Prominent medical experts who have been involved in corporate marketing campaigns do not always disclose this involvement when publishing in medical and scientific journals, sitting on committees or taking up education appointments, according to an investigation based on the Crikey Register of Influence.
The register identifies some of the associations between key opinion leaders and industry marketing or disease-awareness campaigns. Most experts listed on the register have featured in advertorials funded by pharmaceutical or other companies.
Professor Jennie Brand-Miller, the head of human nutrition at the University of Sydney, is regarded as a key opinion leader on diet after linking the traditional indigenous foods with healthy Glycemic Index (GI) control. She appeared in an advertorial in Australian Doctor (November 19, 2010), promoting GI diet during pregnancy, which was sponsored by infant formula giant Danone.
Brand-Miller is a member of the National Committee for Nutrition, which is chartered with providing education and public awareness on matters relating to nutrition in Australia. The NCN sets research policy on nutrition and regularly makes submissions to government ministers — including the prime minister — and parliamentary inquiries.
She said no payment had been made by Danone for the advertorial, so no disclosure was necessary. “The article [advertorial] served a useful purpose,” she told Crikey.
She later revealed that Danone contributed for her to attend a symposium overseas: “They paid 50% of my air fare to a symposium in Shanghai, at which I gave an invited paper. I cannot recall whether an honorarium was paid or not.”
Professor Brand-Miller has since contributed to a peer-reviewed journal article without disclosing her involvement with Danone. Carbohydrate Nutrition Is Associated with the 5-Year Incidence of Chronic Kidney Disease was first published online on January 12 by the American Society for Nutrition, arguing a high cereal fibre diet is protective against the development of chronic kidney disorder in older adults.
Professor Brand-Miller only disclosed her involvement with a not-for-profit glycemic index-based food endorsement program, University of Sydney GI testing service and as the author of The New Glucose Revolution series.
Melbourne cardiologist Associate Professor John Amerena is a based jointly at the Department of Clinical and Biomedical Sciences at the University of Melbourne and the Department of Epidemiology and Preventative Medicine at Monash University. He is a prominent medical expert in cardiology and has been widely published in his field of expertise.
Dr Amerena appeared in an advertorial for Australian Doctor (November 15, 2010) promoting a drug for prevention of cardiovascular complications in high-risk diabetic patients, funded by Boehringer Ingelheim. Dr Amerena says he only makes disclosures about his involvement with BI on certain occasions.
“I receive an honorarium for educational meetings, most of which are accredited for CME points,” he said. “[I give] disclosures for formal educational lectures and advisory boards.”
Author, journalist and conjoint lecturer at the University of Newcastle, Ray Moynihan, specialises in conflicts of interest in medicine. He says in Australia medical experts are generally not obligated to disclose commercial associations.
“These specialists write disease definitions, guidelines and treatment thresholds used by our regular GPs,” he said, explaining the Australian medical landscape tends to be very fragmented and most medical steering committees are largely directed by doctor’s associations, which are generally populated by expert physicians.
He these conflicts aren’t well enough controlled, which impacts on the level of trust the public can have in advice from medical practitioners.
The situation in the United States and the United Kingdom is similar, according to Moynihan. Yet in a recent article published in the British Medical Journal — A new deal on disease definition — he points out that significant progress has been made to better manage conflicts of interest within large establishments such as the US National Institute of Health and UK National Institute for Health and Clinical Excellence by ensuring all panel members are free of any ties with commercial entities.
“The cultural norms in medicine are changing as we speak,” he said.
In the US, change is happening fast with Congress introducing the Sunshine Act in 2009 to create transparency about the ties between doctors and drug companies. Under the act, which will be available to the public in August 2011, all contributions given to doctors by drug companies over $100 dollars in value will be recorded on a register.
Moynihan said more work needs to be done in this area: “I can’t think of anyone taking a lead on the conflict of interest problem in Australia.”
The Australian arm of the pharmaceutical company GlaxoSmithKline has made some moves, agreeing to report the total value of its payments to Australian healthcare professionals via grants, consultancies, speaking fees and other payments. As Crikey health blog Croakey reports, the company has revealed more than $2 million in payments across its local businesses.