1
|
Murayama A, Kugo H, Kamamoto S. Evaluation of non-research and research industry payments to pediatric hematologist/oncologists in the United States between 2013 and 2021. Leuk Lymphoma 2024; 65:774-782. [PMID: 38349842 DOI: 10.1080/10428194.2024.2317344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 02/06/2024] [Indexed: 02/15/2024]
Abstract
Financial interactions between healthcare industry and pediatric hematologist/oncologists (PHOs) could be conflicts of interest. Nevertheless, little is known about financial relationships between healthcare industry and PHOs. This cross-sectional analysis of the Open Payments Database examined general and research payments to PHOs from healthcare industry in the United States between 2013 and 2021. Payments to the PHOs were analyzed descriptively. Trends in payments were assessed using generalized estimating equation models. Of 2784 PHOs, 2142 (76.9%) PHOs received payments totaling $187.3 million from the healthcare industry between 2013 and 2021. Approximately, $46.3 million (24.8%) were general payments and $137.7 million (73.5%) were funding for research where PHOs served as principal investigators (associated research funding). Both general payments and associated research funding considerably increased between 2014 and 2019. The number of PHOs receiving general payments and associated research funding annually increased by 2.2% (95% CI: 1.2-3.3%, p < .001) and 5.0% (95% CI: 3.3-6.8%, p < .001) between 2014 and 2019, respectively.
Collapse
Affiliation(s)
- Anju Murayama
- School of Medicine, Tohoku University, Sendai City, Japan
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Hinari Kugo
- School of Medicine, Tohoku University, Sendai City, Japan
| | - Sae Kamamoto
- Hamamatsu University School of Medicine, Hamamatsu, Japan
| |
Collapse
|
2
|
Guan ML, Pillinger MH, Abeles AM. Accuracy of Financial Disclosures in US-Based Rheumatology Journals. Arthritis Care Res (Hoboken) 2024; 76:304-309. [PMID: 37522281 DOI: 10.1002/acr.25211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/07/2023] [Accepted: 07/19/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE Transparency of disclosure in publication is necessary for readers to be aware of any potential conflicts of interest (PCOIs). Past studies of accuracy of disclosure in rheumatology journals have focused exclusively on clinical practice guidelines and not research works. We assessed discrepancy in reporting PCOIs in clinically oriented manuscripts published in the three top-ranked (by impact factor) US-based general rheumatology journals. METHODS We reviewed disclosures provided by first, second, and last authors of 50 published clinically oriented articles in each of the three top-ranked general US rheumatology journals. For each author, we extracted payment reports from the Open Payments Database (OPD) related to consulting fees, honoraria, and speaker or faculty compensation. We defined a PCOI as a payment received from a company with an ongoing clinical trial or a medication on the market related to the manuscript's subject matter within the 36 months before the online publication date. We additionally analyzed each author individually to determine whether their reported disclosures matched PCOIs from the OPD. RESULTS Of 150 articles analyzed, 101 included authors with PCOIs. Ninety-two of these 101 publications (92%) contained inaccurate (non- or under-) disclosures. Among 135 authors with PCOIs, 118 reported inaccurately (87%). All 14 articles that published clinical trial results (and all 23 of their qualifying authors) had disclosure inaccuracies. CONCLUSION Inaccurate financial disclosure by authors remains an issue in clinically oriented research studies reported in top rheumatology journals. Improved community education and firmer expectations would permit readers to better assess any possible impact of PCOIs on publications.
Collapse
Affiliation(s)
- Mary L Guan
- New York University Grossman School of Medicine, New York City
| | - Michael H Pillinger
- New York University Grossman School of Medicine and US Department of Veterans Affairs, New York City
| | - Aryeh M Abeles
- New York University Grossman School of Medicine, New York City
| |
Collapse
|
3
|
Schäffer A, Groh KJ, Sigmund G, Azoulay D, Backhaus T, Bertram MG, Carney Almroth B, Cousins IT, Ford AT, Grimalt JO, Guida Y, Hansson MC, Jeong Y, Lohmann R, Michaels D, Mueller L, Muncke J, Öberg G, Orellana MA, Sanganyado E, Schäfer RB, Sheriff I, Sullivan RC, Suzuki N, Vandenberg LN, Venier M, Vlahos P, Wagner M, Wang F, Wang M, Soehl A, Ågerstrand M, Diamond ML, Scheringer M. Conflicts of Interest in the Assessment of Chemicals, Waste, and Pollution. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:19066-19077. [PMID: 37943968 DOI: 10.1021/acs.est.3c04213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Pollution by chemicals and waste impacts human and ecosystem health on regional, national, and global scales, resulting, together with climate change and biodiversity loss, in a triple planetary crisis. Consequently, in 2022, countries agreed to establish an intergovernmental science-policy panel (SPP) on chemicals, waste, and pollution prevention, complementary to the existing intergovernmental science-policy bodies on climate change and biodiversity. To ensure the SPP's success, it is imperative to protect it from conflicts of interest (COI). Here, we (i) define and review the implications of COI, and its relevance for the management of chemicals, waste, and pollution; (ii) summarize established tactics to manufacture doubt in favor of vested interests, i.e., to counter scientific evidence and/or to promote misleading narratives favorable to financial interests; and (iii) illustrate these with selected examples. This analysis leads to a review of arguments for and against chemical industry representation in the SPP's work. We further (iv) rebut an assertion voiced by some that the chemical industry should be directly involved in the panel's work because it possesses data on chemicals essential for the panel's activities. Finally, (v) we present steps that should be taken to prevent the detrimental impacts of COI in the work of the SPP. In particular, we propose to include an independent auditor's role in the SPP to ensure that participation and processes follow clear COI rules. Among others, the auditor should evaluate the content of the assessments produced to ensure unbiased representation of information that underpins the SPP's activities.
Collapse
Affiliation(s)
- Andreas Schäffer
- Institute for Environmental Research, RWTH Aachen University, 52074 Aachen, Germany
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, 210023 Nanjing, China
- Key Laboratory of the Three Gorges Reservoir Region's Eco-Environment, Chongqing University, 400045 Chongqing, China
| | - Ksenia J Groh
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, 8600 Dübendorf, Switzerland
| | - Gabriel Sigmund
- Environmental Technology, Wageningen University and Research, 6700 AA Wageningen, The Netherlands
| | - David Azoulay
- Center for International Environmental Law (CIEL), Washington, D.C. 20005, United States
| | - Thomas Backhaus
- Institute for Environmental Research, RWTH Aachen University, 52074 Aachen, Germany
- Department of Biological and Environmental Sciences, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Michael G Bertram
- Department of Wildlife, Fish, and Environmental Studies, Swedish University of Agricultural Sciences, Umeå 907 36, Sweden
- Department of Zoology, Stockholm University, Stockholm 114 18, Sweden
- School of Biological Sciences, Monash University, Melbourne 3800, Australia
| | - Bethanie Carney Almroth
- Department of Biological and Environmental Sciences, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Ian T Cousins
- Department of Environmental Science, Stockholm University, 10691 Stockholm, Sweden
| | - Alex T Ford
- Institute of Marine Sciences, University of Portsmouth, Portsmouth PO4 9LY, United Kingdom
| | - Joan O Grimalt
- Department of Environmental Chemistry, IDAEA-CSIC, 08034 Barcelona, Catalonia, Spain
| | - Yago Guida
- National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba 305-8506, Ibaraki, Japan
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, 21941-902 Rio de Janeiro, RJ, Brazil
| | - Maria C Hansson
- The Centre for Environmental and Climate Science (CEC), Lund University, 22362 Lund, Sweden
| | - Yunsun Jeong
- Division of Environmental Health, Korea Environment Institute (KEI), 30147 Sejong, Republic of Korea
| | - Rainer Lohmann
- Graduate School of Oceanography, University of Rhode Island, Narragansett, Rhode Island 02881, United States
| | - David Michaels
- Department of Environmental & Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, D.C. 20052, United States
| | - Leonie Mueller
- Institute for Environmental Research, RWTH Aachen University, 52074 Aachen, Germany
| | - Jane Muncke
- Food Packaging Forum Foundation, 8045 Zurich, Switzerland
| | - Gunilla Öberg
- University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Marcos A Orellana
- Global Toxics and Human Rights Project, American University Washington College of Law, Washington, D.C. 20016, United States
| | - Edmond Sanganyado
- Department of Applied Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, United Kingdom
| | - Ralf Bernhard Schäfer
- Institute for Environmental Sciences Landau, RPTU Kaiserslautern-Landau, 76829 Landau, Germany
| | - Ishmail Sheriff
- School of Civil Engineering, Universiti Sains Malaysia, 14300 Nibong Tebal, Penang, Malaysia
| | - Ryan C Sullivan
- Department of Chemistry and Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania 15217, United States
| | - Noriyuki Suzuki
- National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba 305-8506, Ibaraki, Japan
| | - Laura N Vandenberg
- Department of Environmental Health Sciences, School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts 01003, United States
| | - Marta Venier
- Indiana University, Bloomington, Indiana 47405, United States
| | - Penny Vlahos
- Marine Sciences, University of Connecticut, Groton, Connecticut 06340, United States
| | - Martin Wagner
- Department of Biology, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Fang Wang
- State Key Laboratory of Soil and Sustainable Agriculture, Institute of Soil Science, Chinese Academy of Sciences, Nanjing 210008, China
| | - Mengjiao Wang
- Greenpeace Research Laboratories, Department of Biosciences, University of Exeter, Exeter EX4 4RN, United Kingdom
| | - Anna Soehl
- International Panel on Chemical Pollution, 8044 Zürich, Switzerland
| | - Marlene Ågerstrand
- Department of Environmental Science, Stockholm University, 10691 Stockholm, Sweden
| | - Miriam L Diamond
- Department of Earth Sciences and School of the Environment, University of Toronto, Toronto M5S 3B1, Canada
| | - Martin Scheringer
- Institute of Biogeochemistry and Pollutant Dynamics, ETH Zürich, 8092 Zürich, Switzerland
- RECETOX, Masaryk University, 625 00 Brno, Czech Republic
| |
Collapse
|
4
|
Murayama A. Industry-Sponsored Research Funding to Rheumatologists in the United States Between 2014 and 2022. J Rheumatol 2023; 50:1510-1513. [PMID: 37582555 DOI: 10.3899/jrheum.2023-0417] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Affiliation(s)
- Anju Murayama
- School of Medicine, Tohoku University, Sendai City, Miyagi, Japan.
| |
Collapse
|
5
|
Ozieranski P, Martinon L, Jachiet PA, Mulinari S. Tip of the Iceberg? Country- and Company-Level Analysis of Drug Company Payments for Research and Development in Europe. Int J Health Policy Manag 2022; 11:2842-2859. [PMID: 35297231 PMCID: PMC10105170 DOI: 10.34172/ijhpm.2022.6575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 02/21/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Creating new therapies often involves drug companies paying healthcare professionals and institutions for research and development (R&D) activities, including clinical trials. However, industry sponsorship can create conflicts of interest (COIs). We analysed approaches to drug company R&D payment disclosure in European countries and the distribution of R&D payments at the country and company level. METHODS Using documentary sources and a stakeholder survey we identified country- regulatory approaches to R&D payment disclosure. We reviewed company-level descriptions of disclosure practices in the United Kingdom, a country with a major role in Europe's R&D. We obtained country-level R&D payment data from industry trade groups and public authorities and company-level data from eurosfordocs.eu, a publicly available payments database. We conducted content analysis and descriptive statistical analysis. RESULTS In 32 of 37 studied countries, all R&D payments were reported without named recipients, following a self-regulatory approach developed by the industry. The methodological descriptions from 125 companies operating in the United Kingdom suggest that within the self-regulatory approach companies had much leeway in deciding what activities and payments were considered as R&D. In five countries, legislation mandated the disclosure of R&D payment recipients, but only in two were payments practically identifiable and analysable. In 17 countries with available data, R&D constituted 19%-82% of all payments reported, with self-regulation associated with higher shares. Available company-level data from three countries with self-regulation suggests that R&D payments were concentrated by big funders, and some companies reported all, or nearly all, payments as R&D. CONCLUSION The lack of full disclosure of R&D payments in countries with industry self-regulation leaves considerable sums of money unaccounted for and potentially many COIs undetected. Disclosure mandated by legislation exists in few countries and rarely enhances transparency practically. We recommend a unified European approach to R&D payment disclosure, including clear definitions and a centralised database.
Collapse
Affiliation(s)
- Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | | | | | - Shai Mulinari
- Department of Sociology, Lund University, Lund, Sweden
| |
Collapse
|
6
|
van Bilsen MWT, Bartels RHMA. Influence of Industry in Hydrocephalus and Vertebral Augmentation Literature. World Neurosurg 2022; 161:350-353. [PMID: 35505554 DOI: 10.1016/j.wneu.2021.11.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate whether financial bias exists in hydrocephalus and vertebral augmentation literature. METHODS A systematic literature search was performed in PubMed of studies concerning vertebral augmentation and cerebrospinal fluid valves. The relationship between reported conflicts of interest and the nature of the conclusion (positive vs. neutral and negative) was analyzed. RESULTS Having a conflict of interest was significantly associated with reporting a positive conclusion in studies investigating valves for hydrocephalus (92.3% positive conclusion vs. 36.4%; P = 0.001), but not for cement augmentation studies (80.5% positive conclusion vs. 65.7%; P = 0.087). As studies concerning vertebral augmentation implants had only positive conclusions, no analysis could be performed. CONCLUSIONS Our findings suggest a positive relationship between reported conflict of interest and positive outcome in neurosurgical literature concerning cerebrospinal fluid valves.
Collapse
Affiliation(s)
- Martine W T van Bilsen
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Ronald H M A Bartels
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
7
|
Torgerson T, Wayant C, Cosgrove L, Akl EA, Checketts J, Dal Re R, Gill J, Grover SC, Khan N, Khan R, Marušić A, McCoy MS, Mitchell A, Prasad V, Vassar M. Ten years later: a review of the US 2009 institute of medicine report on conflicts of interest and solutions for further reform. BMJ Evid Based Med 2022; 27:46-54. [PMID: 33177167 DOI: 10.1136/bmjebm-2020-111503] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 01/17/2023]
Abstract
Conflicts of interest (COIs) in healthcare are increasingly discussed in the literature, yet these relationships continue to influence healthcare. Research has consistently shown that financial COIs shape prescribing practices, medical education and guideline recommendations. In 2009, the Institute of Medicine (IOM, now the National Academy of Medicine) published Conflicts of Interest in Medical Research, Practice, and Education-one of the most comprehensive reviews of empirical research on COIs in medicine. Ten years after publication of theIOM's report, we review the current state of COIs within medicine. We also provide specific recommendations for enhancing scientific integrity in medical research, practice, education and editorial practices.
Collapse
Affiliation(s)
- Trevor Torgerson
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Cole Wayant
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Lisa Cosgrove
- Department of Counseling Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Jake Checketts
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Rafael Dal Re
- Epidemiology Unit, Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad, Autónoma de Madrid, Madrid, Spain
| | - Jennifer Gill
- Division of Hematology Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Samir C Grover
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Gastroenterology, St Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Nasim Khan
- Division of Rheumatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Rishad Khan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Gastroenterology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Ana Marušić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Matthew S McCoy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aaron Mitchell
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vinay Prasad
- Division of Hematology Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Senior Scholar in the Center for Health Care Ethics, Oregon Health & Science University, Portland, Oregon, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| |
Collapse
|
8
|
Elsolh K, Tham D, Scaffidi MA, Gimpaya N, Bansal R, Torabi N, Li J, Verma Y, Khan R, Grover SC. OUP accepted manuscript. J Can Assoc Gastroenterol 2022; 5:214-220. [PMID: 36196272 PMCID: PMC9527658 DOI: 10.1093/jcag/gwac018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Propensity score matching (PSM), a statistical technique that estimates a treatment effect by accounting for predictor covariates, has been used to evaluate biologics for inflammatory bowel disease (IBD). Financial conflicts of interest are prevalent in the marketing of biologic medications. It is unclear whether this burden of conflicts is present among authors of PSM studies comparing IBD biologics and biosimilars. Objective This study was aimed to determine the prevalence of financial conflicts of interest among authors of PSM studies evaluating IBD biologics and biosimilars. Methods We conducted a systematic search for PSM studies comparing biologics and biosimilars in IBD treatment. We identified 21 eligible studies. Two independent authors extracted self-declared conflicts from the disclosures section. Each participating author was searched on the Centers for Medicare & Medicaid Services Open Payments to identify payment amounts and undisclosed conflicts. Primary outcome was the prevalence of author conflicts. Secondary analyses assessed for an association between conflict prevalence and reporting of positive outcomes. Results Among 283 authors, conflicts were present among 41.0% (116 of 283). Twenty-three per cent (27 of 116) of author conflicts involved undisclosed payments. Studies with positive outcomes were significantly more likely to include conflicted authors than neutral studies (relative risk = 2.34, 95% confidence interval: 1.71 to 3.21, P < 0.001). Conclusions Overall, we found a high burden of undisclosed conflicts among authors of PSM studies comparing IBD biologics and biosimilars. Given the importance of PSM studies as a means for biologic comparison and the potential for undue industry influence from these payments, authors should ensure greater transparency with reporting of industry relationships.
Collapse
Affiliation(s)
- Karam Elsolh
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Tham
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael A Scaffidi
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
- Faculty of Health Sciences, School of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Nikko Gimpaya
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rishi Bansal
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nazi Torabi
- Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Juana Li
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Yash Verma
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rishad Khan
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Samir C Grover
- Correspondence: Samir C. Grover, MD, MEd, FRCPC, Division of Gastroenterology, St. Michael’s Hospital, Department of Medicine, University of Toronto, 30 Bond Street, 16-046 Cardinal Carter Wing, Toronto, Ontario M5B 1W8, Canada, e-mail:
| |
Collapse
|
9
|
Putman MS, Goldsher JE, Crowson CS, Duarte-García A. Industry Payments to Practicing US Rheumatologists, 2014-2019. Arthritis Rheumatol 2021; 73:2138-2144. [PMID: 34164951 DOI: 10.1002/art.41896] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/08/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Payments from the pharmaceutical industry to practicing physicians may influence prescribing behavior. The objective of this study was to investigate the nature, quantity, and geographical distribution of payments to US rheumatologists. METHODS General payments from industry sponsors to US rheumatologists from 2014-2019 were extracted from the Centers for Medicare & Medicaid Services (CMS) Open Payments database. Gender was identified by linking physicians to the National Plan and Provider Enumeration System (NPPES) registry. Data were reported in aggregate, trends over time were assessed using linear regression models, and differences by gender were analyzed using the Wilcoxon rank-sum test. RESULTS Over the six-year time period from 2014-2019, a total of $221,254,966 from 1,610,668 payments were made to 5,723 rheumatologists. The median payment was $15 (interquartile range (IQR) $10 - $22) and the median amount of payments received by individual rheumatologists was $2,818 (IQR $464 to $11,560). The majority of rheumatologists (3,416/5,723, 59%) received under $5,000, but 368/5,723 (6%) received over $100,000 each and accounted for 78% of the total. The yearly value of payments increased over time ($3,703,264 per year, p < 0.001) and the median payment to male rheumatologists was significantly higher than the median payment to female rheumatologists ($3,732, IQR $542-$15,841 vs. $2,084, IQR $394-$8,186, p < 0.001). CONCLUSIONS The value of industry payments have increased over time and are concentrated among a small number of rheumatologists. Future studies should investigate the degree to which industry payments have influenced prescribing in the field of rheumatology.
Collapse
Affiliation(s)
- Michael S Putman
- Division of Rheumatology, Department of Medicine, Medical College of Wisconsin, Wisconsin, WI, USA
| | | | - Cynthia S Crowson
- Department of Quantitative Health Sciences and Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Alí Duarte-García
- Division of Rheumatology and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
10
|
Ji YD, Harris JA, Gibson LE, McKinley SK, Phitayakorn R. The Efficacy of Liposomal Bupivacaine for Opioid and Pain Reduction: A Systematic Review of Randomized Clinical Trials. J Surg Res 2021; 264:510-533. [PMID: 33862580 DOI: 10.1016/j.jss.2021.02.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/04/2021] [Accepted: 02/27/2021] [Indexed: 12/22/2022]
Abstract
Background The opioid crisis has prompted surgeons to search for alternative postoperative methods of analgesia. Liposomal bupivacaine is a long-acting local anesthetic formulation used for pain, potentially reducing opioid use. Evaluation of liposomal bupivacaine as a viable alternative for pain management is needed. The objective was to assess the efficacy of randomized clinical trials (RCTs) of liposomal bupivacaine in postoperative pain management and opioid consumption. Material and Methods The authors extracted RCTs comparing liposomal bupivacaine versus placebo or active comparators for postoperative pain or opioid reduction from PubMED/MEDLINE, Cochrane Library, and ClinicalTrials.gov. Exclusion criteria included nonhuman studies, non-RCTs, pooled studies, and inability to access full text. The following variables were abstracted: surgical specialty, number of subjects, pain and opioid outcomes, and authors' financial conflicts of interest. Results We identified 77 published RCTs, of which 63 studies with a total of 6770 subjects met inclusion criteria. Liposomal bupivacaine did not demonstrate significant pain relief compared to placebo or active agents in 74.58% of RCTs. Of the studies evaluating narcotic use, liposomal bupivacaine did not show a reduction in opioid consumption in 85.71% of RCTs. Liposomal bupivacaine, when compared to standard bupivacaine or another active agent, yielded no reduction in opioid use in 83.33% and 100.00% of studies, respectively. Clinical trials with a financial conflict of interest relating to the manufacturer of liposomal bupivacaine were significantly more likely to show pain relief (OR: 14.31 [95% CI, 2.8, 73.10], P = 0.0001) and decreased opioid consumption (OR: 12.35 [95% CI 1.40, 109.07], P = 0.0237). Of the 265 unpublished RCTs on ClinicalTrials.gov, 47.54% were withdrawn, terminated, suspended, or completed without study results available. Conclusions The efficacy of liposomal bupivacaine for providing superior postoperative pain control relative to placebo or another active agent is not supported by a majority of RCTs. Underreporting of trial results and bias due to underlying financial relationships amongst authors are two major concerns that should be considered when evaluating the available evidence.
Collapse
Affiliation(s)
| | | | - Lauren E Gibson
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Roy Phitayakorn
- Harvard Medical School, General and Endocrine Surgery, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
11
|
Abstract
Enormous progress has been made in the field of rheumatology in the past several decades, historically led by publicly funded academic innovators but in more recent times with much greater involvement of the pharmaceutical industry. This shift in resources has created a complex new model for reinvestment in the medical community in which the vast majority of private funds are redirected towards influencing the prescription behaviour of practitioners through 'key opinion leaders', with the main purpose of enhancing and perpetuating profit rather than innovation and critical thinking, and often at the expense of partnerships with scientists (that is, basic and translational researchers) and academic collaborations. This new episteme brings multiple opportunities to rethink approaches to sustaining long-term critical research in the field, ultimately maximizing the return on investment: scientific knowledge for the benefit of patients and society. Central to such strategies should be the rebalancing of academia-industry partnerships towards academic research and the involvement of 'innovation and knowledge leaders', rather than mostly key opinion leaders.
Collapse
Affiliation(s)
- Jose U Scher
- Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, NY, USA.
| | - Georg Schett
- Department of Internal Medicine, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, Erlangen, Germany.
| |
Collapse
|
12
|
Relationships among commercial practices and author conflicts of interest in biomedical publishing. PLoS One 2020; 15:e0236166. [PMID: 32706798 PMCID: PMC7380625 DOI: 10.1371/journal.pone.0236166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/30/2020] [Indexed: 11/29/2022] Open
Abstract
Recently, concerns have been raised over the potential impacts of commercial relationships on editorial practices in biomedical publishing. Specifically, it has been suggested that certain commercial relationships may make editors more open to publishing articles with author conflicts of interest (aCOI). Using a data set of 128,781 articles published in 159 journals, we evaluated the relationships among commercial publishing practices and reported author conflicts of interest. The 159 journals were grouped according to commercial biases (reprint services, advertising revenue, and ownership by a large commercial publishing firm). 30.6% (39,440) of articles were published in journals showing no evidence of evaluated commercial publishing relationships. 33.9% (43,630) were published in journals accepting advertising and reprint fees; 31.7% (40,887) in journals owned by large publishing firms; 1.2% (1,589) in journals accepting reprint fees only; and 2.5% (3,235) in journals accepting only advertising fees. Journals with commercial relationships were more likely to publish articles with aCOI (9.2% (92/1000) vs. 6.4% (64/1000), p = 0.024). In the multivariate analysis, only a journal’s acceptance of reprint fees served as a significant predictor (OR = 2.81 at 95% CI, 1.5 to 8.6). Shared control estimation was used to evaluate the relationships between commercial publishing practices and aCOI frequency in total and by type. BCa-corrected mean difference effect sizes ranged from -1.0 to 6.1, and confirm findings indicating that accepting reprint fees may constitute the most significant commercial bias. The findings indicate that concerns over the influence of industry advertising in medical journals may be overstated, and that accepting fees for reprints may constitute the largest risk of bias for editorial decision-making.
Collapse
|
13
|
Wayant C, Walters C, Zaaza Z, Gilstrap C, Combs T, Crow H, Vassar M. Evaluation of Financial Conflicts of Interest Among Physician-Authors of American College of Rheumatology Clinical Practice Guidelines. Arthritis Rheumatol 2020; 72:1427-1434. [PMID: 32039569 DOI: 10.1002/art.41224] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 02/04/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Clinical practice guidelines (CPGs) underpin patient care, and ideally authors of these guidelines would be free from outside influence. However, it has been shown many times that authors of professional society CPGs receive large sums of money from industry drug companies, creating financial conflicts of interest. This study investigated industry payments catalogued in the Open Payments Database (OPD) that have been received by authors of the American College of Rheumatology (ACR) CPGs. METHODS Guidelines on the ACR web site that were published during or after August 2014 were used to retrieve the list of authors. All general, research, associated research, and ownership payments reported on the OPD between the date of publication of the CPG and 12 months prior were extracted in a parallel and blinded manner by 2 investigators. RESULTS Of the 89 US-based physician-authors from the 5 ACR CPGs identified within the study timeframe, 56 (62.9%) had received at least 1 payment according to OPD records. These 56 authors had received a median of $522 (interquartile range $119-2,500), which, combined, was a total of $9,728,751. Nineteen authors had received at least 1 industry payment relevant to the CPG recommendations, for a median amount of $748 and a total of $1,961,362 in relevant payments. Of the total relevant payments received, a significant proportion was undisclosed (for ACR CPGs during or after August 2014, undisclosed payments were $699,561, or 35.7% of the total). CONCLUSION Fewer than one-half of the US-based physician-authors of ACR CPGs during or after August 2014 had received guideline-relevant industry payments. Nonetheless, a substantial proportion of the money received was not disclosed. Conflict of interest disclosure is a bare minimum requirement, and more permanent solutions may include divestiture or inclusion of more nonconflicted authors.
Collapse
Affiliation(s)
- Cole Wayant
- Oklahoma State University Center for Health Sciences, Tulsa
| | - Corbin Walters
- Oklahoma State University Center for Health Sciences, Tulsa
| | - Zachary Zaaza
- Oklahoma State University Center for Health Sciences, Tulsa
| | | | - Tyler Combs
- Oklahoma State University Center for Health Sciences, Tulsa
| | - Hanna Crow
- Oklahoma State University Medical Center, Tulsa
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa
| |
Collapse
|
14
|
Affiliation(s)
- Jake Checketts
- Department of Orthopedic Surgery, Oklahoma State University Center for Health Sciences, Tulsa, OK 74107, US
- Department of Psychiatry, Oklahoma State University Center for Health Sciences, US
| | - Matt Vassar
- Department of Psychiatry, Oklahoma State University Center for Health Sciences, US
| |
Collapse
|