Many of the clinicians on the boards or governing councils of the biggest US medical societies and associations have received large payments from the pharmaceutical and medical device industry, which calls into question their impartiality, say researchers reporting a new analysis of publicly available information.
The American Society of Clinical Oncology (ASCO) topped the list for both payments to individuals and for research payments.
The new analysis, published May 27 by The BMJ, was based on data from the US government's Open Payments database of financial relationships in the healthcare industry.
"These powerful doctors' groups have enormous influence in the US and globally, including over the definitions of disease, which determine who's healthy and who's sick," lead author Ray Moynihan, PhD, Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia, said in a statement.
"It's basic common sense that these leaders should be free from financial ties to companies which stand to gain enormously from the work of these medical associations," he adds.
For their study, the researchers focused on the leading medical societies for the 10 costliest diseases in the US. They used published materials to identify leaders of each society, with leaders being defined as members of the board or governing council.
However, these individuals often play a background role in the work of a medical society. In reality, the leaders are active officers (such as the president, etc) and these individuals are often not allowed to have any links with industry, as ASCO pointed out in comments to Medscape Medical News.
Individual and Research Payments
Having identified ‘leaders' at each medical society, the team then searched for these individuals in the Open Payments database for the years 2017–2019.
They focused on any financial relationship a leader might have had in his or her current year of board membership, as well as the four years before and after membership, with consultancy, royalties, and hospitality among the included payments.
Of 328 leaders identified, 235 (72%) had financial ties to industry. Out of 293 leaders who were medical doctors, 235 (80%) had financial ties. Not one organization had a leadership free of financial ties.
The 235 leaders who were physicians received a total of $129.9 million, at a median to each leader of $31,805.
This included almost $24.8 million for general payments, $104.6 million for research, predominantly to institutions where the leader was a principal investigator, and $500,000 for other payments.
ASCO topped the list of the 10 medical societies, with the highest amounts both as payments to individuals and research payments.
ASCO 'leaders' were found to have received a median of $518,000 per individual.
The next largest amounts were of $251,000 for leaders at the American College of Rheumatology; at the bottom of the list were median total payments of $404 per individual at the American College of Physicians (ACP) and $212 per individual at the American Psychiatric Association (APA).
'Leaders' at ASCO were also linked to research payments totaling more than $54 million, compared with almost $21 million at the American College of Cardiology, just over $216,000 at the APA, and approaching $168,000 at the ACP.
The payments made by companies to medical association leaderships ranged from almost $17 million dollars from AstraZeneca to less than $30,000 from Shire.
What impact these financial relationships may ultimately have on patient care
is one of the "major research questions" that remains unanswered, the authors comment. "Urgently needed are more detailed investigations of potential relationships between industry payments to associations, their leaders and guideline writers, and the nature of their guidelines, medical education, and advocacy on issues relevant to sponsors," they add.
"This paper suggests that Board members of some associations may have influence over guideline development. It is important to clarify that ASCO's Board does not create, review or approve ASCO guidelines, nor do they set guideline topics," the society's chief executive officer Clifford Hudis, MD, told Medscape Medical News in a statement.
"The study found that the large majority (97%) of financial relationships identified among ASCO Board leadership were payments for research-related activities. They also note that such payments go predominantly to individuals' academic institutions, not to the individuals themselves. Such research partnerships are an essential part of clinical cancer research, and play a significant role in making progress in cancer treatment," Hudis added.
"Like other professional medical societies that adhere to the Council of Medical Specialty Societies' Code for Interactions with Companies, our senior leadership (Board chair; past, current and -elect presidents; CEO; and scientific journal editors-in-chief) may not have direct financial relationships with healthcare companies," he said.
In addition, Hudis added a note of caution about the database that was used for the analysis reported in this article.
"Open Payments alone should not be considered a comprehensive source of financial information. Data is reported by companies, does not require physician verification, excludes some financial relationships, and there is a limited time frame in which inaccuracies can be contested. Therefore, errors — both large and small — often go unchecked," he noted.
Need for Reform
In their analysis, Moynihan and coauthors emphasize the "novel finding" that there is such an enormous variation in the extent of financial ties that were found in their analysis.
They suggest that for the medical societies that have extensive links with industry, cutting free "will require time and major reform, whereas for others it will be quick and relatively easy."
Yes, it will take a varied approach, agree Jake Checketts, BS, and Matt Vassar, PhD, both from the Oklahoma State University Center for Health Sciences in Tulsa, writing in an accompanying editorial.
"Tackling financial conflicts of interest in medicine cannot rely on a 'cookie cutter' approach for all specialties and associations," they write.
"For example, oncologists' ties with industry for research payments…present unique challenges that might not be overcome with blanket policies and regulations."
They instead propose a five-step approach, including each association taking "the initiative to evaluate its present conflicts" and the creation of standards to promote medical associations "that are free from financial conflicts of interest".
"These steps," Checketts and Vassar write, "could mitigate or even eliminate the overwhelming presence of financial conflicts of interest among medical societies and associations."
"This would protect these groups from producing biased documents or policies, which in turn would protect all physicians and the patients they treat," they add.
This study was funded by the National Health and Medical Research Council.
Study coauthor Joel Lexchin reports a number of financial deals with various institutions. Moynihan, Checketts, and Vassar have disclosed no relevant financial relationships.
BMJ. Published online May 27, 2020. Full text, Editorial
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Cite this: ASCO Tops Medical Societies for Industry Payments - Medscape - May 29, 2020.