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Hidden influence: Financial conflicts you might have missed

Last week we posted about the influence of drug and medical device companies on prescribing through payments to physicians. Thanks to the Physician Payments Sunshine Act making this data available and increased media coverage on the issue, we’re seeing industry being called out more for paying doctors. 

But we’ve also seen examples of industry influencing medicine and health policy in even sneakier ways. These conflicts of interest are only recently getting attention in the media, so we wanted to highlight these important examples, in case you missed them.

Industry in disease advocacy research

It’s no secret that industry often creates or co-opts patient advocacy groups to further their agenda. In fact, there’s a word for it – astroturfing. Funding from industry is not all bad — it fact, can help these groups provide crucial services like patient hotlines, family support, and education. However, research from disease advocacy organizations that are industry-funded can be skewed to support pharma’s point of view. And when this research is publicized, the industry funding remains hidden.

Dr. Susan Molchan recently highlighted the problem of “astroturf” research in HealthNewsReviewThe Alzheimer’s Association put out a report a few weeks ago that the U.S. could save $7.9 trillion by 2050 through early diagnosis of Alzheimer’s. However, as Molchan points out, there is no effective treatment for Alzheimer’s, whether or not it’s caught early. Despite this fact, the Alzheimer’s Association (which is funded in part by Eli Lilly) suggests in the report that “development and approval of beta-amyloid imaging biomarkers” will help diagnose cognitive impairment earlier – eventually saving trillions. 

“I suspect the ‘study’ and the push for early diagnosis are part of the long game… to help push through approval for payment by Medicare and subsequently by insurance companies for these scans,” writes Molchan. 

It’s not always easy to tell when industry funding plays a role in disease advocacy research, especially because drug makers are not required to report payments they make to non-profits in the way they report payments to doctors. However, a bill soon to be introduced by Senator Claire McCaskill (D-MO), could help untangle the threads. The bill would add to the Physician Payments Sunshine Act, including non-profit and advocacy group payments to the list of payments pharmaceutical companies must disclose. We’ll be following this bill closely as it progresses. 

Payments to textbook authors

When doctors and researchers publish a study in a journal, they are asked to disclose any financial interests or industry payments. Textbook authors are not required to disclose these conflicts – but they probably should be.

Brian J. Piper, Drew A. Lambert, Ryan C. Keefe, Phoebe U. Smukler, Nicolas
A. Selemon & Zachary R. Duperry (2018): Undisclosed conflicts of interest among biomedical
textbook authors, AJOB Empirical Bioethics, DOI: 10.1080/23294515.2018.1436095

A recent study from researchers at Bowdoin College found that many authors of six popular medical textbooks have substantial conflicts of interest they did not disclose. Out of 1,152 authors, more than 50% received an industry payment in 2014.

The vast majority of industry payments though, went to the authors of one specific textbook – Harrison’s Principles of Internal Medicine. These authors received a total of $11 million from industry between 2009 and 2013, according to ProPublica‘s “Dollars For Docs” database. Two authors of Harrison’s Principles made more than $800,000 from industry payments during this time. These hefty sums have the potential to influence how textbook authors write about the benefits and risks of treatments and procedures. 

“Sadly, after six years doing these types of studies, we were not surprised by these findings,” said Dr. Brian Piper, lead author of the study, in STAT. What is surprising, said Piper, is the continued lack of standards for disclosing conflicts of interest in textbooks.