August 15th, 2019
Recent developments in research on financial conflicts of interest in medicine are helping health care watchdogs hold health professionals and institutions accountable for their financial relationships with industry. Read on!
Last year, Dr. José Baselga, former chief medical officer at Memorial Sloan Kettering Cancer Center, came under fire for not disclosing millions of dollars he was receiving from the drug industry, and later resigned from his position. However, Baselga is by no means the only cancer center leader who received industry payments. In a JAMA Internal Medicine Research Letter, researchers Dr. David Carr and Dr. H. Gilbert Welch found that half of directors of National Cancer Institute (NCI)–designated cancer centers received payments from industry in 2017. About 40% received payments unrelated to research, and 23% received payments more than $5000 in payments unrelated to research, which, according to the NCI, constitutes a “significant financial interest.”
This is significant, not only because NCI cancer centers shape cancer care, but they receive substantial public funding ($330 million in 2018). Given that taxpayers are subsidizing these cancer centers, there should be limits on receiving funds from industry, especially for non-research related payments.
Journals generally require authors to disclose financial conflicts of interest before publishing a paper. But do the journal editors themselves disclose their own conflicts? Not necessarily, a new study in BMJ Open finds. Researchers found that only 16 out of 130 high-impact medical journals reported financial conflicts held by journal editors, even though the vast majority required this disclosure from authors. Additionally, journal editors typically receive larger payments from industry compared to non-editor physicians, making disclosure all the more important.
“You want to make sure that third parties, such as advertisers, do not influence content. The only defense we have is the objectivity of the editors” said Dr. Arthur Caplan, study co-author and head of the division of medical ethics at the NYU Langone Medical Center, in STAT. But this objectivity is compromised when editors receive industry payments and don’t disclose them.
We’ve written previously about the lack of evidence for off-label use of gabapentinoids, such as Neurontin and Lyrica. Researchers found that most double-blind RCTs of gabapentinoids show minimal pain relief for off-label uses — either no change compared to placebo, or change of less than 1 point on 10-point pain scale, which is not considered clinically meaningful. Additionally, the side effects of gabapentinoids can be serious; as many as one in three patients taking a high dose of gabapentinoids experience dizziness or sleepiness, which can lead to falls or other adverse events.
Given the limited effectiveness of off-label use and risk of adverse events, why are gabapentinoids (especially expensive brand-name versions) so readily subscribed? Part of the answer may be due to industry involvement. In a recent research letter in JAMA Internal Medicine, Dr. Taeho Greg Rhee and Dr. Joseph Ross from Yale University explored the association between industry payments to physicians and brand-name gabapentinoid prescribing. They found that between 2014 and 2016, manufacturers of 3 brand-name gabapentinoids made payments amounting to $11.5 million to more than 50,000 physicians. Physicians who received payments from the brand-name companies were almost twice as likely to prescribe the more expensive gabapentinoids instead of generic drugs.
“The relationship between doctors and the pharmaceutical industry has fueled the opioid crisis — the same thing could be happening with the gabapentinoid drugs,” said Rhee, in Medscape.