Patients, clinicians favor disclosure of financial ties to industry

A review and analysis of previously published studies finds that patients, research participants and journal readers believe financial relationships between medicine and industry should be disclosed, in part because those financial ties may influence research and clinical care, according to a report in the April 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

"Financial ties to the pharmaceutical, biotechnology and medical device industries are common in clinical medicine and biomedical research," the authors write as background information in the article. "In clinical care, financial ties affect how physicians prescribe drugs and use devices, and may otherwise influence professional behavior. In research, financial ties have been associated with biased analysis and presentation of data, restrictions on publication and reduced sharing of data. As a result, financial ties have recently received substantial attention from the media and policymakers." Public disclosure of these ties has been recommended or required by medical associations, medical journals, lawmakers, academic medical centers and companies.

Despite this demand for disclosure, little is known about how financial information affects decision-making, the authors note. Adam Licurse, B.A., of Yale School of Medicine, New Haven, Conn., and colleagues systematically reviewed 20 original studies assessing the attitudes of patients, research participants and journal readers toward financial disclosures.

Of these studies, 11 assessed financial ties and perceptions of quality. "In clinical care, patients believed financial ties decreased the quality and increased the cost of care," the authors write. "In research, financial ties affected perceptions of study quality. In two studies, readers' perceptions of journal article quality decreased after disclosure of financial ties."

Eight studies evaluated the acceptability of financial ties. In these studies, patients were more likely to view personal gifts to clinicians as unacceptable than professional gifts. "Patients were concerned that these gifts affect the cost and quality of care and that these gifts influence clinical judgment," the authors write.

In six of 10 studies examining the importance of disclosure, most patients and research participants reported believing financial ties should be disclosed. In the other four, about one-fourth of these populations believed ties should be disclosed. "Although many disclosure recipients want to know about financial ties, fewer believed that disclosure would affect their decision-making," the authors continue. "Most research participants were not concerned about physician financial ties with industry, with as few as 7 percent reporting concern in one study."

"As information on physician and researcher financial ties becomes more publicly available, further research is needed to explore the optimal format for widespread consumer use and the effect on patient decision-making in clinical care and research," they conclude.

(Arch Intern Med. 2010;170[8]:675-682. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: Co-author Dr. Joffe served as a paid member of a Data and Safety Monitoring Committee for a Genzyme Corporation clinical trial. Dr. Gross has served as an expert witness. This study was supported by a Doris Duke Clinical Research Fellowship. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

"During the past decade, a legion of biomedical ethicists, medical students, journalists and elected officials have demanded increased openness in the form of public reporting of financial relationships at the institutional, state and national level," writes Eric G. Campbell, Ph.D., of the Institute for Health Policy, Massachusetts General Hospital, Boston, in an accompanying editorial.

"From a policy perspective, it seems likely that public disclosure is a first step toward a more active role by government and health care institutions in evaluating and managing physician-industry relationships," Dr. Campbell writes. "In the least, these relationships will no longer be a part of the hidden culture of medical practice in the United States, and this transparency will help prevent the further erosion of public trust in the medical profession."

(Arch Intern Med. 2010;170[8]:667. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org. To contact editorial author Eric G. Campbell, Ph.D., call Sue McGreevey at 617-724-2764 or e-mail smcgreevey@partners.org.