How financial conflicts of interest affect medicine

Ahn R, et al. Financial ties of principal investigators and randomized controlled trial outcomes: cross sectional study. BMJ. 2017;356.

Not neonatology but a study of how principal investigators’ financial ties to the pharmaceutical industry are associated with outcomes of controlled trials of drug efficacy funded by either industry drug wholesalers or non-industry sources. The authors searched Google with the name of the PI and the drug company producing the medication being tested in a randomized controlled trial, they also used a couple of databases to identify the financial links between investigators and drug companies. Two thirds of the PIs had some financial ties with the companies producing the drugs that they were testing.

Of all principal investigators, 156 (39%) reported advisor/consultancy payments, 81 (20%) reported speakers’ fees, 81 (20%) reported unspecified financial ties, 52 (13%) reported honorariums, 52 (13%) reported employee relationships, 52 (13%) reported travel fees, 41 (10%) reported stock ownership, and 20 (5%) reported having a patent related to the study drug. The prevalence of financial ties of principal investigators was 76% (103/136) among positive studies and 49% (29/59) among negative studies. In unadjusted analyses, the presence of a financial tie was associated with a positive study outcome (odds ratio 3.23, 95% confidence interval 1.7 to 6.1). In the primary multivariate analysis, a financial tie was significantly associated with positive RCT outcome after adjustment for the study funding source (odds ratio 3.57 (1.7 to 7.7).

Most of the financial ties were not clearly reported on the primary publication. Even for publicly funded trials financial links with industry are associated with a much higher chance that you will show that the drug that you have a vested financial interest in is effective. I don’t know what we can do about such things, realistically. I have received travel expenses (usually indirectly through the organizing committee of a conference) from industry (specifically from Mallickrodt and from Chiesi) . I think we should make more effort to be transparent about all of these links, and more effort to reduce them and make them more arms length also.

Two other articles address related issues this week, the first (Lin DH, et al. Financial conflicts of interest and the centers for disease control and prevention’s 2016 guideline for prescribing opioids for chronic pain. JAMA internal medicine. 2017) examined comments sent to the CDC following release of a new guideline which aimed to restrict opioid prescribing in the hope of having an impact on the current epidemic of opioid related deaths in the USA (which is spreading across Canada also, from Vancouver in our direction). There were 158 organisations who submitted comments about the draft guidelines, one third of them received financial support from opioid manufacturers, those organisations were much more likely to be negative about the guideline, (although many were positive and some submitted suggestions to improve). Organisations were not required to state any potential conflicts when submitting comments so these authors also had to do a bit of detective work to find these links.

The CDC should require commenters to reveal their potential conflicts of interest.

Another article examined financial conflicts of interest among Hematologist-Oncologists who use Twitter, although we don’t know what they were tweeting about in this study, other research has shown that physicians using twitter tweet about medical subjects more than 60% of the time and often mention drugs or medical products. They found that 80% of the Twitter active Hematologists had a financial conflict of interest. I don’t think that there are many who report, or have a link to a report of, their potential conflicts of interest.

Twitterers beware!


About Keith Barrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
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