A BRITISH MEDICAL JOURNAL STUDY reveals that almost three quarters of leaders of influential medical groups have financial ties to industry.
Payments to them totalled almost $130m, with an average $31,000 per leader.
Some organisations will require major reform to restore public trust, say experts.
The results show that up to 80% of the US-based medical doctors who lead influential professional medical associations had financial relationships with industry, and that during 2017-19, leaders of 10 influential groups received almost $130m from industry over about a five year period.
Although there was considerable variation among associations, these findings raise questions about independence and integrity, adding weight to calls for policy reform, say the researchers.
Evidence exists of extensive financial ties between health professionals and industry across many areas of healthcare, and calls for more independence from industry in production and use of evidence are growing.
But there is a lack of information on the extent of financial ties among leaders of medical associations and societies that are influential across research, education, and practice, including guideline development.
So a team of researchers set out to investigate the financial relationships between pharmaceutical and device manufacturers and the leaders of influential US professional medical associations that represent and educate doctors working across the most common and costly diseases areas.
These included heart disease, mental disorders, diabetes, osteoarthritis, cancer, chronic lung disease and asthma, back problems and infectious diseases.
They asked peers in each of the disease areas to name the key associations run by doctors for doctors, and then used publicly available documents to identify members of the boards or governing councils of those organisations.
They then searched the US government’s Open Payments database for details of those leaders’ financial relationships with companies making drugs and medical devices for their current year of board membership, and the four years before and one year after membership.
They found that 235 of 328 leaders (72%) had financial ties to industry. Among 293 leaders who were medical doctors or doctors of osteopathy, 235 (80%) had ties.
Total payments for 2017-19 leadership were almost $130m (£103m; 119m euros), with a median amount for each leader of $31,805.
However, there was considerable variation among the associations, with median amounts ranging from $212 for leaders of the American Psychiatric Association to $518,000 for the American Society of Clinical Oncology.
The largest research payments flowed to leaders of the American Society of Clinical Oncology ($54m) and the American College of Cardiology ($21m).
The largest general payments – which can include fees for consultancy, speaking, royalties and hospitality – were given to leaders of the North American Spine Society ($9.5m) and the Orthopaedic Trauma Association ($4.7m).
The researchers point to some limitations, which may have affected the accuracy and generalisability of their findings.
Nevertheless, they say a complete set of payments is not yet available for leaders in 2018 and 2019, suggesting these results could be an underestimate of the total amount of payments.
As such, they support recommendations that doctors’ groups and their guideline writers become free of financial relationships with industry.
‘Our study’s novel findings of enormous variation in the extent of these ties suggest that for some groups such independence will require time and major reform, whereas for others it will be quick and relatively easy,’ they conclude.
‘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,’ says lead author Dr Ray Moynihan, Assistant Professor at Bond University in Australia, who researches the problem of over diagnosis.
‘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 says.
These findings suggest that tackling financial conflicts of interest in medicine cannot rely on a ‘cookie cutter’ approach for all specialties and associations, say researchers based at Oklahoma State University in a linked editorial.
They propose several actions, such as each association reviewing present conflicts and altering recruitment processes ‘to yield balanced and diverse groups of physician leaders largely free from financial conflicts of interest.’
They also call for greater reliance on resources like the Sunshine Act and Open Payments to help eliminate the need for the traditional ‘honour system’ of financial self-disclosure, which they say is ineffective and inaccurate at best.
‘These steps could mitigate or even eliminate the overwhelming presence of financial conflicts of interest among medical societies and associations,’ they write.
‘This would protect these groups from producing biased documents or policies, which in turn would protect all physicians and the patients they treat.’
- Nine weeks after Governor Andrew Cuomo closed all but essential businesses and services, many of the state’s essential workers are now finding themselves struggling with their employers and insurance companies for injury benefits related to Covid-19, and for those who die, their survivors are left to pick up the mantle.
Infected front-line staff, from health-care workers to grocery store clerks, are being asked to prove they contracted the virus on the job in order to receive workers’ compensation and death benefits, union leaders and elected officials say.
In some cases, insurance companies are asking nurses to identify which patient may have exposed them to the virus or when they had a breach of personal protective equipment, the officials said.
‘There was an assumption that the employers were doing the right thing, that they were considering this a workplace illness because it was pretty obvious that all essential workers, to have to be out there while we were all sheltered in place, of course were exposed,’ Pat Kane, executive director of the New York State Nurses Association, said in an interview.
‘Certainly in the nurses’ case, there is a sign on the door that says “This patient has Covid,” and you know you are going to be doing procedures that put you at risk. That’s your job.’
According to labour and elected officials, under the state’s workers’ compensation law, the burden falls on the employee to show they contracted the virus at work and not elsewhere, leaving first responders to pinpoint the specific circumstances in which they might have been exposed – a monumental task in a pandemic, they say, and harder still for survivors of the deceased.
Labour unions, including NYSNA (New York State Nurses Association) and the New York State AFL-CIO, have called unsuccessfully on the New York State Workers’ Compensation Board to acknowledge Covid-19 as an ‘occupational disease’ for front-line workers, which they say would create the presumption that they contracted it as part of the hazards of the workplace.
The unions are now eying a bill in the State Legislature that would add the virus directly to the law, removing a significant administrative hurdle to workers receiving benefits.
The provision would mean employees in workplaces with a documented outbreak would be eligible to receive salary, healthcare, and survivors’ benefits for Covid-related illness unless it could be proven that they contracted the virus in the community.
- Dental Assistants from Union Community Health Center (UCHC) in the Bronx, which is affiliated with nearby St. Barnabas Hospital (SBH) rallied today to celebrate their reinstatement and press St. Barnabas for #CrisisPay.
The UCHC dental assistants were sent to St. Barnabas when their clinic closed in the surge of the COVID-19 crisis. Instead of being assigned work for which they were appropriately trained, they were given tasks far beyond their scope of work, including working with psychiatric patients and moving dead bodies. When they complained, St. Barnabas management sent them home.
After three weeks of pressure from Union representatives and delegates, SBH reinstated the workers with full back pay.