One of the things I like most about being a scientific researcher is the surprise that comes with unexpected findings. Our study on industry payments to influential medical leaders published today in The BMJ certainly brought a few surprises for me, and some unexpected good news.
Our research team used the United States government’s amazing Open Payments database, which publishes details of almost all payments to doctors from drug and device companies. These payments, also called transfers of value, can range from a $10 meal to a $10 000 consultancy to a $10 million research grant.
We investigated industry payments to recent leaders of 10 influential professional medical associations, such as the American College of Cardiology and the American Psychiatric Association. We focused on these groups because they hold enormous power in the US and globally, often funding research, running medical education, and producing clinical guidelines. Importantly they can also play a role in setting definitions of disease and thresholds for diagnosis, which determine whether you are defined as healthy or sick.
The most surprising finding from our study was this: for some of these powerful medical associations, their board members were generally receiving almost nothing from pharmaceutical or device companies. Over five years or so, the leaders of the American College of Physicians each received a median of just $404, in total. The figure for the psychiatrists’ association board was only $212 each.
This was particularly surprising for psychiatrists. As readers may remember, it was the high levels of entanglement between some psychiatrists and drug companies revealed in US congressional hearings over ten years ago which helped produce the bi-partisan Sunshine Act and the new Open Payments database, to help clean up the mess of undue industry influence in medicine.
The other key surprise in our findings was the total amount of payments which flowed from industry to the 330 leaders of the 10 medical associations over the time period we looked at. It was a whopping US$130 million. And that is an underestimate because data were not yet available for some years for the most recent leadership.
We also unexpectedly found enormous variation in the total amounts of dollars flowing to leaders across the 10 organisations. Total payments linked to board members of the American Society of Clinical Oncology, largely for research, were over $55 million for the years we looked at. Total payments for the American Thoracic Society leadership was under $4 million.
Of course, there are differing views on the appropriateness of influential leaders having such extensive ties to industry. A common argument is that the best and brightest doctors will have these ties because they’re the ones industry seeks to work with. Another related argument is that a doctor’s decision about which drug to prescribe, or their conclusions about a study they have run, are unaffected by the company sponsoring their education or research.
While I respect those views, I feel they fly in the face of a mountain of evidence that these financial conflicts of interest can and do distort medical research, education, and practice. This is not just an academic concern. This influence contributes to a medical culture that overstates treatment benefits, downplays harms, and labels far too many healthy people.
Like others I think the role of these medical leaders is so vital in setting the tone of medical culture, they should be entirely free of financial ties to industry. And like others I feel the time is long overdue to start taking pathways to more independence from commercial interests in healthcare, which is the focus of a current BMJ themed collection and a call to action which you can sign.
Almost 20 years ago, The BMJ ran a similar themed collection which included a two-part series titled “Who Pays for the Pizza?,” which I wrote when I was an investigative journalist living in Washington D.C.
The bad news is that all these years later drug companies are still paying for an awful lot of doctors’ pizza, and a lot more besides.
The surprising good news is that quite a few leaders of powerful medical associations have started to change their dietary habits.
Ray Moynihan is an Assistant Professor at Bond University’s Institute for Evidence-Based Healthcare, and honorary Associate Professor at the University of Sydney.
Competing interests: None declared.