Twenty-six of the country's physician cancer center directors took in a combined $4.4 million in payments from pharmaceutical and medical-device companies in 2017, a new report found.
Authors of the paper, published online Monday by JAMA Internal Medicine, wrote that their findings raise the question of whether such payments serve the public interest and urged policymakers and the public to consider whether such payments should be allowed, limited or eliminated altogether. The report focused on National Cancer Institute-designated cancer centers, 70 of which received $330 million in core public funding in fiscal 2018.
Of the 53 physicians who are cancer center directors listed in the CMS' Open Payments database in 2017, the report found 27, or 51%, received no industry payments that year. Author Dr. David Carr, a molecular genetics pathology fellow at UC San Diego, said in an interview he was pleasantly surprised by that finding, especially since other research has found higher rates of industry payments to physicians. A 2016 JAMA Oncology study found 86% of National Comprehensive Cancer Network guideline authors had financial conflicts of interest.
"The centers that we were looking at in this study are the most prestigious cancer centers in the country," Carr said. "They're doing cutting-edge research and they're caring for thousands and thousands of cancer patients. And the fact that half of them are successfully led by nonconflicted directors is a really promising finding. We hope that over time this number continues to grow."
In cases where there were payments, they were more likely to be unrelated to research. Of the $4.4 million in total payments, $2.5 million went to 22 directors for nonresearch purposes and $1.9 million went to 12 directors for research.
Among the larger group that received payments unrelated to research, 12, or 23%, received more than $5,000, which is NCI's threshold for having a significant financial interest. Two of those received payments greater than $50,000, the larger of which was nearly $2.3 million for "compensation for services other than consulting, including serving as faculty or a speaker at a venue other than a continuing education program."
On the research side, the largest payment in 2017 was $863,000. Of the 12 directors who received research payments, 10 received more than $5,000 and four received more than $50,000.
Some have argued that research payments are less problematic, the report notes, while physicians have little reason to take industry money that's unrelated to research. But Carr argues there are plenty of reasons to be concerned about companies that have a financial stake in a study's outcome paying for the research. Industry-funded studies are more likely to reach pro-industry conclusions, he said.
While the Open Payments data shows the names of specific physicians who received industry payments, Carr said he and his co-author did not include that information because their intent was not to draw attention to specific individuals or institutions.
The NCI did not return a request for comment by deadline. The Association of American Cancer Institutes convened a conflicts of interest task force following reports by the New York Times and ProPublica that Memorial Sloan Kettering Cancer Center's chief medical officer failed to disclose several millions of dollars in payments from drug and healthcare companies when he published dozens of research articles.
The Association of American Cancer Institutes task force issued a number of recommendations, including that cancer center leaders disclose conflicts of interest at all times, including public speaking engagements and webinars. The group also says leaders should disclose all dollar amounts when applicable, regardless of any artificial money limits, such as more than $10,000.
In a separate opinion piece in the Los Angeles Times, Carr and co-author Dr. H. Gilbert Welch, a senior researcher in Brigham and Women's Hospital's Center for Surgery and Public Health, wrote that most clinical trials on new products are funded by industry, giving them considerable input in the design and conduct of research.
"That's a problem," they wrote. "The reason is simple: Industry-funded evaluations are more likely to reach pro-industry conclusions. There is a considerable body of research attesting to this fact. 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."