A significant proportion of topmost doctors in the United States (US) fail to disclose ‘conflict of interest’ by way of their financial ties to medical device companies and the pharmaceutical industry, while publishing in top peer-reviewed medical journals.
Based on a recent study published in the Journal of the American Medical Association (JAMA), non-profit investigative news organisation, ProPublica, and the New York Times conducted a joint review last month.
The JAMA study sought to examine the association between “the physicians receiving the top compensation from surgical and/or medical device manufacturers and their academic affiliation, expertise, and disclosure of conflicts of interest”.
The researchers did a bibliometric analysis (statistical analysis of publications) of the top 100 physicians receiving the highest compensation from 10 large surgical and medical device manufacturers in 2015 and used payment information from the Centers for Medicare & Medicaid Services Open Payments Database.
Only in 37.3% of the cases — 84 of 225 of the relevant publications in 2016 — had the authors declared their conflict of interest, they found.
The NYT article reviewed some cases of top doctors with industry ties who had failed to disclose the conflict of interest while publishing.
Take the case of Dr Howard A “Skip” Burris III.
He is the president of clinical operations and chief medical officer at the Sarah Cannon Research Institute in Nashville, US, as well as the president-elect of the American Society of Clinical Oncology.
In more than 50 journal articles that he has authored over the past few years, Dr Burris declared that he had no conflict of interest.
But, it turns out that drug companies have paid his hitherto employer Sarah Cannon Research Institute nearly $114,000 “for consulting and speaking”, and nearly $8 million “for his research during the period for which disclosure was required,” report the NYT and ProPublica.
Similarly, Dr Robert J Alpern, the dean of the Yale School of Medicine, was one of the authors of a journal article in 2017 about an experimental treatment developed by pharmaceutical company, Tricida, for chronic kidney disease.
The clinical trial had not only been financed by Tricida, but Dr Alpern failed to disclose that he served on the company’s board of directors and had stock holdings in the company.
Then there is the case of Dr Carlos L Arteaga, director of the Harold C Simmons Comprehensive Cancer Center in Dallas, US.
In a 2016 study, published in The New England Journal of Medicine, about the breast cancer drug, Kisqali, manufactured by pharma giant Novartis, he declared he had nothing to disclose.
But Dr Arteaga had received “more than $50,000 from drug companies in the three-year disclosure period, including more than $14,000 from Novartis”, the findings said.
Publications in journals are the primary way for the biomedical establishment to communicate to and inform the public about medical breakthroughs and latest scientific discoveries.
Needless to say, companies reap immense benefits when research about their drug or any other product being tested is published in the top journals. Given that these are peer-reviewed journals, it boosts the profile and even the apparent reliability of the company and its product in question.
As the NYT article states, “Calls for transparency stem from concerns that researchers’ ties to the health and drug industries increase the odds they will, consciously or not, skew results to favour the companies with whom they do business.”
“Studies have found that industry-sponsored research tends to be more positive than research financed by other sources. And that in turn can sway which treatments become available to patients.”
This is why all prestigious peer-reviewed journals require authors to list any potential conflicts of interest.
However, as the NYT and ProPublica review noted, besides the impartial and erroneous disclosures by doctors being widespread, “journals themselves often gave confusing advice and did not routinely vet disclosures by researchers, although many relationships could have been easily detected on a federal database.”
The article quoted Dr Mehraneh Dorna Jafari, one of the authors of the JAMA study and an assistant professor of surgery at the University of California, Irvine, School of Medicine, as saying: “The system is broken. The journals aren’t checking and the rules are different for every single thing.”
Of course, non-disclosure of financial relationships between top doctors-cum-researchers with the pharma and healthcare industry seems to be a common practice.
In December 2018, renowned oncologist (cancer doctor) Dr José Baselga, the former chief medical officer of Memorial Sloan Kettering Cancer Center, had to resign under pressure as one of the editors-in-chief of prominent peer-reviewed journal, Cancer Discovery, for failing to disclose his conflicts of interest “in dozens of articles in medical journals”.
What’s more, last year a study had found that the authors of some of the most authoritative and popular medical textbooks in the world had not disclosed financial conflicts of interest with the pharmaceutical industry and medical product companies — in the form of patents or compensation from pharmaceutical companies.
In fact, the study found that the authors of Harrison's Principles of Internal Medicine, regarded the Bible for biomedical education worldwide, had received compensation amounting to $11.07 million between 2009 and 2013 from the pharma industry.