Industry funding of patient and health consumer organisations: systematic review with meta-analysisBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.l6925 (Published 22 January 2020) Cite this as: BMJ 2020;368:l6925
- Alice Fabbri, postdoctoral research associate1,
- Lisa Parker, postdoctoral research associate1,
- Cinzia Colombo, researcher2,
- Paola Mosconi, head of laboratory2,
- Giussy Barbara, gynaecologist3,
- Maria Pina Frattaruolo, gynaecologist3,
- Edith Lau, pharmacist1,
- Cynthia M Kroeger, postdoctoral research associate1,
- Carole Lunny, postdoctoral research associate4,
- Douglas M Salzwedel, information specialist4,
- Barbara Mintzes, associate professor1
- 1Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW 2006, Australia
- 2Laboratory of Medical Research on Consumer Involvement, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
- 3Gynaecology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- 4Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Correspondence to: B Mintzes
- Accepted 4 December 2019
Objective To investigate pharmaceutical or medical device industry funding of patient groups.
Design Systematic review with meta-analysis.
Data sources Ovid Medline, Embase, Web of Science, Scopus, and Google Scholar from inception to January 2018; reference lists of eligible studies and experts in the field.
Eligibility criteria for selecting studies Observational studies including cross sectional, cohort, case-control, interrupted time series, and before-after studies of patient groups reporting at least one of the following outcomes: prevalence of industry funding; proportion of industry funded patient groups that disclosed information about this funding; and association between industry funding and organisational positions on health and policy issues. Studies were included irrespective of language or publication type.
Review methods Reviewers carried out duplicate independent data extraction and assessment of study quality. An amended version of the checklist for prevalence studies developed by the Joanna Briggs Institute was used to assess study quality. A DerSimonian-Laird estimate of single proportions with Freeman-Tukey arcsine transformation was used for meta-analyses of prevalence. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) was used to assess the quality of the evidence for each outcome.
Results 26 cross sectional studies met the inclusion criteria. Of these, 15 studies estimated the prevalence of industry funding, which ranged from 20% (12/61) to 83% (86/104). Among patient organisations that received industry funding, 27% (175/642; 95% confidence interval 24% to 31%) disclosed this information on their websites. In submissions to consultations, two studies showed very different disclosure rates (0% and 91%), which appeared to reflect differences in the relevant government agency’s disclosure requirements. Prevalence estimates of organisational policies that govern corporate sponsorship ranged from 2% (2/125) to 64% (175/274). Four studies analysed the relationship between industry funding and organisational positions on a range of highly controversial issues. Industry funded groups generally supported sponsors’ interests.
Conclusion In general, industry funding of patient groups seems to be common, with prevalence estimates ranging from 20% to 83%. Few patient groups have policies that govern corporate sponsorship. Transparency about corporate funding is also inadequate. Among the few studies that examined associations between industry funding and organisational positions, industry funded groups tended to have positions favourable to the sponsor. Patient groups have an important role in advocacy, education, and research, therefore strategies are needed to prevent biases that could favour the interests of sponsors above those of the public.
Systematic review registration PROSPERO CRD42017079265.
Contributors: AF, CC, PM, EL, and BM conceived the study idea. DMS conducted the literature search. AF, LP, CC, PM, EL, MPF, GB, and BM screened abstracts and full texts and acquired the data. CMK and CL analysed the data. AF wrote the first draft of the manuscript. All authors edited drafts of this article and approved the final version. BM is the guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
Funding: There is no specific funding for this study. AF was supported as a postdoctoral fellow by the National Health and Medical Research Council of Australia (NHMRC), project grant No 1122332. CMK was supported as a postdoctoral fellow by the NHMRC, project grant No 1139997.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; PM and CC report an unconditional grant from the Smith Kline Foundation outside the submitted work; PM and CC are authors of some of the studies included in the review and were not involved in extracting data from or assessing the quality of their own studies; PM is a member of the Board of Europa Donna, the European Breast Cancer Coalition; BM is a member of the European network of Health Action International (HAI-Europe) and given this relationship she was not involved in extracting data from or assessing the quality of the two studies published by HAI-Europe2041; BM acted as an expert witness on behalf of plaintiffs in a Canadian class action suit on cardiovascular risks of testosterone; the remaining authors declare no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: Not required.
Data sharing: All data relevant to the study are included in the article or uploaded as supplementary information.
The senior author (BM) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.
Dissemination to participants and related patient and public communities: Systematic review results will be disseminated to patient groups through publicly accessible conferences, workshops, and the media.
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