When physicians tweet about a drug, medicine or other commercial product, they might have ties to its maker that they are not disclosing, suggests a small study published Tuesday in JAMA Internal Medicine.
The study examined the tweeting habits of 634 hematologist-oncologists in the U.S. and found that 504 of them, or nearly 80%, had financial conflicts of interest ranging from $100 to upwards of $1,000.
Twitter gives physicians direct access to cancer patients who are active on the social media site and follow oncologists who treat their cancer. But unless conflicts of interest are disclosed, patients might not know if a physician tweeting praises about a treatment has received payments from that drug's maker.
“Twitter is a concentration of conflicted oncologists,” said Dr. Vinay Prasad, the corresponding author of the study who is a hematologist-oncologist and assistant professor of medicine at the Oregon Health and Sciences University. He said he had no conflicts to report, a claim that public data available on ProPublica's Dollars for Docs website confirms.
The researchers are still sifting through tweets to find where physicians disclosed those conflicts. So far, they've come up empty-handed.
“(In) not a single example we've looked at so far have we seen a single person say, 'By the way, I'm paid by…'” Prasad said, describing the tweets as “superlative soup” that often lauded specific treatments or combinations. “It's usually super positive messages: 'FDA approved this new drug'...This drug combination is 'pretty amazing.'”
The researchers looked at financial conflict of interest data from the year 2014 through ProPublica's Dollars for Docs website and the CMS' Open Payments website. They examined general payments, which cover costs such as consulting fees and food, and they looked at research payments, which include research funding.
The 504 doctors found to have conflicts of interest received a median general payment of $1,644.77 and a median research payment of $11,064.21. Of those doctors, 44.3% received more than $1,000 in funding from companies such as drug- and devicemakers.
“Our results raise the question of how FCOIs (financial conflicts of interest) should be disclosed and managed in an age in which information, interpretation and criticism associated with cancer products and practices are increasingly available on social media,” the researchers wrote.
“As a minimum standard, physicians who are active on Twitter should disclose financial conflicts of interest in their five-line profile biography, possibly with a link to a more complete disclosure,” they suggested.
Or, Prasad proposed, they could use hashtags along the lines of #Igetpaidbythemaker or #financialconflict.
Cancer patients who are active on Twitter often follow oncologists who treat that cancer, Prasad said. As a result, these physician have a direct line to patients who might not know that a physician tweeting about a treatment has received money from the drug's maker.
“I think people have the right to at least know if there's untoward influence,” Prasad said.
The 634 hematologist-oncologists represented approximately 4% of all practicing hematologist-oncologists in the U.S. In their study, the researchers acknowledged that this fraction of a subspecialty represented a tiny proportion of practicing physicians in the U.S. These and other limitations should inspire further study into conflicts of interest among tweeting physicians, they wrote.
The idea for the study came from being embroiled in “vicious debate” on Twitter about a year ago, said Prasad. He had been tweeting that oncologists needed to speak up when cancer drugs cost too much, and five physicians responded that it was not his place to comment. Six others defended him.
“It got to be such a nasty debate that I looked up all 11 people in the conflict of interest database,” Prasad said. “I found that of the five people (who said oncologists should not comment on costs) ... the median conflict was $64,000.”