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What these medical journals do not reveal: top doctors connect with the industry

This article was written and reported in collaboration with ProPublica, the non-profit journalism organization.

One is the Dean of the Yale Medical School. Another is the director of a cancer center in Texas. A third is the next president of the most prominent society of cancer doctors.

These leading medical personalities are among dozens of physicians who have failed to report their financial relationships with pharmaceutical and healthcare companies in the publication of their studies in recent years, according to medical journals, according to a New York Times and New York Times review from ProPublica and data from other recent investigations.

Dr. Howard A. "Skip" Burris III., The President-elect of the American Society of Clinical Oncology, said he had not been involved in more than 50 journal articles in recent years, including the prestigious New England Journal of New York Medicine.

However, pharmaceutical companies paid nearly $ 114,000 to his employer for advice and lectures, and nearly $ 8 million for his research during the period for which disclosure was required. His omissions extended to the Journal of Clinical Oncology, published by the group he will lead.

In addition to the widespread physicians, The Times and ProPublica magazine stated that magazines themselves often gave confusing advice and did not do. Englisch: bio-pro.de/en/region/freiburg/magaz…5/index.html Routine research by veterinarians, though many relationships in a federal database could easily be detected .

Medical journals that impart the latest scientific knowledge to the public often have a reciprocal relationship with Internet researchers who publish on their sites. Reporting a study to a leading journal can improve their profile – not to mention the drug or other tested product. And magazines improve their seal of approval by releasing exclusive, groundbreaking research from renowned researchers. Overall, the reporting system still seems to have many of the shortcomings that the Institute of Medicine had discovered almost a decade ago, when it recommended fundamental changes to its approach to conflicts of interest. That still has to happen.

Views on transparency are based on concern that researchers' links to the healthcare and pharmaceutical industries increase the likelihood that they will consciously or not influence results, favoring the companies they do business with. Studies have shown that industry-sponsored research tends to be more positive than research funded from other sources. And that in turn can affect which treatments are available to patients. There is no indication that Dr. Burris and the other physicians with incomplete disclosures conducted investigation was manipulated or falsified.

The magazine's editors say they introduce changes that better standardize disclosures and reduce errors. However, some have argued that since most researchers follow the rules, stringent new requirements would be costly and unnecessary.

Since September, when Dr. José Baselga, the chief physician of the Memorial Sloan Kettering Cancer, which has gained attraction, has found the subject appeal Center in New York, resigned after The Times and ProPublica reported that he had not revealed his industry relations in dozens of journal articles.

[Read more about doctors at Memorial Sloan Kettering and their financial relationships with companies.]

Dr. Burris, president of the Department of Clinical Surgery and chief physician of the Sarah Cannon Research Institute in Nashville, asked questions about the payments made to his employer. He defended it and said the payments had been made to the institution, although the New England Journal of Medicine requires disclosure of all such payments.

Other prominent researchers who have given false information include Robert J. Alpern, the dean of the Yale School of Medicine, who did not disclose a report on a Tricida-developed experimental treatment in a journal article published in 2017, which he served on the company's board of directors and owned. Tricida, which develops therapies for chronic kidney disease, had funded the clinical study that was the subject of the article.

Dr. Alpern said in an e-mail that he initially believed that his disclosure – that he had been an advisor to Tricida – was appropriate. "Because of recent concerns over disclosures," he told The American Society of Nephrology's The Clinical Journal, published in October, that he also served on the Tricida board of directors and had stock holdings in the company.

The Journal shared Alpern first with, that his disclosure was sufficient. But after The Times and ProPublica had contacted the publication in November, they claimed to correct the article.

Dr. Howard A. Burris III Credit Beth Gwinn / Getty Images

"Failure to disclose this information at the time of the peer review violates our policies," Dr. Rajnish Mehrotra, editor of the journal Chef, said in an e-mail.

He later said that an additional investigation had revealed that all 12 authors of the article had provided incomplete information and that the journal intended to refer the matter to the Ethics Committee of the American Society of Nephrology. Dr. Mehrotra also said that the magazine had decided to conduct a review of some recent articles to assess the broader issue.

Dr. Carlos L. Arteaga, director of Harold C. Simmons Comprehensive Cancer Center in Dallas, said he was the author of a study of 2016 that was published in the New England Journal of Medicine, "nothing to reveal" Kisqali, produced by Novartis. However, Arteaga had received more than $ 50,000 from pharmaceutical companies during the three-year disclosure period, including more than $ 14,000 from Novartis.

In an e-mail, Dr. Arteaga's failure as an "inexcusable mistake and error" and then submitted a correction.

Dr. Jeffrey R. Botkin, vice vice president of research at the University of Utah, recently argued in JAMA, a leading medical journal that researchers should be confronted with abuse orders if they do not disclose their relationships with interested companies. "They really distort the information others rely on to evaluate this research," he said. "Money is a very strong influencer, and people's opinions are subtly biased by this financial relationship. "

Dr. Howard C. Bauchner, editor-in-chief of JAMA, said, however, that reviewing any author's disclosures was not worth the time or effort" The vast majority of authors is honest and wants to live up to its obligation to communicate to readers and publishers "What their conflicts of interest might be," he said in an interview with Medical Journal Editors, considering a policy that would hand over to investigators who make significant disclosure mistakes, for potential misconduct charges.

Concerns over the influence of pharmaceutical companies on medical research have existed for decades. Senator Estes Kefauver held hearings on this issue in 1959, and there was renewed concern in the 2000s after a series of scandals had occurred in which prominent doctors did not disclose their industry links.

Medical journals and professional societies strengthened their requirements. The drug industry has confined itself to compensating physicians by banning gifts such as tickets for sporting events or luxury travel – although evidence of setbacks and corruption is still emerging in law enforcement. A federal law from 2010 provided that pharmaceutical and equipment manufacturers must publicly report their payments to physicians.

Despite these changes, the conflict-resolution system remains fragmented and weakly enforced. For medical journals and professional societies, there are a number of guidelines on what types of relationships need to be reported. Often the researcher has to decide what is relevant. For those who do not abide by the rules, apart from a correction, there are few effects.

For example, the American Association for Cancer Research has warned authors that they are threatening a three-year ban if it finds a potential conflict is omitted. However, the group's policy on conflicts of interest does not include a mention of such a penalty, and it was said that no author has ever been banned. The failure of Dr. Baselga revealed his industry ties to the magazine Cancer Discovery of the association, for which he is one of the two editors-in-chief. The association said that they were aware of Dr. Baselga examined.

Most authors seem to disclose their links to corporate interests. For example, about two-thirds of the authors of the Kisqali study reported relationships with companies, including Novartis. The researchers, who are not Dr. Arteaga, dr. Burris and dr. Denise A. Yardley, a senior investigator with Dr. med. Burris Collaborates with Sarah Cannon,

The Tennessee-based research center received more than $ 105,000 in Yardley's fees for consultations, lectures and other services during the three years in which she did not declare any conflicts.

The Sarah Cannon Institute indicated that it had switched to ASCO's "universal disclosure practice" a year ago. the cancer group that Dr. Burris will lead. Doctors must disclose all payments, including payments to their institutions.

"We believe we comply with the highest ethical standards in the industry by not paying personal compensation to our senior physicians," the center said. 19659003] ASCO said it had corrections to Dr. Burris & # 39; would publish disclosures in The Journal of Clinical Oncology for the past four years. The group said that Dr. Burris in the fall of 2017, as Dr. Burris aspired to a leadership role in the organization, working with him to disclose all of his business relationships, including indirect payments. Dr. Burris becomes president in June 2019.

"Medical disclosure systems and processes are not yet perfect or ASCOs," the group said in an email.

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