By David Kingsley

The Growing Importance of Data

      The time has come for citizens to recognize the corrupting influence of university-industrial relationships and to organize efforts to call them out.  In a democracy, data generated in taxpayer funded healthcare systems should be controlled by the public through a democratic process. If corporate wealth and power are determining factors in who has access to healthcare data and/or who is recognized as legitimate analysts and interpreters of government information, the American people will be sitting ducks for manipulation, and exploitation.

    Growing problems resulting from big data and A.I. call for pushback by concerned scientists and citizens in general. Computing power and speed, massive collections of data, and technologically sophisticated data analytics will increasingly play a major role in the fairness, quality, and control of the U.S. healthcare system.  Control over these processes by industrial interests through manipulation of government agencies, universities, and political actors will result in inefficient, costly, corrupt, and inequitable healthcare.

An Example of Industry-University Collaboration in Real Time

     An insidious collaboration between the American Health Care Association (AHCA) and the Brown University Center for Gerontology & Healthcare Research (BU CGHR) serves as an example of how a university and industry can team up to thwart efforts by advocates to improve the quality of nursing home care.

 I have written about the Brown University-AHCA relationship in a previous blog post (here). However, a colleague recently sent me an article jointly authored by AHCA representatives and employees of BU CGHR which greatly increased my concern over the blatantly self-serving and corrupted nature of industry influenced research.

    The article[1], published in the Journal of the American Geriatrics Society, included six authors, four of whom are employees of the AHCA.  Ostensibly, the purpose of the article was to address the need for and cost of legislation requiring an increase in minimum staffing.  The authors concluded (based on their statistical analyses which I consider questionable at best) that the legislation would cost an additional $7.25 billion.  On page 7, they advance the usual deceptive AHCA hardship narrative that “SNFs operate under tight operating margins (median 0.7% in 2019), and margins have declined since 2013.”  They conveniently ignore cash flowing to investors through home office allocations and networks of related parties such as real estate, labor contracting, and a host of other subsidiaries.

    Even the lead author of the article is an AHCA employee.  Nevertheless, the article conflict of interest statement noted that “The authors report no financial conflicts of interest.” Saying that there is no conflict of interest in this publication is about as Orwellian as saying “War is Peace” (see: Brown University policy on conflicts of interest in university affiliated research (here).

    The conflict-of-interest statement included in the article describes the AHCA, as “the largest national trade association representing skilled nursing ….facilities.”  This is a clever filtering of reality through the most positive lens possible.  In fact, the AHCA represents not “facilities,” but chains of facilities owned by investment banks, private equity firms, real estate investment trusts, publicly listed C corporations, and other legal/financial corporate types..  Most of these corporations have multi-billion or multi-million-dollar revenues.  Furthermore, the AHCA has a large political PAC for influencing legislation on behalf of corporations funding them.

Science, Statistics, & Research Integrity

    When an industry can leverage the cachet of a venerable academic institution and produce dubious statistical models and write articles favorable to entities with a financial interest in the outcome of research, human rights and adequate healthcare will inevitably become secondary to cash flow.  Money takes precedence over healthcare, suffering is increased, and lives are shortened.

    Advocates and scholars must speak out about the Brown University collaboration with AHCE and other such industry-university relationships.  The role of government, think tanks, and philanthropic foundations in these relationships should not be overlooked either.  We cannot be passive. The problem of data control and manipulation by industrial interests will only deepen and become more serious and destructive as A.I. becomes available.  

    Let’s have a much-needed discussion about science and research integrity.  Let’s separate science from scientism.  Observational studies of complex, dynamic, social systems based on data dumps are beset with fallacies and they are easily manipulated.  Therefore, poor research with the imprimatur of a leading university unjustifiably undermines efforts to improve the quality of nursing home care.  When the nursing home industry chooses to withhold corporate financial information from the public, we cannot accept studies regarding staffing as scientific.  By providing only partial information, the industry and its lackies in Universities cannot claim to be basing their claims on scientific evidence.

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[1] Hawk T., White EM, Bishnoi C. Schwartz LB, Baier RR, Gifford DR. Facility characteristics and costs associated with meeting  proposed minimum staffing levels in skilled nursing facilities. J. Am Geriatr Soc. 2022; 1-10. Doi: 10.1111/jgs. 17678.