Financial Conflicts of Interest of US-Based Authors in Neurology Journals

ObjectiveTo detail the scope, nature, and disclosure of financial conflicts of interest (COI) between the pharmaceutical and medical device industries (Industry) and authors in high-impact clinical neurology journals.MethodsUsing the Centers for Medicare and Medicaid Services Open Payments database (OPD), we retrieved information on payments from Industry to 2,000 authors from randomly selected 2016 articles in 5 journals. We categorized payments by type (Research, General, and Associated Research/institutional), sponsoring entity, and year (from 2013 to 2016). Each author's self-disclosures were compared to OPD-listed Industry relationships to measure discordance. Payments were manually reviewed to identify those from manufacturers of products that were directly tested or discussed in the article. We also quantified the prevalence and value of these nondisclosed, relevant COI.ResultsTwo hundred authors from 158 articles had at least one OPD payment. Median/mean annual payments per author were $4,229/$19,586 (General); $1,702/$5,966 (Research); and $67,512/$362,102 (Associated Research). Most neurologists received <$1,000/y (74.6%, 93.0%, and 79.5% for General, Research, and Associated Research, respectively), but a sizeable minority (>10% of authors) received more than $10,000 per year, and several received over $1 million. Of 3,013 payments deemed directly relevant to the article, 39.7% were not self-disclosed by the authors, totaling $3,379,093 ($1,446,603 General; $25,532 Research; $1,906,958 Associated Research).ConclusionIndustry-related financial relationships are prevalent among US-based physicians publishing in major neurology journals, and incomplete self-disclosure is common. As a profession, academic and other neurologists must work to establish firm rules to ensure and manage disclosure of financial COI.

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Scope and nature of financial conflicts of interest between neurologists and industry

Neurology ◽

10.1212/wnl.0000000000008067 ◽

2019 ◽

Vol 93 (10) ◽

pp. 438-449 ◽

Cited By ~ 3

Author(s):

Nathaniel M. Robbins ◽

Mark J. Meyer ◽

James L. Bernat

Keyword(s):

Medical Device ◽

Conflicts Of Interest ◽

Public Trust ◽

Trends Over Time ◽

Financial Conflicts Of Interest ◽

Open Payments ◽

Over Time ◽

Financial Relationships

ObjectiveTo detail the scope and nature of financial conflicts of interest (COIs) between neurologists and the pharmaceutical and medical device industries (Industry) using the Centers for Medicare and Medicaid Services Open Payments (OP) database, with a focus on trends from 2013 to 2016.MethodsPayments from Industry to US neurologists were categorized into research payments, general (nonresearch) payments, and value of ownership in Industry. We performed descriptive analyses to detail the scope and nature of these relationships and trends over time.ResultsAt least 9,505 neurologists received at least one payment from Industry each year. From 2013 to 2016, 1.6 million payments totaled $354 million, of which 99.5% of payments and 85.6% of payment value were for general/nonresearch-related payments. Most neurologists (between 65% and 80%) received less than $1,000 per year, but over 200 neurologists each received more than $100,000 during some years. Several received over $1 million. General payments are increasing, research payments are steady, and neurologists' ownership and investments are decreasing.ConclusionsNeurologists have extensive financial relationships with Industry, though this is driven by a well-paid minority. As a profession, we must work to establish firm rules to manage these potential COIs, ensuring that relationships with Industry yield synergistic advances while minimizing bias and maintaining public trust.

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P.013 Conflicts of interest in neurosurgical research - comparing voluntary physician disclosure to mandatory company data

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.119 ◽

2016 ◽

Vol 43 (S2) ◽

pp. S24-S24 ◽

Cited By ~ 2

Author(s):

PJ McDonald ◽

ER Shon ◽

AV Kulkarni

Keyword(s):

Voluntary Disclosure ◽

Conflicts Of Interest ◽

Average Rate ◽

Industry Data ◽

Ethical Implications ◽

The Us ◽

Financial Conflicts Of Interest ◽

Author Disclosure ◽

Open Payments

Background: Industry involvement in neurosurgical research is common, creating financial conflicts of interest (COIs). Most journals require voluntary disclosure of financial COIs. In 2013, the Sunshine Act (SA) was passed in the US, mandating industry disclosure of all payments to physicians. The accuracy of voluntary disclosure can now be determined by comparing voluntary author disclosure with industry data. Methods: We reviewed disclosure statements and calculated rates of voluntary disclosure in major neurosurgical journals before (2011) and after (2013) the Sunshine Act to determine if voluntary disclosure increased after its implementation. We then determined the accuracy of voluntary disclosure in 2013, comparing voluntary disclosure with industry disclosure on the Open Payments Database (OPD). Mean, median and range of industry payments to neurosurgeons were calculated Results: Voluntary disclosure significantly increased in JNS-Spine only (10.7% to 35.4%,p<0.001) after implementation of the SA. The average rate of non-disclosure in all journals studied was 38.3% (Range 33.8%-42.2%)$32,598,522.97 of industry payments were provided to 656 authors in the five-month period studied (Average $49,692.87/author) Conclusions: Voluntary COI disclosure in JNS- Spine increased after implementation of the Sunshine Act. Industry payments to physicians publishing in neurosurgery journals are common and rates of non-disclosure of COIs are high. The ethical implications of COIs and non-disclosure are discussed.

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Financial conflicts of interest among editorialists in high-impact journals

Blood Cancer Journal ◽

10.1038/bcj.2017.92 ◽

2017 ◽

Vol 7 (9) ◽

pp. e611-e611 ◽

Cited By ~ 4

Author(s):

V Kaestner ◽

V Prasad

Keyword(s):

Conflicts Of Interest ◽

High Impact ◽

Financial Conflicts Of Interest

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Protecting Research, Preserving Trust

10.1093/oxfordhb/9780198732372.013.12 ◽

2015 ◽

Author(s):

Josephine Johnston ◽

Naomi Scheinerman

Keyword(s):

Biomedical Research ◽

Special Interest ◽

Conflicts Of Interest ◽

Research Integrity ◽

Research Institutions ◽

The Past ◽

Financial Interests ◽

Financial Conflicts Of Interest ◽

The U.S ◽

Financial Relationships

This chapter reviews the two main concerns about financial relationships with industry: that they could conflict with research-related obligations leading to biased or flawed research and an incomplete research record, and that they could undermine trust in biomedical research, researchers, and research institutions. We show that these concerns are valid, and that they persist in the U.S., despite a gradual tightening over the past decade of rules and regulations regarding financial conflicts of interest in biomedical research. The threat that financial interests can pose to research integrity should be of special interest to psychiatry for two reasons: they are prevalent in this field, and they pose heightened risks due to the nature of psychiatry itself. Finally, we recommend that psychiatry—and individual research psychiatrists—take more seriously the threat posed by financial relationships with industry, and work together to develop additional strategies for avoiding and managing financial conflicts of interest.

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A Systematic Review of State and Manufacturer Physician Payment Disclosure Websites: Implications for Implementation of the Sunshine Act

The Journal of Law Medicine & Ethics ◽

10.1111/jlme.12136 ◽

2014 ◽

Vol 42 (2) ◽

pp. 208-219 ◽

Cited By ~ 8

Author(s):

Alison R. Hwong ◽

Noor Qaragholi ◽

Daniel Carpenter ◽

Steven Joffe ◽

Eric G. Campbell ◽

...

Keyword(s):

Systematic Review ◽

Medical Device ◽

Affordable Care Act ◽

Conflicts Of Interest ◽

Teaching Hospitals ◽

Public Disclosure ◽

Physician Payment ◽

Patient Protection ◽

Individual Physician ◽

Financial Conflicts Of Interest

Public disclosure of industry payments to physicians is one way to address financial conflicts of interest in medicine. As part of the Patient Protection and Affordable Care Act, the Physician Payment Sunshine Act (PPSA) requires pharmaceutical, medical device, and biologics manufacturers who have at least one product reimbursed by Medicare or Medicaid to disclose payments to physicians and teaching hospitals on a public website starting in 2014. The physician payment data will contain individual physician names, monetary values, and specific products connected to payments.According to the Final Regulations issued by the Centers for Medicare and Medicaid Services (CMS) in February 2013, the law will make transparent the extent and nature of relationships between physicians, teaching hospitals, and manufacturers.

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Financial conflicts of interest at three prominent oncology clinical pathway vendors.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.6529 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 6529-6529

Author(s):

Robert Michael Daly ◽

Peter Bach ◽

Ray D. Page

Keyword(s):

Clinical Pathway ◽

Conflicts Of Interest ◽

Clinical Pathways ◽

Advisory Board ◽

Treatment Pathway ◽

Prescribing Behavior ◽

The Public ◽

Financial Conflicts Of Interest ◽

American Society ◽

Open Payments

6529 Background: The American Society of Clinical Oncology (ASCO) reports that in 2015 62% of oncology practices are adhering to a clinical pathway and 31% are adhering to more than one pathway. ASCO and the American Medical Association have raised concerns about the conflicts of interest of those that design these pathways. Methods: Using the public Centers for Medicare and Medicaid Services Open Payments database, we abstracted the 2015 financial conflicts of interest for the 2016 voting members of the Value Pathways (a combined effort of US Oncology and NCCN), the medical oncology committee chairs for Via Oncology, and the medical advisory board for eviti. We focused on national pathway vendors and on non-research general payments, such as gifts, consulting, and speaker fees. Results: Nearly all involved in pathway development received non-research general payments in 2015, including 92% of US oncology, 84% of NCCN, 84% of Via Oncology, and 69% eviti. The average general payments ranged from $3.5K for US Oncology Value Pathways voting members to $15.3K for NCCN Value Pathways voting members. Eight percent of US Oncology voting members, 19% of the eviti medical advisory board, 28% of Via Oncology chairs, and 42% of NCCN voting members received $10,000 or more in general payments in 2015. Conclusions: Given the prominent role clinical pathways have on oncologists’ prescribing behavior and the often subjective nature of determining on-pathway treatment, pathway vendors should take care to make accessible their conflict of interest policies and elucidate how they manage relationships of concern.Steps would include potentially limiting the number of committee members receiving payments and limiting the amount of general payments to each physician.

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Trends in financial relationships between industry and individual medical oncologists in the United States from 2014 to 2017: A cohort study.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.6520 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 6520-6520

Author(s):

Deborah Catherine Marshall ◽

Elizabeth Stieglitz Tarras ◽

Kenneth Rosenzweig ◽

Deborah Korenstein ◽

Susan Chimonas

Keyword(s):

Cohort Study ◽

Conflicts Of Interest ◽

The United States ◽

Absolute Number ◽

Medical Oncologists ◽

Trends Over Time ◽

Inappropriate Relationships ◽

Open Payments ◽

Over Time ◽

Financial Relationships

6520 Background: Industry-physician financial relationships in medical oncology are common and introduce conflicts of interest. The Open Payments (OP) program collects and discloses data on industry payments to physicians, in part to discourage inappropriate relationships. However, the effect of OP on how oncologists engage with industry is unknown. Our aim was to evaluate trends in physician-level payments to test whether the implementation of OP has resulted in fewer physicians engaging with industry and has shifted the nature of interactions towards those considered more appropriate. Methods: We performed a retrospective cohort study of US medical oncologists in 2014 from the National Plan and Provider Enumeration System. OP data for general (non-research) payments between 2014-2017 were matched to physician to evaluate receipt of payments over time. We calculated the percentage of physicians receiving payments, annual value and number of payments, and average annual trends over time, including by nature of payment. Results: From 2014-2017, medical oncologists received 1.4 million industry payments totaling $330.6 million. The absolute number of medical oncologists receiving payments decreased 4% on average annually ( P= .006), and proportionally from 67.2% to 59.6% overall. The value and number of payments have not significantly changed. The value and number of payments increased for accredited/certified CME (+821% and +209% annually) and decreased for non-accredited/certified CME (-18% and -25% annually). The value and number of food/beverage payments remained the same. The value and number of royalty/licensing payments increased. Conclusions: Fewer oncologists are receiving payments, but spending has not decreased suggesting that physicians are less likely to engage and industry is more selective. Increased payments for accredited CME suggest that less appropriate speaker’s fees are being avoided. Food/beverage payments are not decreasing, thus these interactions may not be recognized as problematic. Increasing royalty/licensing payments require ongoing scrutiny. Changes in physician payments since the inception of OP highlight the importance of transparency in policymaking.

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