Second only to the American Society of Clinical Oncology, the volunteer leaders of the American College of Rheumatology with ties to industry received the highest median payment amounts, a new cross-sectional study reveals.
Steven Echard
Total research payments exceeded $54 million to ASCO leaders and $20 million to ACR leaders, for example. The investigators identified the 10 most common and costly conditions in the United States – including heart disease, trauma-related disorders, mental disorders, and others. They then used a new national database to explore the financial relationships between pharmaceutical and device manufacturers and the leaders of “influential U.S. professional medical associations active across these disease areas.” Steven Echard, executive vice president of the American College of Rheumatology, responded to the study findings, published in the BMJ. “We require our leaders to tell us about any payments they receive as part of their professional and personal activities that may pose actual or potential conflicts, post this information transparently to our website, and adjust what projects and initiatives they can participate in to avoid any undue influence,” he said in an interview.
“Many of the disclosures included in the study were due to individuals participating in research projects to move the needle forward in the care of rheumatology patients,” he added.
There remains an ongoing debate about how close the relationships should be between medical associations and industry, wrote lead author Ray Moynihan, PhD, assistant professor in the Institute for Evidence-Based Healthcare at Bond University, Gold Coast, Australia, and colleagues.
Majority report relationship with industry
Dr. Moynihan and associates conducted the first study to evaluate these relationships in such detail. Using the U.S. government’s Open Payments database, established in 2013, they assessed research payments and general payments for consultancy, royalties, and hospitality. The study included the current year of board membership, as well as the 4 years prior and 1 year after membership.
Overall, out of 293 physician association leaders, 235 or 80% had a financial relationship. None of the associations in the study featured a leadership free of financial ties.
Payments totaled almost $130 million, including nearly $25 million in general payments, almost $105 million for research, and about half a million in other payments. The research payments went primarily to institutions with leaders named as principal investigators, they noted.
“The most common misperception [in the BMJ study] is that all the funding identified represents personal payments to the individuals,” Mr. Echard said. “Because research dollars are included, almost 80% of the payments referenced in the article – sometimes more – go to individuals’ academic institutions.” These funds cover overhead, lab materials, protected time for said research, research assistant salaries, and other expenses.
“We have other board of director members who have no industry relationships at all,” he added.
Part of business model
“Faculty members are expected to bring in funding to support research, so most academic institutions receive industry funding, and it’s considered part of their business model,” Mr. Echard said. “For this reason, we generally do not consider these payments the same as being on advisory boards, speakers bureaus, or going to dinners, etc.”
The median total amounts linked to individual leaders varied between associations. For example, the median amount was $518,000 for ASCO leaders, as previously reported by Medscape Medical News.
Volunteer leaders for the ACR received a median $251,000. Not all ACR board of director members receive funding in this range, Mr. Echard said. “We have board of director members who work at academic institutions that can receive funding that high due to their participation in research studies, particularly when looking over a 4-year period prior to their leadership role, as the study did.”
At the lower end, median total payments were $404 for leaders of the American College of Physicians and $212 for those of the American Psychiatric Association.
In an accompanying editorial, Jake Checketts, DO, and Matt Vassar, PhD, of the Oklahoma State University Center for Health Sciences, Tulsa, proposed five actions that “could mitigate or even eliminate the overwhelming presence of financial conflicts of interest among medical societies and associations. This would protect these groups from producing biased documents or policies, which in turn would protect all physicians and the patients they treat.”
They made five proposals:
- Each association must take the initiative to evaluate its present conflicts using open payments.
- Associations should alter their recruitment processes to yield balanced and diverse groups of physician leaders largely free from financial conflicts of interest.
- The creation of standards for promoting medical associations that are free from financial conflicts of interest, similar to the framework within the Institute of Medicine’s standards for producing clinical practice guidelines we can trust.
- Greater reliance on the Sunshine Act and open payments in the United States (and elsewhere for countries with similar data) could eliminate the need for the traditional “honor system” of financial self-disclosure, which is ineffective and inaccurate at best.
- All medical associations, guidelines groups, and policy makers provide links from their documents and websites to open payments data for each U.S.-based physician contributor. Such links would make it easier for anyone, including patients, to evaluate any risk of bias.
On a final note, the ACR prohibits key college leaders, including the ACR president, ACR president-elect, foundation president, and others from having direct financial ties to commercial entities in their conflict of interest guidelines.
“We agree that actively managing conflict of interest is important to maintaining the integrity and reputation of an association with the medical community and with the public,” Mr. Echard said. “And all actual, potential, and perceived conflicts of interest should be addressed and managed through a disclosure process.”
Several authors of the study reported receiving grants from the Australian National Health and Medical Research Council. Mr. Echard, Dr. Checketts, and Dr. Vassar had no relevant disclosures.
SOURCE: Moynihan R et al. BMJ. 2020;369:m1505.