Dozens of physicians failed to disclose industry ties. Should that be considered misconduct?

Dozens of physicians in the past few years have failed to disclose their financial ties when they've published research in medical journals, according to a New York Times and ProPublica analysis.

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Analysis details

For the analysis, the Times and ProPublica examined whether physicians followed financial disclosure rules and reported their industry ties when they published research in medical journals, including Cancer Discovery, the Clinical Journal of the American Society of Nephrology (CJASN), and the New England Journal of Medicine (NEJM). The Times and ProPublica reviewed data from Open Payments, the federal database that tracks payments from health care companies to physicians, as well as financial disclosure statements. The Times and ProPublica also interviewed physicians, medical journal editors, and others to identify lapses in financial disclosures. 

Findings

The Times and ProPublica found many physicians and other researchers in recent years have failed to disclose their financial ties when they published research in medical journals.

For example, the Times and ProPublica found that:

  • Robert Alpern, the dean of Yale School of Medicine, did not disclose his role as a board member for the pharmaceutical company Tricida or his stock ownership in an article published last year in the Clinical Journal of the American Society of Nephrology;
  • Carlos Arteaga, director of the Harold C. Simmons Comprehensive Cancer Center, did not disclose his financial ties to Novartis in a 2016 journal article published in NEJM about the drugmaker's breast cancer drug Kisqali;
  • José Baselga, former CMO of Memorial Sloan Kettering Cancer Center, did not disclose his financial ties to Bristol-Myers Squibb and other health care companies in dozens of articles published over the past few years in Cancer Discovery, NEJM and The Lancet;
  • Howard Burris, president-elect of the American Society of Clinical Oncology (ASCO), did not identify his employer's financial ties to AstraZeneca, Genentech, and Novartis in more than 50 journal articles;
  • Craig Thompson, CEO of Memorial Sloan Kettering Cancer Center, did not include conflict-of-interest statements regarding his ties to Agios, Charles River Laboratories, Merck, and another health care company in a 2018 article published in the Journal of Clinical Investigation;
  • Jedd Wolchok, immunotherapy researcher at Memorial Sloan Kettering Cancer Center, did not disclose his financial ties to more than 30 health care companies, including Merck and BeiGene, in more than a dozen articles and letters published in NEJM and other publications; and
  • Denise Yardley, senior investigator at the Sarah Cannon Research Institute, did not disclose her employer's financial ties to Novartis in the 2016 journal article about Kisqali.

In addition, the Times and ProPublica found medical journals do not:

  • Adequately enforce financial disclosure rules;
  • Provide researchers with clear advice on what financial ties they should disclose; and
  • Vet the financial disclosures submitted by researchers, even though medical journals could easily identify financial ties using Open Payments.

However, the Times and ProPublica found medical journals recently have begun updating the financial disclosure statements of dozens of journal articles tied to the seven physicians. For instance, NEJM last week updated financial disclosures for several journal articles authored by Burris to include his affiliations to 30 health care companies.

Jennifer Zeis, a spokesperson for NEJM, said the journal is contacting the researchers who did not provide financial disclosures and is asking researchers to ensure they have checked their financial disclosures against Open Payments.

Discussion

Jeffrey Botkin, an associate vice president for research at the University of Utah, in a recent JAMA viewpoint wrote that researchers who do not disclose their financial ties should face misconduct charges. Botkin wrote, "They really are falsifying the information that others rely on to assess that research. Money is a very powerful influencer, and people's opinions become subtly biased by that financial relationship"

However, some of the researchers identified in the Times and ProPublica investigation said they had thought the disclosures they had submitted to medical journals were accurate, or their failure to submit certain disclosures was an oversight.

ASCO said, "Disclosure systems and processes in medicine are not perfect yet, and neither are ASCO's."

Bernard Lo, chair of a 2009 Institute of Medicine panel that raised concerns of financial disclosure lapses, acknowledged that medical journals have started to address systemic flaws related to financial disclosures, but said medical journals are "certainly not out in front trying to be trailblazers." He added, "The fact that it hasn't been done means that nobody has it on their priority list."

But Howard Bauchner, the editor in chief of JAMA, said implementing procedures to verify researchers' financial disclosures would not be worth the investment because "[t]he vast majority of authors are honest and do want to fulfill their obligations to tell readers and editors what their conflicts of interest could be" (Ornstein/Thomas, New York Times/ProPublica, 12/8; Thomas/Ornstein, New York Times/ProPublica, 12/8).

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