Physician directors of major cancer centers should not receive industry payments, say Gilbert Welch, MD, MPH, and David Carr, MD, both from the University of California in San Diego.
Having reported their findings on industry payments to cancer center directors in an academic journal, the pair then took to a newspaper op-ed to voice their concerns.
"National Cancer Institute (NCI) designated cancer centers have a central role in shaping cancer care in the United States," Welch and Carr write.
"Their directors should be free of industry payments in order to serve the public interest in unbiased evaluation of cancer therapies and to be in a position to make disinterested judgments about the conflicts of researchers on their faculties," they write in an August 5 op-ed piece in the LA Times.
It follows their investigation into industry payment to NCI physician directors, which they report in a research letter published August 5 in JAMA Internal Medicine.
Slightly over half of physicians who direct major academic cancer centers across the United States received no industry compensation in the year 2017, the study found.
This is the good news, Welch and Carr write in the op-ed.
"Physician directors must remain unbiased in order to objectively assess the real value of new cancer therapies," they argue.
"Of course, that means slightly under half did receive industry payments," they point out.
They found that many of the payments to directors fell under the category of "chump change" — a meal, a hotel room, an airline ticket.
However, approximately one-third of 53 NCI cancer center directors reviewed received over $5000 in 2017 — the threshold amount the NCI uses to define "significant financial interest," they note.
These findings are "bad news," they argue in the newspaper op-ed.
"Industry funding has been shown to distort medical research through a variety of mechanisms that all work in the same direction: overstating the value of new products," they comment.
As an example, they cite a 2003 study that showed that the odds of investigators reaching a pro-industry conclusion were over three times higher in industry-funded studies than in those not funded by industry.
In another study, authors who reviewed 30 trials came to the conclusion that "systematic bias favors products which are made by the company funding the research."
"If industry funding can skew academic physicians' research, imagine the problems with consulting fees, stock options and corporate board compensation," Welch and Carr comment in their op-ed.
Details of Industry Payments
In their research letter, Welch and Carr reviewed open payments data from the Centers for Medicare & Medicaid Services to look at industry payments made to physician directors of NCI-designated cancer centers across the United States between 2015 and 2017.
As of July 2017, there were 53 physician directors of NCI-designated cancer centers across the United States.
In the same year, a total of $4.42 million payments were made to the these directors, including $1.89 million in research payments made to 12 directors and $2.53 million in nonresearch payments made to 22 directors.
Of the 12 directors who received research payments, 10 received more than $5000 and four received over $50,000, Welch and Carr observe.
While 51% of the directors received no payments from industry, 36% received more than $5000 and physician directors who received payments were more likely to receive payments unrelated to research than research payments, they note.
Indeed, some 23% of physician directors received payments unrelated to research in excess of $5000, Welch and Carr point out.
Two directors also received payments of more than $50,000; the larger of these payments was for $2.27 million.
Almost all of these payments unrelated to research were categorized as "compensation for services other than consulting," they note.
"Our findings raise the question of whether industry payments to the directors of publicly supported institutions, such as NCI-designated cancer centers, serve the public interest," Welch and Carr write in the paper, somewhat rhetorically. Presumably, that is why they also wrote the newspaper op-ed, to give voice to their opinions on the matter.
Cancer is now the pharmaceutical industry's largest market and there is a lot at stake in terms of promoting — and selling — new drugs.
"There is an inherent tension between the interests of industry and those of the public in medical care," they point out.
On the one hand, the goal of industry is to maximize the price and volume of sales. While on the other hand, the public has an interest in having an unbiased evaluation of new products in order to better evaluate both their potential benefits and harms.
Welch and Carr have disclosed no relevant financial relationships.
JAMA Intern Med. Published online August 5, 2019. Abstract
LA Times. Published online August 5, 2019. Op-Ed