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Pharma funding of patient organisations. Drug Ther Bull 2024:dtb-2024-000060. [PMID: 39389761 DOI: 10.1136/dtb.2024.000060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
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Somers AMJ, Duits AJ, Samson MJ, Schnog JJB. Pharmaceutical company funding of cancer patient advocacy organizations in the Netherlands. J Cancer Policy 2024; 41:100493. [PMID: 38876202 DOI: 10.1016/j.jcpo.2024.100493] [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: 01/20/2024] [Revised: 05/26/2024] [Accepted: 06/10/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Financial conflicts of interest (FCOI) of medical professionals and associated organizations with pharmaceutical companies (pharma) might contribute to the use of low value oncological treatments. Value criteria for oncological drug approvals in the Netherlands have recently become more stringent leading to objections by cancer patient advocacy organizations (cPAOs). Considering the importance of cPAOs input in cancer patient care we analyzed whether pharma funding of cPAOs occurs in the Netherlands. METHODS The cPAO websites and available annual reports were evaluated for disclosure of pharma funding for the years 2021 and 2022. Also, data from the Dutch Healthcare Transparency Registry (DHTR) were extracted. RESULTS Twenty-one of 34 (61.8 %) cPAOs received pharma funding (with 20 registered in the DHTR), and for 13 (29.4 %) cPAOs no reporting of pharma funding could be found. Three of the cPAOs disclosed pharma funding directly on their main website. Online educational material was available from 22 cPAOs on their websites with pharma funding disclosed on the educational material in 5. The total registered amount of pharmaceutical funding was €667,232.00 in 2021 and €536,098.00 in 2022. The median (and interquartile ranges) DHTR registered amount of support per cPAO that received funding in the studied period was €23,799.50 (14,823.75-84,663.30). The most common funding category as defined in the DHTR was project sponsorship. CONCLUSIONS Financial support by the pharmaceutical industry is common for Dutch cPAOs. Given the importance of cPAOs and their objective input in the societal debate on the availability of cancer drugs, the potential influence of pharma sponsoring should be critically evaluated.
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Affiliation(s)
- Anne M J Somers
- Department of Hematology-Medical Oncology, Curaçao Medical Center, J.H.J. Hamelbergweg, Willemstad, Curaçao
| | - Ashley J Duits
- Curaçao Biomedical & Health Research Institute, Pater Eeuwensweg 36, Willemstad, Curaçao; Department of Medical Education, Curaçao Medical Center, J.H.J. Hamelbergweg, Willemstad, Curaçao; Institute for Medical Education, University Medical Center Groningen, Hanzeplein 1, the Netherlands; Red Cross Blood Bank Foundation, Pater Eeuwensweg 36, Willemstad, Curaçao
| | - Michael J Samson
- Department of Radiation Oncology, Curaçao Medical Center, J.H.J. Hamelbergweg, Willemstad, Curaçao.
| | - John-John B Schnog
- Department of Hematology-Medical Oncology, Curaçao Medical Center, J.H.J. Hamelbergweg, Willemstad, Curaçao; Curaçao Biomedical & Health Research Institute, Pater Eeuwensweg 36, Willemstad, Curaçao.
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Gentilini A, Miraldo M. The role of patient organisations in research and development: Evidence from rare diseases. Soc Sci Med 2023; 338:116332. [PMID: 37866173 DOI: 10.1016/j.socscimed.2023.116332] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/27/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023]
Abstract
Patient organisations play an increasingly crucial role in the pharmaceutical sector, yet their impact on innovation remains unexplored. We estimate the impact of patient organisations on R&D activity in the context of rare diseases in Europe using a proprietary dataset that maps clinical trials from discovery to phase III across 29 countries, 1893 indications, and 30 years (1990-2019). By applying difference-in-differences and event study methodologies to a panel of 1,646,910 unique R&D observations, we find that country-indication pairs with at least one operating patient organisation have a higher rate of R&D activity compared to those without, with stronger effect in more prevalent rare diseases compared to ultra-rare conditions. We observe a lag in effects from patient organisation introduction, suggesting it takes approximately five years for these organisations to affect R&D activity. Overall, our work suggests that patient organisations play an important role in steering R&D efforts in rare diseases. Further research is needed to better understand mechanisms driving this effect and the potential impact of patient organisations on existing health inequities.
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Affiliation(s)
- Arianna Gentilini
- Department of Health Policy, London School of Economics and Political Science, London, UK.
| | - Marisa Miraldo
- Department of Economics and Public Policy, Centre for Health Economics and Policy Innovation, Imperial College Business School, Imperial College London, London, UK
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Ozieranski P, Saghy E, Mulinari S. Pharmaceutical industry payments to NHS trusts in England: A four-year analysis of the Disclosure UK database. PLoS One 2023; 18:e0290022. [PMID: 37910526 PMCID: PMC10619808 DOI: 10.1371/journal.pone.0290022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 07/21/2023] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION Although hospitals are key health service providers, their financial ties to drug companies are little understood. We examine non-research pharmaceutical industry payments to English National Health Service (NHS) trusts-hospital groupings providing secondary and tertiary care. METHODS We extracted data from the industry-run Disclosure UK database, analysing it descriptively and using the Jonckheere-Terpstra test to establish whether a statistically significant time trend existed in the median values of individual payments. We explained payment value and number per trust with random effects models, using selected trust characteristics as predictors. RESULTS Drug companies reported paying £60,253,421 to 234 trusts, representing between 90.0% and 92.0% of all trusts in England between 2015 and 2018. As a share of payments to all healthcare organisations, the number of payments rose from 38.6% to 39.5%, but their value dropped from 33.0% to 23.6%. The number of payments for fees for service and consultancy and contributions to costs of events increased by 61.5% and 29.4%. The median payment value decreased significantly for trusts overall (from £2,250.8 to £1,758.5), including those with lower autonomy from central government; providing acute services; and from half of England's regions. The random effects model showed that acute trusts received significantly more money on average than trusts with all other service profiles; and trusts from East England received significantly less than those from London. However, trusts enjoying greater autonomy from government did not receive significantly more money than others. Trusts also received significantly less money in 2018 than in 2015. CONCLUSION NHS trusts had extensive pharmaceutical industry ties but were losing importance as payment targets relative to other healthcare organisations. Industry payment strategies shifted towards events sponsorship, consultancies, and smaller payments. Trusts with specific service and geographical profiles were prioritised. Understanding corporate payments across the health system requires more granular disclosure data.
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Affiliation(s)
- Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Bath, United Kingdom
| | - Eszter Saghy
- Division of Pharmacoeconomics, Faculty of Pharmacy, University of Pecs, Pecs, Hungary
| | - Shai Mulinari
- Department of Sociology, Lund University, Lund, Sweden
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Gentilini A, Parvanova I. Industry funding of patient organisations in the UK: a retrospective study of commercial determinants, funding concentration and disease prevalence. BMJ Open 2023; 13:e071138. [PMID: 37369404 PMCID: PMC10410975 DOI: 10.1136/bmjopen-2022-071138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES To assess the relationship between UK-based patient organisation funding and companies' commercial interests in rare and non-rare diseases in 2020. DESIGN Retrospective analysis of the value and volume of payments from pharmaceutical companies to patient organisations in the UK matched with data on the conditions supported by patient organisations and drugs in companies' approved portfolios and research and development pipelines. SETTING UK. PARTICIPANTS 74 pharmaceutical companies making payments to 341 UK-based patient organisations. MAIN OUTCOME MEASURES Alignment between the commercial interests of pharmaceutical companies and the disease area focus of patient organisations; difference in the volume and value of payments to patient organisations broken down by prevalence of conditions; industry funding concentration, measured as the number of companies funding each patient organisation, the share of overall industry funding coming from each contributing company and the share of industry funding of each organisation comprised by the single highest payments. RESULTS 1422 payments were made by 74 companies to 341 patient organisations. Almost all funds (90%) from pharmaceutical companies were directed to patient organisations that are aligned with companies' approved drug portfolios and research and development pipelines. Despite rare diseases affecting less than 5% of the UK population, more than 20% of all payments were directed to patient organisations which target such conditions. Patient organisations focusing on rare diseases relied on payments from fewer companies (p value=0.0031) compared to organisations focusing on non-rare diseases. CONCLUSIONS Companies predominantly funded patient organisations operating in therapeutic areas relevant to companies' portfolio or drug development pipeline. Patient organisations focusing on rare diseases received more funding relative to the number of patients affected by these conditions and relied more heavily on payments from fewer companies compared to organisations targeting non-rare diseases. Increased independence of patient organisations could help avoid conflicts of interest.
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Affiliation(s)
- Arianna Gentilini
- Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - Iva Parvanova
- Department of Health Policy, The London School of Economics and Political Science, London, UK
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6
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Rickard E, Carmel E, Ozieranski P. Comparing pharmaceutical company payments in the four UK countries: a cross-sectional and social network analysis. BMJ Open 2023; 13:e061591. [PMID: 36990486 PMCID: PMC10069501 DOI: 10.1136/bmjopen-2022-061591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/18/2023] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES To examine the characteristics of pharmaceutical payments to healthcare and patient organisations in the four UK countries. Compare companies spending the most; types of organisations receiving payments and types of payments in the four countries. Measure the extent to which companies target payments at the same recipients in each country and whether it differs depending on the type of recipient. DESIGN Cross-sectional comparative and social network analysis. SETTING England, Scotland, Wales, Northern Ireland. PARTICIPANTS 100 donors (pharmaceutical companies) reporting payments to 4229 recipients (healthcare organisations and patient organisations) in 2015. MAIN OUTCOME MEASURES For each country: payment totals and distribution; average number of common recipients between companies; share of payments to organisations fulfilling different roles in the health ecosystem and payments for different activities. RESULTS Companies prioritised different types of recipient and different types of activity in each country. There were significant differences in the distribution of payments across the four countries, even for similar types of recipients. Recipients in England and Wales received smaller individual payments than in Scotland and Northern Ireland. Overall, targeting shared recipients occurred most frequently in England, but was also common in certain pockets of each country's health ecosystem. We found evidence of reporting errors in Disclosure UK. CONCLUSIONS Our findings suggest a strategic approach to payments tailored to countries' policy and decision-making context, indicating there may be specific vulnerabilities to financial conflicts of interest at subnational level. Payment differences between countries may be occurring in other countries, particularly those with decentralised health systems and/or high levels of independence across its decision-making authorities. We call for a single database containing all recipient types, full location details and published with associated descriptive and network statistics.
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Affiliation(s)
- Emily Rickard
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Emma Carmel
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Bath, UK
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Zvonareva O. Patient engagement in drug development: configuring a new resource for generating innovation. CRITICAL PUBLIC HEALTH 2023. [DOI: 10.1080/09581596.2023.2188140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Affiliation(s)
- Olga Zvonareva
- Department of Health, Ethics and Society, CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Mulinari S, Pashley D, Ozieranski P. Advancing International Comparison of Pharmaceutical Industry Funding of Patient Advocacy: Focus on Denmark. Health Policy 2022; 126:1256-1262. [DOI: 10.1016/j.healthpol.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 10/18/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022]
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Lexchin J. Donations Made and Received: A Study of Disclosure Practices of Pharmaceutical Companies and Patient Groups in Canada. Int J Health Policy Manag 2022; 11:2046-2053. [PMID: 35021614 PMCID: PMC9808287 DOI: 10.34172/ijhpm.2021.172] [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: 05/31/2021] [Accepted: 12/13/2021] [Indexed: 01/12/2023] Open
Abstract
Given the increasing role of patient groups in pharmaceutical policy-making in Canada, this observational study was undertaken to determine whether companies that are members of Innovative Medicines Canada (IMC) list, on their publicly available websites, the names of patient groups that they make donations to and reciprocally, whether patient groups publicly list the names of the companies that they receive donations from. Websites of IMC members were searched for the names of the patient groups receiving donations, value of the donations and year the donations were made. The website of each patient group that was listed as receiving a donation was then searched for information about the name of companies making donations along with the value of the donations, year the donations were made and percent of the patient groups' income represented by the donation. For donations over $50 000, an attempt was made to match donations that companies made to donations that patient groups received. Eleven of 44 IMC members reported making 165 donations to 114 different patient groups. Seventy-nine of these 114 groups reported receiving 373 donations from IMC members. Information about the value of donations, the year that they were given and received and the percent of patient groups' income that they represented was limited. Donations made and received could not be matched because of the absence of information about the donations. Reporting on websites about donations by both companies and patient groups in Canada is haphazard, inconsistent and incomplete. Reforms are need to both the way that companies and patient groups report donations.
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Affiliation(s)
- Joel Lexchin
- School of Health Policy and Management, York University, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Trayer J, Rowbotham NJ, Boyle RJ, Smyth AR. Industry influence in healthcare harms patients: myth or maxim? Breathe (Sheff) 2022; 18:220010. [PMID: 36337122 PMCID: PMC9584590 DOI: 10.1183/20734735.0010-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/31/2022] [Indexed: 11/05/2022] Open
Abstract
Healthcare is a major global industry accounting for a significant proportion of government spending. Drug and medical device manufacturers are publicly traded companies with a responsibility to their shareholders to maximise profits by increasing sales. In order to achieve this, industry exerts influence over every part of healthcare including academic research, medical education, clinical guideline development, physician prescribing and through direct interactions with patients. In contrast, healthcare services seek to provide effective, safe and evidence-based treatments. This article examines interactions with industry across these domains and seeks to identify mutually beneficial relationships and potential conflict leading to patient harms. Case studies are used to illustrate these interactions. There is no single solution for improving healthcare's relationship with industry, although increased transparency has raised awareness of this issue. We briefly discuss some successful interventions that have been tried at national and regulatory level. While industry influence is widespread in healthcare and this has benefits for shareholders, healthcare practitioners have an ethical obligation to prioritise their patients' best interests. Industry interactions with healthcare professionals have a valid role in product development and distribution, but industry sponsorship of healthcare education and practice, guideline development or regulatory decision-making can have harmful consequences for patients. Healthcare practitioners need to carefully consider these issues when deciding whether to collaborate with industry. Educational aims To explore the many areas where industry influences healthcare and the subsequent effects on patient care. Case studies are used to illustrate examples of beneficial and harmful effects of this influence.To raise awareness of the effects of industry influence and for readers to consider their own potential conflicts of interest.To suggest potential ways to improve the current system with a focus on solutions which have successfully been trialled already.
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Affiliation(s)
- James Trayer
- Dept of Paediatric Allergy, Imperial College Healthcare NHS Trust, London, UK
| | - Nicola J. Rowbotham
- Evidence Based Child Health Group, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Robert J. Boyle
- Dept of Paediatric Allergy, Imperial College Healthcare NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Alan R. Smyth
- Evidence Based Child Health Group, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
- Dept of Paediatric Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Murayama A, Senoo Y, Harada K, Kotera Y, Saito H, Sawano T, Suzuki Y, Tanimoto T, Ozaki A. Awareness and Perceptions among Members of a Japanese Cancer Patient Advocacy Group Concerning the Financial Relationships between the Pharmaceutical Industry and Physicians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063478. [PMID: 35329160 PMCID: PMC8952770 DOI: 10.3390/ijerph19063478] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/02/2022] [Accepted: 03/11/2022] [Indexed: 02/04/2023]
Abstract
Objectives: Awareness and perceptions of financial conflicts of interest (FCOI) between pharmaceutical companies (Pharma) and healthcare domains remain unclear in Japanese cancer patient communities. This study aimed to assess awareness (RQ1), the influence of FCOI on physician trustworthiness (RQ2), and their perception (RQ3) among the Japanese cancer patient advocacy group members. Methods: A cross-sectional study using a self-administered survey was conducted with a Japanese cancer patient advocacy group between January and February 2019. The main outcome measures included awareness and perceptions of physician–Pharma interactions, their impact on physician trustworthiness, and attitudes towards FCOI among medical and other professions. Furthermore, we performed thematic analyses on the comments which responders provided in the surveys. Results: Among the 524 contacted members, 96 (18.3%) completed the questionnaire, including 69 (77.5%) cancer patients. In RQ1, most of the respondents were aware of physician–Pharma interactions, although the extent differed based on the nature of the interaction. Furthermore, the respondents mainly considered these interactions influential on clinical practice (RQ2) and agreed to the need for further regulation of physician–Pharma interactions (QR3). In qualitative analyses (n = 56), we identified the 4 following themes: perception towards the FCOI (Theme 1), concerns about the respondent’s treatment (Theme 2), reason of physician–Pharma interactions (Theme 3), and possible solutions from the patient perspective (Theme 4). Conclusions: Most respondents were generally aware of physician–Pharma-associated FCOI and perceived them negatively. Additionally, participants appeared supportive of further FCOI regulation to protect patient-centred care. Abbreviations: FCOI—financial conflicts of interest; United States—US; Pharma—pharmaceutical companies; RQ—research question.
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Affiliation(s)
- Anju Murayama
- Medical Governance Research Institute, Minato-ku, Tokyo 108-0074, Japan; (Y.S.); (K.H.); (Y.S.); (T.T.); (A.O.)
- School of Medicine, Tohoku University, Sendai 980-8574, Japan
- Correspondence: ; Tel.: +81-90-6321-6996
| | - Yuki Senoo
- Medical Governance Research Institute, Minato-ku, Tokyo 108-0074, Japan; (Y.S.); (K.H.); (Y.S.); (T.T.); (A.O.)
| | - Kayo Harada
- Medical Governance Research Institute, Minato-ku, Tokyo 108-0074, Japan; (Y.S.); (K.H.); (Y.S.); (T.T.); (A.O.)
| | - Yasuhiro Kotera
- School of Health Sciences, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai 980-0873, Japan;
| | - Toyoaki Sawano
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki 972-8322, Japan;
| | - Yosuke Suzuki
- Medical Governance Research Institute, Minato-ku, Tokyo 108-0074, Japan; (Y.S.); (K.H.); (Y.S.); (T.T.); (A.O.)
| | - Tetsuya Tanimoto
- Medical Governance Research Institute, Minato-ku, Tokyo 108-0074, Japan; (Y.S.); (K.H.); (Y.S.); (T.T.); (A.O.)
- Department of Internal Medicine, Navitas Clinic Kawasaki, Tokyo 210-0007, Japan
| | - Akihiko Ozaki
- Medical Governance Research Institute, Minato-ku, Tokyo 108-0074, Japan; (Y.S.); (K.H.); (Y.S.); (T.T.); (A.O.)
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki 972-8322, Japan
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Pashley D, Ozieranski P, Mulinari S. Disclosure of Pharmaceutical Industry Funding of Patient Organisations in Nordic Countries: Can Industry Self-Regulation Deliver on its Transparency Promise? INTERNATIONAL JOURNAL OF HEALTH SERVICES 2022; 52:347-362. [PMID: 35230175 PMCID: PMC9203660 DOI: 10.1177/00207314221083871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Pharmaceutical companies regularly fund patient organizations. It is important for patient organizations’ credibility that there be transparency regarding this financial support. In Europe, the pharmaceutical industry promises to deliver transparency through self-regulation, as opposed to legally binding provisions, but self-regulation's effectiveness is contested. We compared the industry's transparency of funding in four Nordic countries that, given their general reputation for high transparency, offered a critical test of self-regulation's ability to deliver on its transparency promise. For 2017–2019, we compared: national rules regarding funding disclosure; disclosure practices as evidenced by the availability, accessibility, and format of company transparency reports; and disclosure data, including payment descriptions and sums. Transparency problems differed in kind and magnitude between countries. In Norway and Finland, unlike in Sweden and Denmark, data on funding were difficult to access and analyze and sometimes seemed incomplete or missing. We explain that a key factor allowing for country differences is the freedom given to a country's pharmaceutical industry trade associations to form self-regulatory rules, provided they do not fall below the weak, European-level minimum requirements. Transparency could be improved by aligning rules and practices with the FAIR data principles: that is, corporate disclosures should be findable, accessible, interoperable, and reusable.
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Affiliation(s)
- Dylan Pashley
- Department of Sociology, Faculty of Social Sciences, 5193Lund University, Lund, Sweden
| | - Piotr Ozieranski
- Department of Social and Policy Sciences, 1555University of Bath, Bath, UK
| | - Shai Mulinari
- Department of Sociology, Faculty of Social Sciences, 5193Lund University, Lund, Sweden
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Ozieranski P, Pitter JG, Rickard E, Mulinari S, Csanadi M. A 'patient-industry complex'? Investigating the financial dependency of UK patient organisations on drug company funding. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:188-210. [PMID: 34874566 DOI: 10.1111/1467-9566.13409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 06/13/2023]
Abstract
We examined the minimum extent of dependency of UK patient organisations on pharmaceutical industry funding using drug company disclosure reports and patient organisation financial accounts from 2012 to 2016. We used linear regression to explain the overall share of industry funding ('general dependency') and top donor funding ('company-specific dependency') in organisations' income. Predictors included patient organisations' goal; having members and volunteers; geographical scope of activity; headquarter location; expenditure/income ratio; and disease area. The prevalent low levels of general dependency (IQR, 0.1%-6.0%) and company-specific dependency (IQR, 0.1%-4.3%) made a widespread capture of patient organisations unlikely, though only if one excludes the possibility of significant payment under-reporting. However, organisations with considerably higher dependency than others might be more prone to co-optation by industry. Of the 398 organisations, 18 (4.5%) and 8 (2.0%) had general and company-specific financial dependency over 50%, respectively. However, the shares of outliers exceeding the third quartile plus 1.5 times IQR were 51 (12.8%) and 56 (14.1%) for each dependency type. Certain characteristics including activity profile (advocacy) or indicating limited access to resources (remote location) made organisations vulnerable to developing financial dependency. Future research should examine both financial and non-financial links between the two sides and their impact on patient organisations' activity.
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Affiliation(s)
- Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | | | - Emily Rickard
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Shai Mulinari
- Department of Sociology, Lund University, Lund, Sweden
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14
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Ozieranski P, Martinon L, Jachiet PA, Mulinari S. Accessibility and quality of drug company disclosures of payments to healthcare professionals and organisations in 37 countries: a European policy review. BMJ Open 2021; 11:e053138. [PMID: 34916317 PMCID: PMC8679071 DOI: 10.1136/bmjopen-2021-053138] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To examine the accessibility and quality of drug company payment data in Europe. DESIGN Comparative policy review of payment data in countries with different regulatory approaches to disclosure. SETTING 37 European countries. PARTICIPANTS European Federation of Pharmaceutical Industries and Associations, its trade group and their drug company members; eurosfordocs.eu, an independent database integrating payments disclosed by companies and trade groups; regulatory bodies overseeing payment disclosure. MAIN OUTCOME MEASURES Regulatory approaches to disclosure (self-regulation, public regulation, combination of the two); data accessibility (format, structure, searchability, customisable summary statistics, downloadability) and quality (spectrum of disclosed characteristics, payment aggregation, inclusion of taxes, recipient or donor identifiers). RESULTS Of 30 countries with self-regulation, five had centralised databases, with Disclosure UK displaying the highest accessibility and quality. In 23 of the remaining countries with self-regulation and available data, disclosures were published in the portable document format (PDF) on individual company websites, preventing the public from understanding payment patterns. Eurosfordocs.eu had greater accessibility than any industry-run database, but the match between the value of payments integrated in eurosfordocs.eu and summarised separately by industry in seven countries ranged between 56% and 100% depending on country. Eurosfordocs.eu shared quality shortcomings with the underlying industry data, including ambiguities in identifying payments and their recipients. Public regulation was found in 15 countries, used either alone (3), in combination (4) or in parallel with (8) self-regulation. Of these countries, 13 established centralised databases with widely ranging accessibility and quality, and sharing some shortcomings with the industry-run databases. The French database, Transparence Santé, had the highest accessibility and quality, exceeding that of Disclosure UK. CONCLUSIONS The accessibility and quality of payment data disclosed in European countries are typically low, hindering investigation of financial conflicts of interest. Some improvements are straightforward but reaching the standards characterising the widely researched US Open Payments database requires major regulatory change.
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Affiliation(s)
- Piotr Ozieranski
- Department of Social and Policy Sciences, Centre for the Analysis of Social Policy, University of Bath, Bath, UK
| | | | | | - Shai Mulinari
- Department of Sociology, Lunds Universitet, Lund, Sweden
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Rickard E, Ozieranski P. A hidden web of policy influence: The pharmaceutical industry's engagement with UK's All-Party Parliamentary Groups. PLoS One 2021; 16:e0252551. [PMID: 34166396 PMCID: PMC8224875 DOI: 10.1371/journal.pone.0252551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/17/2021] [Indexed: 11/23/2022] Open
Abstract
Our objective was to examine conflicts of interest between the UK’s health-focused All-Party Parliamentary Groups (APPGs) and the pharmaceutical industry between 2012 and 2018. APPGs are informal cross-party groups revolving around a particular topic run by and for Members of the UK’s Houses of Commons and Lords. They facilitate engagement between parliamentarians and external organisations, disseminate knowledge, and generate debate through meetings, publications, and events. We identified APPGs focusing on physical or mental health, wellbeing, health care, or treatment and extracted details of their payments from external donors disclosed on the Register for All-Party Parliamentary Groups. We identified all donors which were pharmaceutical companies and pharmaceutical industry-funded patient organisations. We established that sixteen of 146 (11%) health-related APPGs had conflicts of interest indicated by reporting payments from thirty-five pharmaceutical companies worth £1,211,345.81 (16.6% of the £7,283,414.90 received by all health-related APPGs). Two APPGs (Health and Cancer) received more than half of the total value provided by drug companies. Fifty APPGs also had received payments from patient organisations with conflicts of interest, indicated by reporting 304 payments worth £986,054.94 from 57 (of 84) patient organisations which had received £27,883,556.3 from pharmaceutical companies across the same period. In total, drug companies and drug industry-funded patient organisations provided a combined total of £2,197,400.75 (30.2% of all funding received by health-related APPGs) and 468 (of 1,177–39.7%) payments to 58 (of 146–39.7%) health-related APPGs, with the APPG for Cancer receiving the most funding. In conclusion, we found evidence of conflicts of interests through APPGs receiving substantial income from pharmaceutical companies. Policy influence exerted by the pharmaceutical industry needs to be examined holistically, with an emphasis on relationships between actors potentially playing part in its lobbying campaigns. We also suggest ways of improving transparency of payment reporting by APPGs and pharmaceutical companies.
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Affiliation(s)
- Emily Rickard
- Department of Social and Policy Sciences, University of Bath, Bath, Somerset, United Kingdom
| | - Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Bath, Somerset, United Kingdom
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16
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Affiliation(s)
- Lisa A Bero
- Schools of Medicine and Public Health, University of Colorado, USA
| | - Lisa Parker
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine and Health University of Sydney
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Lignou S, Singh I. Pharmaceutical industry, academia and people with experience of mental illness as partners in research: a need for ethical guidance. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16166.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Several social and policy developments have led to research partnerships in mental health research, which depart from traditional research models. One form of such partnerships is among Research institutions, Industry (pharmaceutical and biotech) and People with lived experience of mental illness (RIPs) in the NIHR services. There are several benefits but also challenges in such partnerships. An ethics-based approach to anticipating and addressing such problems is lacking. Given the expansion of RIPs in treatment development for mental health illness, guidance to support ethical and effective collaborations in NIHR-funded mental health research is essential. Methods: To develop a moral framework for evaluating the ethics of RIPs, we systematically searched PubMed for peer-reviewed literature discussing good practices in research partnerships. Searches were also conducted in websites of known organizations supporting patient engagement with industry in mental health research and in the references of short-listed articles. Following application of exclusion criteria, remaining articles were critically examined and summarised to synthesise principles for ethical RIPs and inform clear guidance and practices. Results: Critical analysis and synthesis of the short-listed articles highlighted the need for two sets of principles to guide ethical RIPs: principles for (a) RIPs as a trustworthy enterprise and (b) fair RIPs. We discuss the application of these principles in problem-solving strategies that can support best practice in establishing fair and effective research partnerships among research institutions, industry and people with lived experience of mental illness in the NIHR services. Conclusions: Ethical guidance is needed to prevent and address challenges in RIPs and to promote the scientific and social benefits of these new research partnership models in mental health research in the NIHR services. We show how the proposed moral framework can guide research partners in designing, sustaining and assessing ethical and effective mental health research collaborations.
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Parker L, Grundy Q, Fabbri A, Mintzes B, Bero L. 'Lines in the sand': an Australian qualitative study of patient group practices to promote independence from pharmaceutical industry funders. BMJ Open 2021; 11:e045140. [PMID: 33563626 PMCID: PMC7875302 DOI: 10.1136/bmjopen-2020-045140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To study how patient groups that accept pharmaceutical industry money perceive and manage the risk of undue influence from their sponsors. DESIGN Empirical ethics approach using a qualitative interview study. SETTING The Australian patient group sector. PARTICIPANTS 27 participants from 23 patient groups, purposively recruited for diversity of group characteristics (degree of pharmaceutical industry funding, health focus, location) and participant role (staff, board members). ANALYSIS Interview data were transcribed and read repeatedly to identify concepts and patterns in the data. These were grouped into conceptual categories that described and explained the findings. We used an inductive analytical approach to identify important themes and concepts in the data. RESULTS Participants in this study described how the patient group sector receives pressure from pharmaceutical company funders to act in ways that prioritise company interests. Groups worked to try and protect their credibility and ability to act in ways of their own choosing using practical rules or 'lines in the sand' about industry funding activities. They were grouped around the dominant topics of: sponsor exclusivity, brand marketing, agenda setting, advocacy and content of group activities. Lines in the sand were largely experience-driven and ethically informed; they varied between groups. There was also variable transparency among groups about financial interactions with pharmaceutical companies. CONCLUSIONS It is important to know about patient group practices around pharmaceutical industry funders as this allows public scrutiny about the adequacy of such practices. Inadequate strategies may mean that funders can influence patient groups activities in ways that do not necessarily prioritise the interests of members. We found that groups differed in their approach, with little independent external guidance to inform responses to commonly encountered types of influence. Inadequate transparency limits the ability of the public to make informed assessments about the risk of bias over the activities of groups that accept industry funding.
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Affiliation(s)
- Lisa Parker
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Quinn Grundy
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Alice Fabbri
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Barbara Mintzes
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Bero
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Roennow A, Sauvé M, Welling J, Riggs RJ, Kennedy AT, Galetti I, Brown E, Leite C, Gonzalez A, Portales Guiraud AP, Houÿez F, Camp R, Gilbert A, Gahlemann M, Moros L, Luna Flores JL, Schmidt F, Sauter W, Finnern H. Collaboration between patient organisations and a clinical research sponsor in a rare disease condition: learnings from a community advisory board and best practice for future collaborations. BMJ Open 2020; 10:e039473. [PMID: 33328257 PMCID: PMC7745690 DOI: 10.1136/bmjopen-2020-039473] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Transparent collaborations between patient organisations (POs) and clinical research sponsors (CRS) can identify and address the unmet needs of patients and caregivers. These insights can improve clinical trial participant experience and delivery of medical innovations necessary to advance health outcomes and standards of care. We share our experiences from such a collaboration undertaken surrounding the SENSCIS® clinical trial (NCT02597933), and discuss its impact during, and legacy beyond, the trial.Summary We describe the establishment of a community advisory board (CAB): a transparent, multiyear collaboration between the scleroderma patient community and a CRS. We present shared learnings from the collaboration, which is split into three main areas: (1) the implementation and conduct of the clinical trial; (2) analysis and dissemination of the results; and (3) aspects of the collaboration not related to the trial.1. The scleroderma CAB reviewed and provided advice on trial conduct and reporting. This led to the improvement and optimisation of trial procedures; meaningful, patient-focused adaptations were made to address challenges relevant to scleroderma-associated interstitial lung disease patients.2. To ensure that results of the trial were accessible to lay audiences and patients, written lay summaries were developed by the trial sponsor with valuable input from the CAB to ensure that language and figures were understandable.3. The CAB and the CRS also collaborated to co-develop opening tools for medication blister packs and bottles. In addition, to raise disease awareness among physicians, patients and caregivers, educational materials to improve diagnosis and management of scleroderma were co-created and delivered by the CAB and CRS.Conclusions This collaboration between POs and a CRS, in a rare disease condition, led to meaningful improvements in patient safety, comfort and self-management and addressed information needs. This collaboration may serve as a template of best practice for future collaborations between POs, research sponsors and other healthcare stakeholders.
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Affiliation(s)
- Annelise Roennow
- Federation of European Scleroderma Associations aisbl, Saint-Maur, Belgium
- Sklerodermiforening, Rødovre, Denmark
| | | | - Joep Welling
- Federation of European Scleroderma Associations aisbl, Saint-Maur, Belgium
| | - Robert J Riggs
- Scleroderma Foundation, Inc, Danvers, Massachusetts, USA
| | | | - Ilaria Galetti
- Federation of European Scleroderma Associations aisbl, Saint-Maur, Belgium
- Gruppo Italiano per la Lotta alla Sclerodermia, Milan, Italy
| | | | - Catarina Leite
- Portuguese Association of Patients with Scleroderma, Monção, Portugal
| | - Alex Gonzalez
- Scleroderma Research Foundation, San Francisco, California, USA
| | | | | | - Rob Camp
- EURORDIS-Rare Diseases Europe, Barcelona, Spain
| | | | | | - Lizette Moros
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Rheinland-Pfalz, Germany
| | - Jose Luis Luna Flores
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Rheinland-Pfalz, Germany
| | - Friedrich Schmidt
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Rheinland-Pfalz, Germany
| | - Wiebke Sauter
- Boehringer Ingelheim Pharma GmbH and Co KG Biberach, Biberach, Baden-Württemberg, Germany
| | - Henrik Finnern
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Rheinland-Pfalz, Germany
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20
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Yamamoto K, Murayama A, Ozaki A, Saito H, Sawano T, Tanimoto T. Financial conflicts of interest between pharmaceutical companies and the authors of urology clinical practice guidelines in Japan. Int Urogynecol J 2020; 32:443-451. [PMID: 33151353 DOI: 10.1007/s00192-020-04547-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/24/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS In Japan, the authors of urology clinical practice guidelines (UCPG) used in patient-centered care are often targeted by pharmaceutical companies with financial payments. However, the financial relationship between UCPG authors and pharmaceutical companies remains unclear. This study aimed to determine the characteristics of industry payments to physicians that may influence recommendations in UCPG and to assess the transparency of payment disclosure. METHODS We considered 193 UCPG authors receiving payments from 79 companies between 2016 and 2017 and the 13 UCPG published by the Japanese Urological Association between 2015 and 2018. We determined 2-year combined mean and median payments to authors, total company payments, and associations between author attributes and payment values using multivariate negative binomial regression. Also, we assessed the extent of the financial disclosure policies among the 13 UCPG. RESULTS Overall, 171 (88.6%) authors received payments with a combined value of $6,169,333. Median and mean payments were $7147 (interquartile range, $1512-$44,807) and $31,965 (standard deviation, $51,684), respectively. University professors working on multiple UCPG with new drug approvals were associated with higher payments. Twelve (92.3%) UCPG failed to disclose financial conflicts. CONCLUSIONS While it remains unclear whether financial entanglements improperly influence the contents of UCPG, most Japanese authors received substantial payments from pharmaceutical companies with little or no disclosure. Because insufficient transparency in disclosure of these financial entanglements may compromise the integrity of UCPG, more rigorous regulation and greater disclosure of financial conflicts of interest are needed.
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Affiliation(s)
- Kana Yamamoto
- Medical Governance Research Institute, Minato-ku, Tokyo, 1087505, Japan.,Department of Internal Medicine, Navitas Clinic, Tachikawa, Tokyo, Japan
| | - Anju Murayama
- Medical Governance Research Institute, Minato-ku, Tokyo, 1087505, Japan.
| | - Akihiko Ozaki
- Medical Governance Research Institute, Minato-ku, Tokyo, 1087505, Japan.,Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Toyoaki Sawano
- Department of Surgery, Sendai City Medical Center, Sendai, Japan
| | - Tetsuya Tanimoto
- Medical Governance Research Institute, Minato-ku, Tokyo, 1087505, Japan
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22
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Ozieranski P, Csanádi M, Rickard E, Mulinari S. Under-reported relationship: a comparative study of pharmaceutical industry and patient organisation payment disclosures in the UK (2012-2016). BMJ Open 2020; 10:e037351. [PMID: 32950962 PMCID: PMC7511620 DOI: 10.1136/bmjopen-2020-037351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine the under-reporting of pharmaceutical company payments to patient organisations by donors and recipients. DESIGN Comparative descriptive analysis of payments disclosed on drug company and charity regulator websites. SETTING UK. PARTICIPANTS 87 donors (drug companies) and 425 recipients (patient organisations) reporting payments in 2012-2016. MAIN OUTCOME MEASURES Number and value of payments reported by donors and recipients; differences in reported payments from/to the same donors and recipients; payments reported in either dataset but not the other one; agreement between donor-recipient ties established by payments; overlap between donor and recipient lists and, respectively, industry and patient organisation data. RESULTS Of 87 donors, 63 (72.4%) reported payments but 84 (96.6%) were mentioned by recipients. Although donors listed 425 recipients, only 200 (47.1%) reported payments. The number and value of payments reported by donors were 259.8% and 163.7% greater than those reported by recipients, respectively. The number of donors with matching payment numbers and values in both datasets were 3.4% and 0.0%, respectively; for recipients these figures were 7.8% and 1.9%. There were 24 and 3 donors missing from industry and patient organisation data during the entire study period, representing 38.1% and 3.6% of those in the respective datasets. The share of donor-recipient ties in which industry and patient organisation data agreed about donors and recipients was 38.9% and 68.4% in each dataset, respectively. Of 63 donors reporting payments, only 3 (4.8%) had their recipient lists fully overlapping with patient organisation data. Of 200 recipients reporting industry funding, 102 (51.0%) had their donor lists fully overlapping with industry data. CONCLUSIONS Both donors and recipients under-reported payments. Existing donor and recipient disclosure systems cannot manage potential conflicts of interest associated with industry payments. Increased standardisation could limit the under-reporting by each side but only an integrated donor-recipient database could eliminate it.
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Affiliation(s)
| | | | - Emily Rickard
- Social and Policy Sciences, University of Bath, Bath, UK
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Lignou S, Singh I. Pharmaceutical industry, academia and people with experience of mental illness as partners in research: a need for ethical guidance. Wellcome Open Res 2020. [DOI: 10.12688/wellcomeopenres.16166.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Several social and policy developments have led to research partnerships in mental health research, which depart from traditional research models. One form of such partnerships is among research institutions, industry (pharmaceutical and biotech) and people with lived experience of mental illness (RIPs). There are several benefits but also ethical challenges in RIPs. An ethics-based approach to anticipating and addressing such ethical issues in mental health research is lacking. Given the expansion of RIPs in treatment development for mental health illness, guidance to support ethical and trustworthy collaborative mental health research projects is essential. Methods: To develop a moral framework for evaluating the ethics of RIPs, we systematically searched PubMed for peer-reviewed literature discussing good practices in research partnerships. Searches were also conducted in websites of known organizations supporting patient engagement with industry in mental health research and in the references of short-listed articles. Following application of exclusion criteria, remaining articles were critically examined and summarised to synthesise principles for ethically acceptable RIPs and inform clear guidance and practices. Results: Critical analysis and synthesis of the short-listed articles highlighted the need for two sets of principles to guide ethical RIPs: principles for (a) RIPs as a trustworthy enterprise (e.g. public accountability, transparency) and (b) fair RIPs (e.g. effective governance, respect). We discuss the application of these principles in problem-solving strategies that can support best practice in establishing fair and successful mental health research partnerships among research institutions, industry and people with lived experience of mental illness. Conclusions: Ethical guidance is needed to prevent and address challenges in RIPs and to promote the scientific and social benefits of these new research partnership models in mental health research. We show how the proposed moral framework can guide research partners in designing, sustaining and assessing ethical and trustworthy collaborative mental health research projects.
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24
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Bigdeli M, Rouffy B, Lane BD, Schmets G, Soucat A. Health systems governance: the missing links. BMJ Glob Health 2020; 5:bmjgh-2020-002533. [PMID: 32784214 PMCID: PMC7422628 DOI: 10.1136/bmjgh-2020-002533] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/17/2020] [Accepted: 07/10/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Maryam Bigdeli
- Health Systems Governance Collaborative, Geneva, Switzerland.,Morocco Country Office, World Health Organization, Rabat, Morocco
| | - Benjamin Rouffy
- Health Systems Governance Collaborative, Geneva, Switzerland.,Health Systems Governance and Financing, World Health Organization, Geneve, Switzerland
| | - Benjamin Downs Lane
- Health Systems Governance Collaborative, Geneva, Switzerland.,Health Systems Governance and Financing, World Health Organization, Geneve, Switzerland
| | - Gerard Schmets
- Health Systems Governance Collaborative, Geneva, Switzerland.,Health Systems Governance and Financing, World Health Organization, Geneve, Switzerland
| | - Agnes Soucat
- Health Systems Governance Collaborative, Geneva, Switzerland .,Health Systems Governance and Financing, World Health Organization, Geneve, Switzerland
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Five years of pharmaceutical industry funding of patient organisations in Sweden: Cross-sectional study of companies, patient organisations and drugs. PLoS One 2020; 15:e0235021. [PMID: 32579571 PMCID: PMC7313941 DOI: 10.1371/journal.pone.0235021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/05/2020] [Indexed: 02/07/2023] Open
Abstract
Background Many patient organisations collaborate with drug companies, resulting in concerns about commercial agendas influencing patient advocacy. We contribute to an international body of knowledge on patient organisation-industry relations by considering payments reported in the industry’s centralised ‘collaboration database’ in Sweden. We also investigate possible commercial motives behind the funding by assessing its association with drug commercialisation. Methods Our primary data source were 1,337 payment reports from 2014–2018. After extraction and coding, we analysed the data descriptively, calculating the number, value and distribution of payments for various units of analysis, e.g. individual companies, diseases and payment goals. The association between drug commercialisation and patient organisation funding was assessed by, first, the concordance between leading companies marketing drugs in specific diseases and their funding of corresponding patient organisations and, second, the correlation between new drugs in broader condition areas and payments to corresponding patient organisations. Results 46 companies reported paying €6,449.224 (median €2,411; IQR €1,024–4,569) to 77 patient organisations, but ten companies provided 67% of the funding. Small payments dominated, many of which covered costs of events organised by patient organisations. An association existed between drug commercialisation and industry funding. Companies supported patient organisations in diseases linked to their drug portfolios, with the top 3 condition areas in terms of funding–cancer; endocrine, nutritional and metabolic disorders; and infectious and parasitic disorders–accounting for 63% of new drugs and 56% of the funding. Conclusion This study reveals close and widespread ties between patient organisations and drug companies. A relatively few number of companies dominated the funding landscape by supporting patient organisations in disease areas linked to their drug portfolios. This commercially motivated funding may contribute to inequalities in resource and influence between patient organisations. The association between drug commercialisation and industry funding is also worrying because of the therapeutic uncertainty of many new drugs. Our analysis benefited from the existence of a centralised database of payments–which should be adopted by other countries too–but databases should be downloadable in an analysable format to permit efficient and independent analysis.
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Moynihan R. Commentary: The Voice of the People, Funded Now by Your Friendly Pharmaceutical Company. JOURNAL OF BIOETHICAL INQUIRY 2020; 17:61-63. [PMID: 32212056 DOI: 10.1007/s11673-020-09965-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 02/12/2020] [Indexed: 06/10/2023]
Abstract
Pharmaceutical industry funding has transformed much grassroots community activism on health into corporate-sponsored advocacy. This critical commentary outlines recent evidence about industry funding of patient advocacy groups, offers a commentary on the history of grassroots activism appearing in this issue of the journal, and calls for greater scrutiny of the impacts and ethics of such sponsorship.
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Adekunle L, Chen R, Morrison L, Halley M, Eng V, Hendlin Y, Wehner MR, Chren MM, Linos E. Association between financial links to indoor tanning industry and conclusions of published studies on indoor tanning: systematic review. BMJ 2020; 368:m7. [PMID: 32019742 PMCID: PMC7190068 DOI: 10.1136/bmj.m7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To assess whether an association exists between financial links to the indoor tanning industry and conclusions of indoor tanning literature. DESIGN Systematic review. DATA SOURCES PubMed, Embase, and Web of Science, up to 15 February 2019. STUDY SELECTION CRITERIA Articles discussing indoor tanning and health were eligible for inclusion, with no article type restrictions (original research, systematic reviews, review articles, case reports, editorials, commentaries, and letters were all eligible). Basic science studies, articles describing only indoor tanning prevalence, non-English articles, and articles without full text available were excluded. RESULTS 691 articles were included in analysis, including empiric articles (eg, original articles or systematic reviews) (357/691; 51.7%) and non-empiric articles letters (eg, commentaries, letters, or editorials) (334/691; 48.3%). Overall, 7.2% (50/691) of articles had financial links to the indoor tanning industry; 10.7% (74/691) articles favored indoor tanning, 3.9% (27/691) were neutral, and 85.4% (590/691) were critical of indoor tanning. Among the articles without industry funding, 4.4% (27/620) favored indoor tanning, 3.5% (22/620) were neutral, and 92.1% (571/620) were critical of indoor tanning. Among the articles with financial links to the indoor tanning industry, 78% (39/50) favored indoor tanning, 10% (5/50) were neutral, and 12% (6/50) were critical of indoor tanning. Support from the indoor tanning industry was significantly associated with favoring indoor tanning (risk ratio 14.3, 95% confidence interval 10.0 to 20.4). CONCLUSIONS Although most articles in the indoor tanning literature are independent of industry funding, articles with financial links to the indoor tanning industry are more likely to favor indoor tanning. Public health practitioners and researchers need to be aware of and account for industry funding when interpreting the evidence related to indoor tanning. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019123617.
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Affiliation(s)
- Lola Adekunle
- Department of Dermatology, Stanford University, Palo Alto, CA 94305, USA
| | - Rebecca Chen
- Department of Dermatology, Stanford University, Palo Alto, CA 94305, USA
| | - Lily Morrison
- Department of Dermatology, Stanford University, Palo Alto, CA 94305, USA
| | - Meghan Halley
- Department of Dermatology, Stanford University, Palo Alto, CA 94305, USA
| | - Victor Eng
- Department of Dermatology, Stanford University, Palo Alto, CA 94305, USA
| | - Yogi Hendlin
- School of Philosophy Erasmus University, Rotterdam, Netherlands
| | - Mackenzie R Wehner
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
- Departments of Health Services Research and of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eleni Linos
- Department of Dermatology, Stanford University, Palo Alto, CA 94305, USA
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Khabsa J, Semaan A, El-Harakeh A, Khamis AM, Obeid S, Noureldine HA, Akl EA. Financial relationships between patient and consumer representatives and the health industry: A systematic review. Health Expect 2019; 23:483-495. [PMID: 31858662 PMCID: PMC7104632 DOI: 10.1111/hex.13013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/05/2019] [Accepted: 11/29/2019] [Indexed: 11/29/2022] Open
Abstract
Background Patients and consumers are increasingly engaged in health policymaking, research and drug regulation. Having financial relationships with the health industry creates situations of conflicts of interest (COI) and might compromise their meaningful and unbiased participation. Objective To synthesize available evidence on the financial relationships between the health industry and patient and consumer representatives and their organizations. Methods We systematically searched MEDLINE and EMBASE. We selected studies and abstracted data in duplicate and independently. We reported on outcomes related to financial relationships of individuals with, and/or funding of organizations by the health industry. Results We identified a total of 14 510 unique citations, of which 24 reports of 23 studies were eligible. Three studies (13%) addressed the financial relationship of patient and consumer representatives with the health industry. Of these, two examined the proportion of public speakers in drug regulatory processes who have financial relationships; the proportions in the two studies were 25% and 19% respectively. Twenty studies (87%) addressed funding of patient and consumer organizations. The median proportion of organizations that reported funding from the health industry was 62% (IQR: 34%‐69%) in questionnaire surveys, and 75% (IQR: 58%‐85%) in surveys of their websites. Among organizations for which there was evidence of industry funding, a median proportion of 29% (IQR: 27%‐44%) acknowledged on their websites receiving that funding. Conclusion Financial relationships between the health industry and patient and consumer representatives and their organizations are common and may not be disclosed. Stricter regulation on disclosure and management is needed.
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Affiliation(s)
- Joanne Khabsa
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aline Semaan
- Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Amena El-Harakeh
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon.,Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Assem M Khamis
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Serena Obeid
- Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | | | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.,Department of Health Research Methods, Evidence, and Impact (HE&I), McMaster University, Hamilton, ON, Canada
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Parker L, Fabbri A, Grundy Q, Mintzes B, Bero L. "Asset exchange"-interactions between patient groups and pharmaceutical industry: Australian qualitative study. BMJ 2019; 367:l6694. [PMID: 31831471 PMCID: PMC7190020 DOI: 10.1136/bmj.l6694] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To understand and report on the nature of patient group interactions with the pharmaceutical industry from the perspective of patient group representatives by exploring the range of attitudes towards pharmaceutical industry sponsorship and how, why, and when interactions occur. DESIGN Empirical qualitative interview study informed by ethics theory. SETTING Australian patient groups. PARTICIPANTS 27 participants from 23 Australian patient groups that represented diverse levels of financial engagement with the pharmaceutical industry. Groups were focused on general health consumer issues or disease specific topics, and had regional or national jurisdictions. ANALYSIS Analytic techniques were informed by grounded theory. Interview transcripts were coded into data driven categories. Findings were organised into new conceptual categories to describe and explain the data, and were supported by quotes. RESULTS A range of attitudes towards pharmaceutical industry sponsorship were identified that are presented as four different types of relationship between patient groups and the pharmaceutical industry. The dominant relationship type was of a successful business partnership, and participants described close working relationships with industry personnel. These participants acknowledged a potential for adverse industry influence, but expressed confidence in existing strategies for avoiding industry influence. Other participants described unsatisfactory or undeveloped relationships, and some participants (all from general health consumer groups) presented their groups' missions as incompatible with the pharmaceutical industry because of fundamentally opposing interests. Participants reported that interactions between their patient group and pharmaceutical companies were more common when companies had new drugs of potential interest to group members. Patient groups that accepted industry funding engaged in exchanges of "assets" with companies. Groups received money, information, and advice in exchange for providing companies with marketing, relationship building opportunities with key opinion leaders, coordinated lobbying with companies about drug access and subsidy, assisting companies with clinical trial recruitment, and enhancing company credibility. CONCLUSIONS An understanding of the range of views patient groups have about pharmaceutical company sponsorship will be useful for groups that seek to identify and manage any ethical concerns about these relationships. Patient groups that receive pharmaceutical industry money should anticipate they might be asked for specific assets in return. Selective industry funding of groups where active product marketing opportunities exist might skew the patient group sector's activity towards pharmaceutical industry interests and allow industry to exert proxy influence over advocacy and subsequent health policy.
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Affiliation(s)
- Lisa Parker
- School of Pharmacy, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, NSW 2006, Australia
| | - Alice Fabbri
- School of Pharmacy, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, NSW 2006, Australia
| | - Quinn Grundy
- Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Barbara Mintzes
- School of Pharmacy, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, NSW 2006, Australia
| | - Lisa Bero
- School of Pharmacy, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, NSW 2006, Australia
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Bad Medicine: Nofreelunch. Br J Gen Pract 2019; 69:620. [DOI: 10.3399/bjgp19x706997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Rickard E, Ozieranski P, Mulinari S. Evaluating the transparency of pharmaceutical company disclosure of payments to patient organisations in the UK. Health Policy 2019; 123:1244-1250. [PMID: 31455562 DOI: 10.1016/j.healthpol.2019.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 08/07/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022]
Abstract
Patient organisations contribute to many areas of pharmaceutical policy. In developing their organisational capacity, many turn to financial support from pharmaceutical companies, which may create conflicts of interests. However, the transparency of the industry's self-regulatory approach to the disclosure of payments to patient organisations has evaded scrutiny. Using company reports disclosing payments to UK patient organisations in 2012-2016, we evaluate the transparency of reporting using indicators derived from industry's European patient organisation Code. We found a large proportion of companies did not have any disclosure reports available despite many having made payments, confirmed by comparing with annual financial accounts of patient organisations registered as charities. Where disclosure reports were available, many payments were not adequately described, resulting in large portions of money being disclosed without clarity as to the payment type and purpose. We found companies were clearer regarding whether payments were financial or benefits-in-kind, but transparency was particularly inadequate as to whether it could be determined if payments were indirect or direct and restricted or unrestricted, and almost no companies mentioned the VAT status of payments. Our findings suggest that the industry's self-regulatory approach to transparency has not been working efficiently. We suggest ways for standardising and increasing the precision of information by pharmaceutical companies and advocate for the introduction of a centralised, and easily accessible national-level payment database.
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Affiliation(s)
- Emily Rickard
- Department of Social and Policy Sciences, University of Bath, Claverton Down, Bath, UK.
| | - Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Claverton Down, Bath, UK
| | - Shai Mulinari
- Department of Sociology, Lund University, Lund, Sweden
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Ozieranski P, Csanadi M, Rickard E, Tchilingirian J, Mulinari S. Analysis of Pharmaceutical Industry Payments to UK Health Care Organizations in 2015. JAMA Netw Open 2019; 2:e196253. [PMID: 31225896 PMCID: PMC6593961 DOI: 10.1001/jamanetworkopen.2019.6253] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/08/2019] [Indexed: 11/14/2022] Open
Abstract
Importance Drug company payments to health care organizations can create conflicts of interest. However, little is known about such financial relationships, especially outside the United States. Objective To examine the concentration and patterns of drug company payments to health care organizations in the United Kingdom. Design, Setting, and Participants This cross-sectional study examined nonresearch payments reported in the industry-run Disclosure UK database. Companies participating in Disclosure UK in 2015 and health care organizations receiving their payments were included in the analysis. The data were analyzed descriptively at the health care organization, payment, and donor levels, considering health care organization categories, payment categories, and companies from February 5 through May 28, 2017, with follow-up checks from June 1 through August 31, 2018. Analysis was conducted from July 10 through December 20, 2018. Main Outcomes and Measures Share of funding and the Gini index (GI) to measure payment concentration (0 indicates perfect deconcentration [eg, all drug companies provide the same value of payments]; 1, perfect concentration [eg, 1 company provides the entire value of payments]) and median and interquartile range (IQR) to measure payment patterns. Results A total of 4028 health care organizations received 19 933 payments, worth US $72 110 156.6, from 100 companies. This study identified 11 categories of health care organizations, with 3-public-sector secondary and tertiary care providers, education and research providers, and professional organizations-accumulating 67.2% of funding. The health care organization categories had varying GIs (range, 0.65-0.92), medians (range, $750.3-$45 862.4), and IQRs (range, $389.1-$1843.9 to $3104.4-$199 868.2). Of 4 payment categories, the top category-donations and grants-captured 50.6% of funding. Joint working (collaborative projects with nonindustry partners) had a lower GI (0.64) than other payment categories (range, 0.79-0.84). The median and IQR were the lowest for contributions to costs of events ($366.8; IQR, $229.3-611.3) and highest for joint working ($14 903.7; IQR, $3185.0-34,748.4). The top 10 firms (58.6% of funding) had payments with varying medians (from $366.8 [IQR, $244.5-611.3] to $9781.3 [IQR, $1834.0-48 906.7]). Conclusions and Relevance Although organizations from across the health care system received funding, the payments were concentrated on a few large donors, payments, and recipients. Different payment and recipient categories had different patterns of payment values, suggesting that the industry has diversified its funding strategies across different parts of the health care system. These results suggest that Disclosure UK requires improved transparency, particularly by including built-in recipient categories, and that organizational conflicts of interest need more policy attention, including disclosure of payments independent of the industry.
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Affiliation(s)
- Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Bath, United Kingdom
| | | | - Emily Rickard
- Department of Social and Policy Sciences, University of Bath, Bath, United Kingdom
| | - Jordan Tchilingirian
- Department of Social and Policy Sciences, University of Bath, Bath, United Kingdom
| | - Shai Mulinari
- Department of Sociology, Lund University, Lund, Sweden
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Iacobucci G. Industry donated over £57m to UK patient organisations from 2012 to 2016. BMJ 2019; 365:l2317. [PMID: 31122945 DOI: 10.1136/bmj.l2317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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