Concern over neurologists’ undeclared financial relationships with industry

By Michael Woodhead

13 Apr 2021

Some neurologists who publish in leading journals have extensive undeclared financial relationships with pharmaceutical and medical device companies, a study shows.

An analysis of articles published in high-impact journals such as Neurology, JAMA Neurology, Lancet Neurology, Annals of Neurology and Brain found that industry payments were going to a well-paid minority of authors, many of whom failed to disclose the conflict of interests.

The review, which covered articles published between 2013 and 2016, focused on 423 US-based neurologists who would have industry payments listed on the Open Payments Database.

It found that about half (52.7%) the authors had no financial links to industry, and most industry payments to neurologist authors were less than US$1000 a year.

However, more than one in six neurologists (18%) who published in the major journals received payments of more than US$10,000 a year, and a handful received over US$1 million per year.

Worryingly, just over half of 3000 industry payments deemed directly relevant to an article were not self-disclosed by the authors. In many articles, authors stated they had no interest to declare when the Open Payments Database showed they had received consultancy and speaker fees, industry research funding to the author or associated funding to the author’s institution.

The review also found that 56 of the neurology authors wrote an article directly related to a drug or device, and almost half (48.2%) of these authors received payment from the relevant industry.

Despite journal policies mandating disclosure of relevant conflict of interest, all but two of these authors did not completely disclose their relevant relationships.

The mean industry payments for academic neurologists were US$19,586 per year in consultancy and speaker fees, US$5,966 in research payments and US$362,102 for associated (institutional) funding for research.

These industry payments to academic neurologists were higher than for neurologists in general, suggesting that “academic leaders, as a result of their expertise, are better positioned to synergistically advance neurologic science through industry cooperation,” the review authors wrote.

“It may also reflect a concerted effort from industry to shape medical opinion and practice; by paying key opinion leaders to speak at company events, Industry pays for leaders’ widespread influence on the prescribing patterns of other physicians,” they said.

However they noted that many industryphysician relationships were healthy, and would not necessarily lead to bias. 

“Whether disclosure actually does mitigate bias and safeguard scientific integrity in cases of COI remains an open debate, as does the optimal level of disclosure; too many disclosures can be distracting and detract from the relevant ones, while underdisclosure limits the readers ability to contextualise an authors conclusions.”

The review investigators said some of the undeclared financial conflicts of interest may have occurred because neurologists did not know about payments to their institutions, or because they could not keep track of all their potential links with industry and the articles they authored.

“However, the sheer magnitude of industry relationships should not preclude accurate reporting of COI, and it remains imperative to transparently disclose relevant payments,” they suggested.

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