Prominent medical experts who have been involved in corporate marketing campaigns do not always disclose this involvement when publishing in medical and scientific journals, sitting on committees or taking up education appointments, according to an investigation based on the Crikey Register of Influence.
The register identifies some of the associations between key opinion leaders and industry marketing or disease-awareness campaigns. Most experts listed on the register have featured in advertorials funded by pharmaceutical or other companies.
Professor Jennie Brand-Miller, the head of human nutrition at the University of Sydney, is regarded as a key opinion leader on diet after linking the traditional indigenous foods with healthy Glycemic Index (GI) control. She appeared in an advertorial in Australian Doctor (November 19, 2010), promoting GI diet during pregnancy, which was sponsored by infant formula giant Danone.
Brand-Miller is a member of the National Committee for Nutrition, which is chartered with providing education and public awareness on matters relating to nutrition in Australia. The NCN sets research policy on nutrition and regularly makes submissions to government ministers — including the prime minister — and parliamentary inquiries.
She said no payment had been made by Danone for the advertorial, so no disclosure was necessary. “The article [advertorial] served a useful purpose,” she told Crikey.
She later revealed that Danone contributed for her to attend a symposium overseas: “They paid 50% of my air fare to a symposium in Shanghai, at which I gave an invited paper. I cannot recall whether an honorarium was paid or not.”
Professor Brand-Miller has since contributed to a peer-reviewed journal article without disclosing her involvement with Danone. Carbohydrate Nutrition Is Associated with the 5-Year Incidence of Chronic Kidney Disease was first published online on January 12 by the American Society for Nutrition, arguing a high cereal fibre diet is protective against the development of chronic kidney disorder in older adults.
Professor Brand-Miller only disclosed her involvement with a not-for-profit glycemic index-based food endorsement program, University of Sydney GI testing service and as the author of The New Glucose Revolution series.
Melbourne cardiologist Associate Professor John Amerena is a based jointly at the Department of Clinical and Biomedical Sciences at the University of Melbourne and the Department of Epidemiology and Preventative Medicine at Monash University. He is a prominent medical expert in cardiology and has been widely published in his field of expertise.
Dr Amerena appeared in an advertorial for Australian Doctor (November 15, 2010) promoting a drug for prevention of cardiovascular complications in high-risk diabetic patients, funded by Boehringer Ingelheim. Dr Amerena says he only makes disclosures about his involvement with BI on certain occasions.
“I receive an honorarium for educational meetings, most of which are accredited for CME points,” he said. “[I give] disclosures for formal educational lectures and advisory boards.”
Author, journalist and conjoint lecturer at the University of Newcastle, Ray Moynihan, specialises in conflicts of interest in medicine. He says in Australia medical experts are generally not obligated to disclose commercial associations.
“These specialists write disease definitions, guidelines and treatment thresholds used by our regular GPs,” he said, explaining the Australian medical landscape tends to be very fragmented and most medical steering committees are largely directed by doctor’s associations, which are generally populated by expert physicians.
He these conflicts aren’t well enough controlled, which impacts on the level of trust the public can have in advice from medical practitioners.
The situation in the United States and the United Kingdom is similar, according to Moynihan. Yet in a recent article published in the British Medical Journal — A new deal on disease definition — he points out that significant progress has been made to better manage conflicts of interest within large establishments such as the US National Institute of Health and UK National Institute for Health and Clinical Excellence by ensuring all panel members are free of any ties with commercial entities.
“The cultural norms in medicine are changing as we speak,” he said.
In the US, change is happening fast with Congress introducing the Sunshine Act in 2009 to create transparency about the ties between doctors and drug companies. Under the act, which will be available to the public in August 2011, all contributions given to doctors by drug companies over $100 dollars in value will be recorded on a register.
Moynihan said more work needs to be done in this area: “I can’t think of anyone taking a lead on the conflict of interest problem in Australia.”
The Australian arm of the pharmaceutical company GlaxoSmithKline has made some moves, agreeing to report the total value of its payments to Australian healthcare professionals via grants, consultancies, speaking fees and other payments. As Crikey health blog Croakey reports, the company has revealed more than $2 million in payments across its local businesses.
Good article but why do we have to rely on investigative journalists to dig this sort of stuff out?
Memo to Dr Steve Hambleton, the new head of the AMA.
What about a register allowing (compelling?) doctors to declare their “vested interests”? As citizens and patients, do we not have a right to know? And if not, why not? (Somebody MUST have suggested this before surely!)
It’s incredible that financial planners have to disclose their interests, among others, but somehow “Doctors” (most of which haven’t really met the academic criteria for a real doctorate), seem to be untouchable. As an allied health professional, I’ve been appalled by the lack of competence in the prescriptions of many (not the majority) of GPs, and am surprised that they haven’t been sued already.
Memo to “Dr” Steve Hambleton – there are many allied health professionals who can see the incompetence of many of your members…allied health professionals also know a lot about evidence-based practice, and can make compelling expert witnesses against dodgy “Doctors”. By the way, Steve, what was the topic of your doctoral dissertation? Did you also contribute to overall knowledge, in order to be awarded a “Doctorate”?
Yes, as Moynihan states, the situation is certainly changing in regards to our impression of the infallibility of medicine and those who recommend certain procedures to us.
But even if a line were drawn and starting today, no more ‘experts’ who are actually being paid by drug companies were on any government committees or speaking in public about what they are paid to say, the damage is done.
For decades, these people have allowed their vested interests to determine how we treat, cure and prevent disease in Australia and around the world. The outcome is that medicine is now the number 1 leading cause of death and nothing has been done to improve this situation. We need to go back to the drawing board, question everything we thought was true before and put an emphasis on evidence-based medicine – not medicine by consensus.
A great start would be for the TGA to no longer be funded by cost recovery whereby all of their operating expenses come from drug licensing fees, making them totally beholden to pharmaceutical companies. There should also be a 5-year ban on TGA and other government health employees leaving their low-paid (relatively) jobs with the public sector and going to work for pharmaceutical companies.
The TGA should be funded to actually run independent safety and efficacy trials on all currently licensed and new medications rather than relying on the drug companies to do this job. Another step in the right direction would be a national requirement to report adverse reactions following administration of any drug or vaccine with penalties for lack of reporting.
Meryl Dorey
Australian Vaccination Network
The new online publication “The Conversation” contains the following statements of intention:
“We aim to be a site you can trust. All published work will carry attribution of the authors’ expertise and, where appropriate, will disclose any potential conflicts of interest, and sources of funding. Where errors or misrepresentations occur, we will correct these promptly. under the CV of each author”
In my reading of this publication they seem to be achieving useful disclosure. It still relies on the integrity of the author of course.
The use of apostolic opinion leaders is fairly standard in the medicines industry. The companies worked out a long time ago it is easier to get a key opinion leader onside and let everyone follow through the usual professional mechanisms of referral, lectures etc than it is to try and convince everyone at all levels of the food chain of your products merits.
When I worked for TGA, it was amazing the lineup of people who came to talk to us bureaucrats. It was also amazing the crap you can get a world expert to say when he’s being paid to say it.
I know its just a silly line by the AVN, but in that line there needs to be some way of accounting for commercial interest other than TGA doing all its own trials. Really, there is isn’t enough money in the country to do that – let alone the health budget. And it isn’t necessary, because the problem isn’t the data, its the use of well groomed opinion to spin it to the profession.
I think there should be a clinical trial register and the unedited regulatory reports of all trials should be available to the public and professionals. FDA actually are close to that with their online database, and we should be a lot closer. Then you need to adequately fund a non-commercial body to produce synopses of this data – TGA can do that but doesn’t really have the technical resources, and the National Prescriber is probably better.
Finally, you need to get doctors to read the boring stuff and not the glossy commercial version. So no more ads in OzDoc, not more dinners, no more sponsored lecture tours.
Like political donations, you choke the money you solve the problem of influence.