At ASCO Annual Meeting, a Candid Look at Conflict of Interest

Cynthia J. Gordon, PhD

Disclosures

July 08, 2015

In This Article

If attendance at an educational session at this year's American Society of Clinical Oncology (ASCO) annual meeting is any indication, then financial conflicts are at the top of many oncologists' minds.

"I'm quite pleased to see that there's almost not a single seat empty in this entire room," said Reshma Jagsi, MD, DPhil, deputy chair of the Department of Radiation Oncology at the University of Michigan and one of the session's speakers. Even an adjoining overflow room nearly filled as the presentations got under way.

The session, titled "Let the Sunshine In: Industry's Impact on Oncology Research and Practice," covered everything from current trends in funding for oncology research and the rise of direct-to-consumer (DTC) advertising, to policies regarding conflicts of interest (COIs) and the implications of the Sunshine Act.

Although the symposium covered a variety of financial conflicts, ultimately a theme emerged: Data on physician financial conflicts are readily available—they are public and transparent—and they unequivocally show that financial ties between oncologists and industry exist. But what do the data say about the potential correlation between these relationships and physicians' prescribing patterns? Is merely publicizing the data on physicians' financial COIs enough to draw conclusions about their behaviors and motivations?

Increasing Prevalence of Industry Spending in Oncology

Over the past two decades, an upward trend has emerged in the proportion of private sector funding for biomedical research, increasing from 21% to 61% between 1994 and 2003, with an uptick continuing over the following 5 years.[1,2] Regarding cancer research specifically, a trial by David Gerber, MD, of UT Southwestern Medical Center, published earlier this year showed an increase in industry funding for clinical oncology trials over the past decade: Since 2007, trials were more likely to be industry sponsored (40% vs 28% before 2007), and these trials also were more likely to be phase 1 (16% vs 9% before 2007).[3]

Industry has been increasing spending in other areas as well. Spending on DTC advertising for pharmaceutical products—which began, primarily in print form, as early as the 1980s—has expanded dramatically in recent years, particularly since 1997.[4] Dr Jagsi showed data that DTC advertising increased from approximately $150 million in 1993 to more than $1.1 billion in 1997. By 2003, that number had nearly tripled to $3.2 billion, peaking at nearly $5 billion in 2007, which coincided with the peak in overall promotional spending on pharmaceutical products.

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