Disclosure-in the blink of an eye

Financial Conflicts of Interest: Payment at the Expense of Patients?

This provocative editorial proposes four steps that can be immediately implemented to reduce the impact of financial conflicts of interest in oncology without stifling collaboration.

An urgent call to raise the bar in oncology

Important breakthroughs in medical treatments have improved outcomes for patients suffering from several types of cancer. However, many oncological treatments approved by regulatory agencies are of low value and do not contribute significantly to cancer mortality reduction, but lead to unrealistic patient expectations and push even affluent societies to unsustainable health care costs. Several factors that contribute to approvals of low-value oncology treatments are addressed, including issues with clinical trials, bias in reporting, regulatory agency shortcomings and drug pricing. With the COVID-19 pandemic enforcing the elimination of low-value interventions in all fields of medicine, efforts should urgently be made by all involved in cancer care to select only high-value and sustainable interventions. Transformation of medical education, improvement in clinical trial design, quality, conduct and reporting, strict adherence to scientific norms by regulatory agencies and use of value-based scales can all contribute to raising the bar for oncology drug approvals and influence drug pricing and availability.

[Observational study of links of interest disclosure at the Congress of General Medicine France and links of interest of French physicians attending]

INTRODUCTION

Medical opinion leaders represent a marketing tool whose effectiveness is well documented in France and worldwide. They are less distrusted than pharmaceutical representatives, but this trust declines when they declare their ties. In France, the public database "Transparence-Santé" presents the financial ties of each professional with the health industries since 2012. These ties must be declared at the beginning of any public intervention since 2002 to improve the transparency of healthcare stakeholders.

OBJECTIVES

This study assessed the compliance with the obligation to disclose conflicts of interests at the Congress of General Medicine France 2020. Its secondary objective was to assess the financial ties of French physicians attending the congress using the data listed in "Transparence-Santé" through the Eurosfordocs project.

METHOD

Prospective cross-sectional observational study of all the interventions available on the congress' internet platform. All speakers, making either an oral or a written and commented presentation, who must declare their conflicts of interest, were included. A descriptive analysis of "Transparence-Santé" data was carried out for the doctors attending the congress.

RESULTS

Among 253 interventions, 34% complied with the disclosure requirement. The doctors participating in symposiums links of interests represented 92% of the global amount of congress' links of interests, with an average of 11,2k€/year, significantly higher than the 126€/year of other physicians.

CONCLUSION

The legal obligation to declare one's conflict of interest at congresses is little respected in France. Involvement of the organizers and using pre-established disclosure formats would improve transparency. It is necessary to develop the independence of speakers to improve research and medical expertise.