Intended for healthcare professionals

Feature BMJ Investigation

Medical royal colleges receive millions from drug and medical devices companies

BMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p1658 (Published 26 July 2023) Cite this as: BMJ 2023;382:p1658

Linked Feature

“You have to be above reproach”: why doctors need to get better at managing their conflicts of interest

Open letter

Royal colleges must be more transparent on payments from industry

  1. Hristio Boytchev, freelance investigative reporter
  1. The BMJ
  1. hboytchev{at}bmj.com

Medical royal colleges do not always disclose publicly the millions of pounds they receive from drug and medical device companies. Critics say voluntary industry transparency initiatives don’t go far enough. Hristio Boytchev reports

Royal colleges in the UK have received more than £9m in marketing payments from drug and medical devices companies since 2015, an analysis by The BMJ has found. The Royal College of Physicians and the Royal College of General Practitioners were the biggest recipients of industry money, the investigation found.

The BMJ asked the colleges to disclose all payments from industry, campaign groups, or patient associations, including the specific amount received from each donor, but they all refused to do so, other than the Royal College of Anaesthetists. The colleges are not obliged to disclose these payments; they are not included in their annual reports and are only available through voluntary industry transparency initiatives, which experts say have severe limitations.

Industry payments have become controversial in recent years, even leading to one drug company being suspended from its representative association.5 Some colleges have already cut ties: since 2012 the College of Psychiatrists of Ireland has refused to take any sponsorship from drug companies, noting that research “overwhelmingly” shows that clinicians are influenced by industry marketing and that this affects prescribing.1

“I can see no justification for anything but full and mandatory disclosure,” says Emma Hardy, Labour member of parliament and chair of the All Party Parliamentary Group on Surgical Mesh Implants. “Medicine is literally a matter of life and death, and patients must be confident they are receiving the best treatment available for the right reasons.”

“Even if we are told the information is independent, funding skews the types of education or information that gets made,” says Margaret McCartney, a general practitioner and former Royal College of General Practitioners trustee and council member. “It means that we become less independent, because we are not setting our own priorities, and that’s bad for the profession.”

The royal colleges told The BMJ that drug and medical device company payments make up a fraction of their overall budgets and that there are clear governance rules around industry payments (see box 1 for all responses from the royal colleges). The Royal College of GPs says that it will publish a full list of college sponsors from April 2024. The drug and medical device companies say that all payments to royal colleges were disclosed transparently and were given with the goal of improving patient care.

Box 1

Responses from the royal colleges

Royal College of GPs

“The college has committed to publishing an annual list of all college sponsors as of the 2023-24 financial year. Wherever possible and subject to any contractual and data handling restrictions that may exist, information on the financial bandwidths of sponsorship funding will also be included. We are not able to provide a list of past sponsors as we do not have the authorisation in place for historical agreements to make them public.”

Royal College of Physicians

“We are not financially dependent as a charity on income received from corporate partnerships, and no corporate partner has ever provided more than 1% of our annual income . . . Any continuing medical education work that has received funding includes a declaration of funding, and the [college] remains solely responsible for project design, development, and implementation. We also publish the names of corporate partners who provide more than £10 000 of support in our annual report.”

Royal College of Ophthalmologists

“We offer opportunities to sponsor our work and activities through collaborative partnerships. We only choose to work with potential funding partners who have the same shared aims as the [college].”

Royal College of Paediatrics and Child Health

“Since 2019, which was when we recorded information in that way, our received funds from pharmaceutical companies and med-tech companies have been considerably less than 1% of college income . . . We are mindful of the wide breadth of views from members and non-members around working with industry and have had many discussions in the college regarding this, hence our due diligence process.”

Royal College of Emergency Medicine

“Partnership and sponsorships form a vital part of the organisation’s fundraising mix . . . [The college] has policies and procedures, which ensure it retains its independence when working with sponsors or partners . . . In 2021 less than 1% of [the college’s] annual income came from pharmaceutical companies.”

Royal College of Obstetricians and Gynaecologists

“Since 2018, annual income from industry has remained below 2% of the overall [college] income . . . Industry involvement will be clearly listed on any [college] products or activities they have supported.”

Royal College of Surgeons of England

“Industry payments make up a small proportion of the Royal College of Surgeons of England’s total income. They are a pragmatic way of funding some of our activities without adding to the financial burden of our membership. We are keenly aware of conflicts of interest, and we do not accept funding that could undermine our reputation.”

The college said that much of the past data in the Disclosure UK database is incorrect, allocating funding to the royal college instead of organisations at the same address.

Royal College of Physicians and Surgeons of Glasgow

“By working with long-standing partners in business and industry, we are able to enhance our educational activities and drive innovation to ensure our members are able to deliver the best outcomes for their patients and inspire the next generation of healthcare professionals . . . Each partnership is considered individually to ensure the independence of the college, and must be in line with our values and ethos.”

Royal College of Anaesthetists

“We do not enter into partnerships where a commercial or industry partner seeks to influence the text of our materials in a manner favourable to its own commercial interests. Neither do we enter partnerships where financial support constitutes an inducement to recommend a particular medicine or medical device. Any new partnership with a financial value of £50 000 or more requires approval by the college’s Board of Trustees.” Data provided by the college show that industry income accounted for 0.28% of total turnover for 2015-22.

Royal College of Pathologists

“The Royal College of Pathologists has clear governance rules around corporate membership, donations, and sponsorship . . . We also have governance policies that cover conflicts of interest, declaration of interests and payments received for senior staff and trustees of the college.”

Royal College of Radiologists

“We work with partners, primarily to support events, ensuring lower costs to our members. Our sponsorship charter ensures that we consider each sponsor on its merits . . . Sponsorship of non-pharma companies amounted to £1m over five years.” The college had a lower figure for drug company payments than the one shown in the Disclosure UK database, probably owing to the college not invoicing a company or having received the payment in 2016, a college spokesperson told The BMJ.

Royal College of Surgeons of Edinburgh

“In an increasingly complex and challenging healthcare landscape, we believe working with partners, public and private, is the best way to support our profession and patients worldwide, but we do not endorse products or favour commercial parties.”

Royal College of Psychiatrists

“The college limits funding from pharmaceutical companies to a maximum of 5% of income. Actual income from pharmaceutical companies between 2015 and 2022 was significantly lower—averaging 0.31% of total income over this period . . . The college’s policy for accepting income from commercial organisations, including the pharmaceutical industry, is set out in Good Psychiatric Practice: Relationships with Pharmaceutical and Other Related Organisations.”

Royal College of Physicians of Edinburgh

“The Royal College of Physicians of Edinburgh will not accept support that could compromise who we are and what we do—or undermine our effectiveness in achieving our goals . . . As part of its ethical sponsorship policy, the college holds strict ‘avoidance criteria’ in order to avoid conflicts of interest in relation to partnerships, sponsorship, exhibitors, bequests, or gifts.”

Royal College of Nursing

“Most amounts of income that we receive from pharma are low level.” A spokesperson added that the college is “not a medical royal college . . . so suggestions of influence on training would be incorrect” and added that the payments concerned the RCN Group, of which the college is a part.

Royal College of Midwives

Declined to comment.

RETURN TO TEXT

More than £9m in payments since 2015

Drug companies gave £7.5m to royal colleges in the years 2015 to 2022, for which data were available (figs 1-5). More than half of the sum went to the Royal College of Physicians and the Royal College of GPs, which received £2.8m and £2.4m, respectively. These data were compiled from Disclosure UK, an online database run by the Association of the British Pharmaceutical Industry (ABPI), where drug companies disclose payments to healthcare organisations, patient groups, and health professionals who have consented for these payments to be made public.2

The biggest donor overall was Pfizer, with £1.8m of payments, followed by Novo Nordisk with £730 000, and Daiichi Sankyo with £478 000. The database shows that these payments were largely for sponsorships of events (£4.6m) and donations and grants (£2.3m).

The BMJ also analysed data from a similar transparency initiative for medical device companies, Transparent MedTech, which is run by MedTech Europe, the European trade association for these firms.3 For the years 2017 (J Larkin, personal communication)4 to 2021, the most recent year with available data, companies declared total payment of £1.7m to royal colleges for “educational grants” and “support to educational events.”

The top recipient was the Royal College of GPs, with £674 000, followed by the Royal College of Surgeons (England) with £414 000, and the Royal College of Surgeons of Edinburgh with £227 000. More than 90% of the money came from just two donors, Johnson and Johnson and Thermo Fisher Scientific, who donated £905 000 and £644 000, respectively.

The BMJ gathered data for all the medical royal colleges as well as other royal colleges relevant to healthcare—including the Royal College of Midwives and the Royal College of Nursing—that were published in the transparency databases.

Conflict of interest scandals

Marketing payments to medical royal colleges and other influential health organisations have gained attention recently. In March 2023 the ABPI temporarily suspended the drug company Novo Nordisk because of “serious breaches” of the association’s code of practice,5 including allegations that it covertly sponsored weight loss courses and promoted its medication to health professionals.6

In response, the two royal colleges that have received by far the most money from the company—the Royal College of GPs, which received £585 000 in 2015-22, and the Royal College of Physicians, which received £126 000—announced that they would cease collaboration with Novo Nordisk and return the sums received.78 But when The BMJ inquired whether the revelations about Novo Nordisk had led to a change in policy for dealing with industry money, none of the 16 royal colleges said that it had.

Some royal colleges have been criticised for their ties to industry in the past. In 2018 the Royal College of GPs was forced to cut ties with Emma’s Diary, a pregnancy advice magazine, after the Information Commissioner’s Office fined the company for illegally collecting and selling the personal information of more than a million people.9 In 2019, the Royal College of Paediatrics and Child Health stopped accepting funding from formula milk companies owing to public pressure.10

Limits of industry transparency initiatives

Industry transparency initiatives are the only way the public can see payments from individual companies to the colleges, but they have been heavily criticised. The ABPI only saves the data on payments for the most recent three years and deletes historical data. The BMJ accessed data from 2015 onwards, when Disclosure UK was first created, from researchers Piotr Ozieranski, a lecturer in the Department of Social and Policy Sciences at Bath University, and Shai Mulinari, a senior lecturer in sociology at Lund University.

The duo told The BMJ about irregularities with the data: payments were reported under wide categories, were changed without explanation, or were inconsistent between data sources. It is impossible to tell how much money goes to each recipient “without many hours of forensic work,” they say.

Disclosure UK has been recognised as being one of the “highest quality and most accessible industry run databases in Europe,” says Amit Aggarwal, executive director of medical affairs and strategic partnerships at the ABPI. He says that the association considers three years a reasonable period to retain data but keeps such matters under review.

Consultation on mandatory disclosure

The UK Department of Health and Social Care recently announced a public consultation on mandatory disclosure of industry payments to the healthcare sector, scheduled for the summer11—something the ABPI says it supports.

In the US, the Physician Payments Sunshine Act requires manufacturers of drugs, medical devices, and biologicals that participate in federal healthcare programmes to report payments to physicians and teaching hospitals. The UK has no transparency initiatives for other industries, including food companies, software, or data analysis companies or medical equipment firms.

All payments to royal colleges should be transparent, says Neena Modi, professor of neonatal medicine at Imperial College London and former president of the Royal College of Paediatrics and Child Health, adding that this applies to all health organisations and The BMJ itself. Modi, who was also a member of the Nestlé International Scientific Advisory Board, says that collaborations between health organisations and industry are necessary and should be remunerated.

“It is deeply disappointing that so many royal colleges negotiate these payments and don’t even tell the full and detailed truth about them,” says Susan Bewley, honorary professor emeritus in obstetrics and women’s health at Kings College London and former chair of the transparency initiative HealthSense UK. “Patients need to trust medical institutions that educate or create and implement guidelines, which should be based on best available evidence, not lobbying,” Bewley says. “Sunshine and full transparency are the very least that patients, and indeed that the doctor members of the colleges, deserve.”

Footnotes

  • Provenance and peer review: Commissioned; peer reviewed.

  • This feature has been funded by the BMJ Investigations Unit. For details see bmj.com/investigations.

References