is their progressive and reformist streak. Indeed, the focus on the fundamental causes of health inequalities have explicitly raised questions about social inequality and corporate dominance of the American political process.¹⁰ Nevertheless, examples of formal expressions of hostility are rare.

CONSIDERATIONS GOING FORWARD

Stronger relationships between SPH and industry may provide financial and other benefits both in the short and the long term; they may even be a source of new and interesting questions and problems for public health researchers to tackle, create opportunities to apply research findings, enhance training and employment options for students, and help faculty access new research tools, techniques, and data sources. At the same time, several observers note that financial rewards from commercialization are speculative and variable.¹¹ Many previous “crises” that led universities to explore industry funding opportunities (including in the 1970s and 1990s) turned out to be blips in retrospect. For more than half a century, biomedical research funding (primarily at the NIH) had attracted bipartisan support unmatched in most other policy areas.¹²

Relationships between SPH and industry also raise a range of concerns. In our reading of scholarship on university–industry interaction in other fields,^{1–3,11,13–15} we found six main questions:

1. What are the likely effects on research orientation? A major concern about growing university–industry relationships outside SPH has been a potential shift from basic to applied research.² Although this is not as much of a concern at SPH (which have long had an applied orientation) as at other institutions, there is a general question of whether a focus on corporate relationships will pull research away from important public health problems and toward those in which there are higher possibilities for private funding. Would this be worse than the distortion of priorities generated by reliance on federal funding, which has been discussed throughout the history of SPH?

2. Are certain funders off-limits? Who decides? Some schools have banned tobacco funding altogether, owing to incompatibility with their missions because of the scientific consensus that tobacco poses a unique threat to health.¹⁵ Nevertheless, should receiving electronic cigarette-maker funding also be regulated? What about soda companies funding obesity research? Should institutions try to make these decisions, or should they be left to individual faculty members?

3. Are there threats to objectivity, academic freedom, and research integrity? Are existing university rules on individual conflicts of interest, and disclosure requirements at journals, sufficient to govern relationships with corporate funders? Considering industry’s history of attempting to intimidate public health scholars who are viewed as partisan, as documented by the American Association of University Professors, these issues are understandably volatile. Do SPH need to go further to ensure the objectivity, freedom, and research integrity of faculty members who are funded by industry? Alternatively, what can be done to protect research that criticizes large corporate funders or potential funders?

4. What effects are there on academic standards? Will corporate relationships undermine academic standards for appointing and promoting professors (e.g., leading to appointing individuals who can bring in considerable corporate funding)? What effects would this have on the ability to attract and retain “genuine” scientists?¹¹ Work for hire relationships—in which academic institutions or faculty members are hired to solve narrow applied problems—are particularly complex, because they typically generate findings that would be difficult to characterize as research that could be the object of rigorous academic evaluation. As a consequence, although such relationships might generate resources, they might be problematic for tenure track faculty, who will be judged and evaluated for promotion on the basis of their research.

5. What effects are there on knowledge sharing and dissemination? Are existing university rules that limit publication delays and secrecy in industry grants and contracts sufficiently exacting? Considering their historical commitment to broad dissemination, do SPH need to go further? Here, too, work for hire relationships raise particular concerns: they typically produce data and other findings that industry views as its own. The demands of open access and faculty ownership may be contradictory to the very purposes of such work. In the (likely small) set of cases in which industry-funded research results in patentable inventions, are existing university intellectual property rules and norms sufficient to govern dissemination? Is a firmer commitment to broad dissemination required for SPH research than for academic research in general?

6. Are there potential reputational risks? Would receiving significant industry funds undermine reputations for individual faculty members, departments, and entire schools for unbiased and evidence-based input into public health policy and practice? What impact would this reputational effect have on the ability of institutions to attract and retain top faculty members and students? It is critical to note that such risks may exist regardless of the extent to which corporate-funded work compromises research integrity, that is, even the perception that it does could have reputational consequence.

Universities attempt to govern industry relationships mainly through individual conflict of interest policies. However, as all these questions suggest, thinking about university relationships is much broader than is thinking only about an individual faculty member’s financial conflicts of interest. An important issue that has received less attention is institutional conflict of interest. As a recent report from the American Association of University Professors suggests, few universities have enacted policies to ensure that the large funding sources of the institution as a whole—through grants, contracts, or financial ties of the academic leadership—do not compromise the research mission.¹⁵

CONCLUSIONS

A candid parsing of the principles at play is a crucial first step in a judicious discussion of the risks and benefits of industry relationships at SPH. Indeed, without such a clear articulation, the very concepts of risk and benefit in the ensuing discussion will be muddled.

As important, faculty engagement with these issues requires careful analysis of the evidence. Because many of the new initiatives represent first ventures, we do not, in fact, know what experience will reveal about the costs and benefits of these initiatives. If institutions do go forward, we urge them to do so in a limited way and to commit to periodic evaluation of the effects of these relationships on what institutions consider their core missions. Administrations should be transparent about the processes and objectives they use to judge whether a particular industry is a good partner for their institution and the criteria that they will use to assess the impact of these partnerships down the line. Only if this is done can we avoid the hazards of flying blind and of being seduced by unwarranted optimism or Cassandra-like fears.