Medical journals don’t reveal doctors’ ties to industry
One is dean of Yale’s medical school. Another is the director of a cancer center in Texas. A third is the next president of the most prominent society of cancer doctors.
These leading medical figures are among dozens of doctors who have failed in recent years to report their financial relationships with pharmaceutical and health care companies when their studies are published in medical journals, according to a review by The New York Times and ProPublica and data from other recent research.
Dr. Howard A. “Skip” Burris III, president-elect of the American Society of Clinical Oncology, for instance, declared that he had no conflicts of interest in more than 50 journal articles in recent years, including in the prestigious New England Journal of Medicine.
However, drug companies have paid his employer nearly $114,000 for consulting and speaking, and nearly $8 million for his research during the period for which disclosure was required. His omissions extended to the Journal of Clinical Oncology, which is published by the group he will lead.
In addition to the widespread lapses by doctors, the review by The Times and ProPublica found journals themselves often gave confusing advice and did not routinely vet disclosures by researchers, although many relationships could have been easily detected on a federal database.
Medical journals, which are the main conduit for communicating the latest scientific discoveries to the public, often have an interdependent relationship with the researchers who publish in their pages. Reporting a study in a leading journal can heighten their profile — not to mention that of the drug or other product being tested. And journals enhance their cachet by publishing exclusive, breakthrough studies by acclaimed researchers.
In all, the reporting system still appears to have many of the same flaws that the Institute of Medicine identified nearly a decade ago when it recommended fundamental changes in how conflicts of interest are reported. Those have yet to happen.
“The system is broken,” said Dr. Mehraneh Dorna Jafari, an assistant professor of surgery at the University of California, Irvine, School of Medicine. She and her colleagues published a study in August that found, of the 100 doctors who received the most compensation from device makers in 2015, conflicts were disclosed in only 37 percent of the articles published in the next year. “The journals aren’t checking and the rules are different for every single thing.”
Calls for transparency stem from concerns researchers’ ties to the health and drug industries increase the odds they will, consciously or not, skew results to favor the companies with whom they do business. Studies have found industry-sponsored research tends to be more positive than research financed by other sources. And in turn can sway which treatments become available to patients. There is no indication the research done by Burris and the other doctors with incomplete disclosures was manipulated or falsified.
Journal editors say they are introducing changes that will better standardize disclosures and reduce errors. But some have also argued that since most researchers follow the rules, stringent new requirements would be costly and unnecessary.
The issue has gained traction since September, when Dr. José Baselga, who was chief medical officer of Memorial Sloan Kettering Cancer Center in New York, resigned after The Times and ProPublica reported he had not revealed his industry ties in dozens of journal articles.
Burris, president of clinical operations and chief medical officer at the Sarah Cannon Research Institute in Nashville referred questions about the payments to his employer. It defended him, saying the payments were made to the institution, although The New England Journal of Medicine requires disclosure of all such payments.
Other prominent researchers who have submitted erroneous disclosures include Dr. Robert J. Alpern, dean of the Yale School of Medicine, who failed to disclose in a 2017 journal article about an experimental treatment developed by Tricida that he served on that company’s board of directors and owned its stock. Tricida, which is developing therapies for chronic kidney disease, had financed the clinical trial that was the subject of the article.
Alpern said in an email that he initially believed that his disclosure — that he had been a consultant for Tricida — was adequate. However, “because of concerns recently raised about disclosures,” he said he notified the publication, The Clinical Journal of the American Society of Nephrology, in October that he also served on Tricida’s board and had stock holdings in the company.