Intended for healthcare professionals

Rapid response to:

Feature BMJ Investigation

Medical royal colleges receive millions from drug and medical devices companies

BMJ 2023; 382 doi: (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

Rapid Response:

How many bite the hand that feeds them? Industry funding of self-censorship

Dear Editor

According to research published in the BMJ in 2020, 72% of leaders of influential US professional medical associations have financial relationships with industry.[1] It therefore seems that Boytchev’s investigation[2]—finding many royal colleges have financial ties with the drug and medical device industries—adds one more to the list marking the “special relationship” between the UK and US.

In their defense, the royal colleges told The BMJ that industry funding represents “a fraction of their overall budgets.” The Royal College of Physicians said “no corporate partner has ever provided more than 1% of our annual income.” Other royal colleges stated pharmaceutical companies provide a similarly small percentage of overall college income.[2]

What can we make of such statements? The implication seems to be that, because the amounts comprise a small contribution to overall budgets, industry funding does not matter—and certainly would not contribute to bias in the royal colleges.

We disagree for the simple reason that many people dare not bite the hand that feeds them.

One of the most concerning aspects of ties to industry—no matter their size, nor whether payments are disclosed—is that they promote the self-censorship of views that are critical of industry and its products. Industry funding need not even alter the private views of recipients for this to occur. For example, consider the possibility that the leadership of some of these organizations hold views critical of industry in general, and/or have concerns about specific medical products. As stewards of royal colleges in receipt of industry funding, will they air those concerns? We think industry funding reduces the chance that they will. In contrast, the reverse--in which individuals self-censor an industry-friendly viewpoint--seems unlikely.

When medical leadership refrains from voicing criticism due to industry funding, such self-censorship contributes to a false impression of the landscape of views. It helps justify the labeling of critical viewpoints as “minority” or “fringe.” It enables the perception of “scientific consensus” around a given issue when in reality no such consensus exists.

Open debate over the safety and efficacy of drugs, biologics, and devices is central to scientific discourse, the progress of medicine, and the health and welfare of patients. Self-censorship is incompatible with that requirement.

Peter Doshi
Kim Witczak
Linda Wastila


[1] 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 May 27;369:m1505. doi: 10.1136/bmj.m1505.

[2] Boytchev H. Medical royal colleges receive millions from drug and medical devices companies. BMJ. 2023 Jul 26;382:1658. doi: 10.1136/bmj.p1658.

Competing interests: PD is senior editor, investigations, The BMJ. He has also received travel funds from the European Respiratory Society (2012) and Uppsala Monitoring Center (2018); grants from the FDA (through University of Maryland M-CERSI; 2020), Laura and John Arnold Foundation (2017-22), American Association of Colleges of Pharmacy (2015), Patient-Centered Outcomes Research Institute (2014-16), Cochrane Methods Innovations Fund (2016-18), and UK National Institute for Health Research (2011-14); and was an unpaid IMEDS steering committee member at the Reagan-Udall Foundation for the FDA (2016-2020). The views and opinions do not necessarily reflect the official policy or position of the University of Maryland.

04 August 2023
Peter Doshi
Associate professor
Kim Witczak, Linda Wastila
University of Maryland School of Pharmacy
Baltimore, MD, U.S.A.