Financial relations between leaders of US medical societies and industryBMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1811 (Published 27 May 2020) Cite this as: BMJ 2020;369:m1811
All rapid responses
The editorial about the study showing that 80% of US based physician leaders of professional medical associations had financial ties to industry “that could unduly influence medical practice and research” deserved comment.(1,2)
Firstly, one must confess that since 2010 Lo’s editorial in the New England Journal of Medicine calling a spade a spade with the title “Serving Two Masters” the issue has been remaining an uncontrolled epidemic which now infects patients associations.(3)
Secondly, could the proposed “five steps” “mitigate or even eliminate the overwhelming presence of financial conflicts of interest”?(1)
1) “association must take the initiative to evaluate its present conflicts” but 93% of the leader of the Orthopedic Trauma Association and the Infectious Diseases Society of America have industry ties. To paraphrase Einstein, we cannot solve our problems with those who created them.
2) “associations should alter their recruitment processes to yield balanced and diverse groups of physician leaders largely free from financial conflicts of interest” has the same drawback. Further, vague terms such as “balanced” and “largely free” are free rides for any tricks. No spoon can be long enough to soup with the drug industry when considering its record.(4)
3) “the creation of standards for promoting medical associations that are free from financial conflicts of interest” will be window dressing as there are neither will nor adequate resources for monitoring and enforcing already existing regulations yet. Tacitus warned “The more corrupt the state, the more numerous the laws.”
4 and 5) certainly “ the reliance” on the Open Payments Databases rather than on self-disclosure will improve transparency but will produce that same results that it has on Wall Street, namely sustaining the status quo with a loss of public confidence in oversight. Last, disclosing conflicts is not dissolving influences.
No solution if no concern for the roots:
a) Why healthcare schemes, frequently national and even more mandatory as in France, do in fact fund the industry to influence prescriptions when they reimburse prescriptions to citizens?
b) Why fraudulent activities in health care are not prosecuted in European countries as in the US?(4) However, settlements, a US judicial euphemism for fines, are too small for revenues. Outterson suggested that “companies might well view such fines as merely a cost of doing business”.(5) Indeed, in July 2012, the recidivist GlaxoSmithKline agreed to pay $3 billion without impact on the continuous rise in share price. Could provisions for such expenses be part of planned fraudulent strategies? Corporate executives should be liable.(6) When Forest Laboratories pleaded guilty to marketing violations in September 2010 and agreed to a $313 million settlement, Obama administration gave up the plan for banning Forest Laboratories from any government contracting, meaning it wanted Solomon gone. Solomon reached the 27th rank on the Forbes Executive Pay in 2011, from the 100th in 2010. Too big to jail?
1 Checketts J, Vassar M. Financial relations between leaders of US medical societies and industry. BMJ. 2020;369:m1811.
2 Moynihan R, Albarqouni L, Nangla C, Dunn AG, Lexchin J, Bero L. Financial ties between leaders of influential US professional medical associations and industry: cross sectional study. BMJ 2020;369:m1505.
3 Parker L, Fabbri A, Grundy Q, Mintzes B, Bero L. "Asset exchange"-interactions between patient groups and pharmaceutical industry: Australian qualitative study. BMJ. 2019;367:l6694.
4 Braillon A. Drug industry is now biggest defrauder of US government. BMJ 2012;344:d8219.
5 Outterson K. Punishing health care fraud--is the GSK settlement sufficient? N Engl J Med. 2012;367:1082-5
6 Pitts P. The bully pulpit. The Hill. Available at http://thehill.com/blogs/congress-blog/healthcare/181565-the-bully-pulpit Accessed 6 June 2020.
Competing interests: AB is among industry independent experts from Jeanne Lenzer’s list.(https://jeannelenzer.com/list-independent-experts)