Under-reported relationship: a comparative study of pharmaceutical industry and patient organisation payment disclosures in the UK (2012–2016)

Abstract

Objectives To examine the under-reporting of pharmaceutical company payments to patient organisations by donors and recipients.

Design Comparative descriptive analysis of payments disclosed on drug company and charity regulator websites.

Setting UK.

Participants 87 donors (drug companies) and 425 recipients (patient organisations) reporting payments in 2012–2016.

Main outcome measures Number and value of payments reported by donors and recipients; differences in reported payments from/to the same donors and recipients; payments reported in either dataset but not the other one; agreement between donor–recipient ties established by payments; overlap between donor and recipient lists and, respectively, industry and patient organisation data.

Results Of 87 donors, 63 (72.4%) reported payments but 84 (96.6%) were mentioned by recipients. Although donors listed 425 recipients, only 200 (47.1%) reported payments. The number and value of payments reported by donors were 259.8% and 163.7% greater than those reported by recipients, respectively. The number of donors with matching payment numbers and values in both datasets were 3.4% and 0.0%, respectively; for recipients these figures were 7.8% and 1.9%. There were 24 and 3 donors missing from industry and patient organisation data during the entire study period, representing 38.1% and 3.6% of those in the respective datasets. The share of donor–recipient ties in which industry and patient organisation data agreed about donors and recipients was 38.9% and 68.4% in each dataset, respectively. Of 63 donors reporting payments, only 3 (4.8%) had their recipient lists fully overlapping with patient organisation data. Of 200 recipients reporting industry funding, 102 (51.0%) had their donor lists fully overlapping with industry data.

Conclusions Both donors and recipients under-reported payments. Existing donor and recipient disclosure systems cannot manage potential conflicts of interest associated with industry payments. Increased standardisation could limit the under-reporting by each side but only an integrated donor–recipient database could eliminate it.

(Image: madstreetz/Flickr)

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This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

Strengths and limitations of this study

  • We examine the under-reporting of pharmaceutical industry payments to patient organisations using large samples of donors and recipients over a period of time.

  • We systematically compare the under-reporting by donors and recipients using five complementary measures at different levels of analysis.

  • One key limitation is that the samples of donors and recipients were not exhaustive.

  • The full extent of under-reporting remains unknown as no definitive list of payments exists.

Introduction

Many patient organisations accept funding from drug companies. A recent UK analysis showed that the industry donated over £57 million (€65 million; $73 million) to 508 patient organisations, with the annual sum more than doubling from 2012 to 2016.1 Another study of 289 US patient organisations found that 156 (67%) received funding from for-profit companies, with a median proportion of 45% of their income coming from drug, medical device or biotechnology companies.2 Although industry funding may benefit patient organisations,3 4 it raises concerns about potential conflict of interests (COIs) compromising patient organisations’ independence and credibility.5–10

Both donors11 and recipients4 assert that any COIs can be managed by careful disclosure of funding. On the donor side, since 2012 members of pharmaceutical industry trade groups in European countries,12 such as the Association of the British Pharmaceutical Industry (ABPI), have disclosed payments to patient organisations annually on each company’s website, including their monetary value and purpose.13 In the UK, the number of companies subscribing to the ABPI Code also includes over 60 non-members of the ABPI; hence, nearly every relevant company is covered.14 However, the self-regulatory approach to payment disclosure has shortcomings, including absent reports, unclear or inadequate payment descriptions and unstandardised reporting.1 15 Likewise, on the recipient side, disclosures published on patient organisations’ websites have been criticised as incomplete or uninformative.16–20 In the UK, a possibly more reliable, yet rarely examined,15 21 source of disclosures are mandatory annual accounts of patient organisations registered as charities with an annual income over £25 000. These accounts serve a dual-purpose of detailing the charity’s activities and ensuring financial transparency.

Notwithstanding the shortcomings of each side’s disclosures, and the potentially complementary information they provide, donor and recipient disclosures are rarely compared. One exception is a recent UK study which identified companies not disclosing payments to patient organisations being mentioned in their annual accounts as donors.15 Another UK study found discrepancies between annual accounts of some patient organisations contributing to health technology assessment in England and drug company payment disclosures.21 Similarly, discrepancies were found between sponsorships reported on patient organisation and drug company websites in Italy.19 More broadly, cross-interrogation of different data sources has revealed undisclosed industry ties among treatment guideline panellists,22–24 clinical trialists, authors of medical journal articles25–29 and some clinical commissioning groups30 and National Health Service trusts in England.31

We examine the under-reporting of payments to UK patient organisations from 2012 to 2016 by comparing payment disclosures made by 87 companies to 425 patient organisations with the annual accounts of the same set of patient organisations. Specifically, by considering the extent to which the industry and patient organisation disclosures differ regarding who provided and received funding, and how much was paid and received, we examine the reliability of the two disclosures systems said to neutralise concerns about COIs.

Strengths and limitations

This is the first study examining the under-reporting of payments to patient organisations using large samples of donors and recipients over a period of time. It systematically compares the under-reporting by the two sides using five complementary measures. These measures account for the varying nature of different types of payment data and therefore can be replicated elsewhere.

Our study has several limitations. First, while Disclosure UK covers a vast majority of the UK pharmaceutical industry,14 our sample was not exhaustive, as demonstrated by additional companies found in patient organisation accounts. Second, excluding companies outside of our sample is likely to have underestimated the under-reporting but reaching data saturation would require several further rounds of data scrapping. Third, we identified patient organisations using drug company disclosure reports, but sampling starting from patient organisations could have produced different results. Fourth, patient organisations registered with charity regulators but with yearly income lower than £25 000 are not required to submit annual accounts. Therefore, we might have excluded, entirely or in specific years, some of the patient organisations identified as recipients of industry funding, if their yearly incomes were below that threshold. Fifth, some patient organisations were excluded due to the conversion of financial years into calendar years, which might have increased discrepancies with drug company disclosure reports. Sixth, some companies might have reported payments from 2016 in subsequent years, but the extent of delayed reporting is likely to have been minimal,1 and there was no delayed reporting in patient organisation annual accounts. Seventh, we only considered annual accounts submitted to charity regulators, while funders might have also (or instead) been disclosed on the charity’s website. However, website disclosures are likely to undergo frequent changes, and often lack transparency.16–20 Eight, evaluating the extent of under-reporting precisely is impossible because no definitive list of payments exists; consequently, there could be payments undisclosed by both sides. Finally, considering payment descriptions could reveal further discrepancies, including different payment goals reported by donors and recipients; it could also identify payments made via third parties (eg, public relations companies43) or benefiting patient organisations indirectly.15

Conclusions and policy implications

Although the full scale of under-reporting of industry payments to patient organisations remains unknown, it concerns both donors and recipients, and involves a considerable number and value of payments. Our findings put a question mark over the key claim that—at least in their current form—publicly available payment disclosures effectively address concerns about COIs resulting from industry payments.

We provide evidence for developing easily achievable improvements in the reporting of payments by both donors and recipients. Consistent with the ABPI Code, the ABPI’s self-regulatory authority, the PMCPA, should investigate any instances of missing payments among the companies that have ratified the Code (data never published or prematurely removed from the public domain), and, if appropriate, penalise companies concerned in accordance with its mandate and available financial (so-called administrative charges) and non-financial (mainly naming and shaming) sanctions.51 52 Separately, drug companies should improve data presentation following earlier recommendations,15 especially standardisation of reporting and elimination of payments with no assigned values. Companies should store data for at least as long as is required by the Charity Commission for England and Wales, that is 5 years. Reduction in under-reporting could also be achieved if the ABPI started to publish yearly reports summarising payments to patient organisations disclosed by companies, as the ABPI currently does with payments to healthcare professionals and organisations in the Disclosure UK database.32 33 Indeed, at least one European country—Sweden—has an industry-run, centralised disclosure database of payments to patient organisations,56 and there is no reason why the ABPI should not have the same.

Given the shortcomings of the industry self-regulatory system, charity regulators should introduce tailored solutions related to reporting corporate funding in annual accounts, including a standardised template comprising a short payment description (including payment form and goal), its value and donor name. Patient organisation websites should report this information separately or include clear signposting to the annual accounts. A key step in refining these solutions would involve in-depth exploration of perspectives of patient organisations. However, ultimately, only a single state-run permanent database integrating payments reported by drug companies and patient organisations could eliminate under-reporting.

References

  1. Ozieranski PRickard E, Mulinari SExposing drug industry funding of UK patient organisationsBMJ 2019;365:l1806.doi:10.1136/bmj.l1806pmid:http://www.ncbi.nlm.nih.gov/pubmed/31122928 FREE Full TextGoogle Scholar
  2. Rose SLHighland JKarafa MTet alPatient advocacy organizations, industry funding, and conflicts of interestJAMA Intern Med 2017;177:34450.doi:10.1001/jamainternmed.2016.8443pmid:http://www.ncbi.nlm.nih.gov/pubmed/28114624 PubMedGoogle Scholar
  3. Taylor J, Denegri SIndustry links with patient organisationsBMJ 2017;356:j1251.doi:10.1136/bmj.j1251pmid:http://www.ncbi.nlm.nih.gov/pubmed/28292970 FREE Full TextGoogle Scholar
  4. Kent AShould patient groups accept money from drug companies? YesBMJ 2007;334:934.doi:10.1136/bmj.39185.461968.ADpmid:http://www.ncbi.nlm.nih.gov/pubmed/17478845 FREE Full TextGoogle Scholar
  5. Hemminki EToiviainen HK, Vuorenkoski LCo-operation between patient organisations and the drug industry in FinlandSoc Sci Med 2010;70:11715.doi:10.1016/j.socscimed.2010.01.005pmid:http://www.ncbi.nlm.nih.gov/pubmed/20163903 CrossRefPubMedGoogle Scholar
  6. McCoy MSCarniol MChockley Ket alConflicts of interest for patient-advocacy organizationsN Engl J Med 2017;376:8805.doi:10.1056/NEJMsr1610625pmid:http://www.ncbi.nlm.nih.gov/pubmed/28249131 CrossRefPubMedGoogle Scholar
  7. Fabbri ASwandari SLau Eet alPharmaceutical industry funding of health consumer groups in Australia: a cross-sectional analysisInt J Health Serv 2019;49:27393.doi:10.1177/0020731418823376pmid:http://www.ncbi.nlm.nih.gov/pubmed/30646806 CrossRefPubMedGoogle Scholar
  8. Lexchin JAssociation between commercial funding of Canadian patient groups and their views about funding of medicines: an observational studyPLoS One 2019;14:e0212399doi:10.1371/journal.pone.0212399pmid:http://www.ncbi.nlm.nih.gov/pubmed/30768629 PubMedGoogle Scholar
  9. Kang S-YBai GKaras Let alPharmaceutical industry support of US patient advocacy organizations: an international contextAm J Public Health 2019;109:55961.doi:10.2105/AJPH.2018.304946pmid:http://www.ncbi.nlm.nih.gov/pubmed/30789768 PubMedGoogle Scholar
  10. Fabbri AParker LColombo Cet alIndustry funding of patient and health consumer organisations: systematic review with meta-analysisBMJ 2020;368:l6925.doi:10.1136/bmj.l6925pmid:http://www.ncbi.nlm.nih.gov/pubmed/31969320 Abstract/FREE Full TextGoogle Scholar
  11. Pearcy JABPI guidance on drug companies and patient organisationsBMJ 2019;364:l740.doi:10.1136/bmj.l740pmid:http://www.ncbi.nlm.nih.gov/pubmed/30777855 FREE Full TextGoogle Scholar
  12. EFPIA. EFPIA code of practice on relationships between the pharmaceutical industry and patient organisations2011Google Scholar
  13. ABPI. ABPI code of practice for the pharmaceutical industry2016Google Scholar
  14. PMCPA. Annual report2016.Google Scholar
  15. Rickard EOzieranski P, Mulinari SEvaluating the transparency of pharmaceutical company disclosure of payments to patient organisations in the UKHealth Policy 2019;123:124450.doi:10.1016/j.healthpol.2019.08.007pmid:http://www.ncbi.nlm.nih.gov/pubmed/31455562 PubMedGoogle Scholar
  16. Mosconi PIndustry funding of patients’ support groups: Declaration of competing interests is rare in Italian breast cancer associationsBMJ 2003;327:344doi:10.1136/bmj.327.7410.344pmid:http://www.ncbi.nlm.nih.gov/pubmed/12907506 FREE Full TextGoogle Scholar
  17. Ball DETisocki K, Herxheimer AAdvertising and disclosure of funding on patient organisation websites: a cross-sectional surveyBMC Public Health 2006;6:201doi:10.1186/1471-2458-6-201pmid:http://www.ncbi.nlm.nih.gov/pubmed/16887025 CrossRefPubMedGoogle Scholar
  18. Rothman SMRaveis VHFriedman Aet alHealth advocacy organizations and the pharmaceutical industry: an analysis of disclosure practicesAm J Public Health 2011;101:6029.doi:10.2105/AJPH.2010.300027pmid:http://www.ncbi.nlm.nih.gov/pubmed/21233424 CrossRefPubMedGoogle Scholar
  19. Colombo CMosconi PVillani Wet alPatient organizations’ funding from pharmaceutical companies: is disclosure clear, complete and accessible to the public? an Italian surveyPLoS One 2012;7:e34974doi:10.1371/journal.pone.0034974pmid:http://www.ncbi.nlm.nih.gov/pubmed/22590498 CrossRefPubMedGoogle Scholar
  20. Lau EFabbri A, Mintzes BHow do health consumer organisations in Australia manage pharmaceutical industry sponsorship? A cross-sectional studyAust Health Rev 2019;43:474.doi:10.1071/AH17288pmid:http://www.ncbi.nlm.nih.gov/pubmed/30021681 PubMedGoogle Scholar
  21. Mandeville KLBarker RPackham Aet alFinancial interests of patient organisations contributing to technology assessment at England’s National Institute for health and care excellence: policy reviewBMJ 2019;364:k5300doi:10.1136/bmj.k5300pmid:http://www.ncbi.nlm.nih.gov/pubmed/30651227 Abstract/FREE Full TextGoogle Scholar
  22. Neuman JKorenstein DRoss JSet alPrevalence of financial conflicts of interest among panel members producing clinical practice guidelines in Canada and United States: cross sectional studyBMJ 2011;343:d5621doi:10.1136/bmj.d5621pmid:http://www.ncbi.nlm.nih.gov/pubmed/21990257 Abstract/FREE Full TextGoogle Scholar
  23. Bindslev JBBSchroll JGøtzsche PCet alUnderreporting of conflicts of interest in clinical practice guidelines: cross sectional studyBMC Med Ethics 2013;14:19doi:10.1186/1472-6939-14-19pmid:http://www.ncbi.nlm.nih.gov/pubmed/23642105 CrossRefPubMedGoogle Scholar
  24. Moynihan RLai AJarvis Het alUndisclosed financial ties between guideline writers and pharmaceutical companies: a cross-sectional study across 10 disease categoriesBMJ Open 2019;9:e025864doi:10.1136/bmjopen-2018-025864pmid:http://www.ncbi.nlm.nih.gov/pubmed/30813119 Abstract/FREE Full TextGoogle Scholar
  25. Rasmussen KSchroll JGøtzsche PCet alUnder-Reporting of conflicts of interest among Trialists: a cross-sectional studyJ R Soc Med 2015;108:101-7doi:10.1177/0141076814557878pmid:http://www.ncbi.nlm.nih.gov/pubmed/25389230 PubMedGoogle Scholar
  26. Olavarria OAHolihan JLCherla Det alComparison of conflicts of interest among published hernia researchers self-reported with the centers for Medicare and Medicaid services open payments databaseJ Am Coll Surg 2017;224:8004.doi:10.1016/j.jamcollsurg.2017.01.052pmid:http://www.ncbi.nlm.nih.gov/pubmed/28167228 PubMedGoogle Scholar
  27. Wayant CTurner EMeyer Cet alFinancial conflicts of interest among oncologist authors of reports of clinical drug trialsJAMA Oncol 2018;4:14268.doi:10.1001/jamaoncol.2018.3738pmid:http://www.ncbi.nlm.nih.gov/pubmed/30178024 PubMedGoogle Scholar
  28. Kesselheim ASWang BStuddert DMet alConflict of interest reporting by authors involved in promotion of off-label drug use: an analysis of Journal disclosuresPLoS Med 2012;9:e1001280doi:10.1371/journal.pmed.1001280pmid:http://www.ncbi.nlm.nih.gov/pubmed/22899894 CrossRefPubMedGoogle Scholar
  29. Cherla DVOlavarria OAHolihan JLet alDiscordance of conflict of interest self-disclosure and the centers of Medicare and Medicaid servicesJ Surg Res 2017;218:1822.doi:10.1016/j.jss.2017.05.037pmid:http://www.ncbi.nlm.nih.gov/pubmed/28985847 CrossRefPubMedGoogle Scholar
  30. Moberly TThe pharma deals that CCGs fail to declareBMJ 2018;360:j5915.doi:10.1136/bmj.j5915pmid:http://www.ncbi.nlm.nih.gov/pubmed/29298768 FREE Full TextGoogle Scholar
  31. Moberly TNHS joint working with industry is out of public sightBMJ 2019;364:l1353.doi:10.1136/bmj.l1353pmid:http://www.ncbi.nlm.nih.gov/pubmed/30917947 FREE Full TextGoogle Scholar
  32. Ozieranski PCsanadi MRickard Eet alAnalysis of pharmaceutical industry payments to UK health care organizations in 2015JAMA Netw Open 2019;2:e196253e53.doi:10.1001/jamanetworkopen.2019.6253pmid:http://www.ncbi.nlm.nih.gov/pubmed/31225896 PubMedGoogle Scholar
  33. Mulinari S, Ozieranski PDisclosure of payments by pharmaceutical companies to healthcare professionals in the UK: analysis of the association of the British pharmaceutical industry’s disclosure UK database, 2015 and 2016 cohortsBMJ Open 2018;8:e023094doi:10.1136/bmjopen-2018-023094pmid:http://www.ncbi.nlm.nih.gov/pubmed/30344175 Abstract/FREE Full TextGoogle Scholar
  34. Office for National Statistics. CPIH index2019. Available: https://www.ons.gov.uk/economy/inflationandpriceindices/timeseries/l522/mm23 [Accessed 22 Nov 2019]. Google Scholar
  35. Ozieranski PCsanadi M, Rickard EUnderreporting of drug industry payments to patient organisations in the UK (2012-2016) Bath2020Google Scholar
  36. Gregory AWatchdog: patient charities must come clean about big pharma cashThe Sunday Times2019Google Scholar
  37. Gregory APatients’ charity Pain UK took cash from Big PharmaThe Sunday Times2019Google Scholar
  38. Vitry A, Löfgren H16. Health consumer groups and the pharmaceutical industry: is transparency the answer? InDemocratizing health: consumer groups in the policy process2392011Google Scholar
  39. Rose SLPatient advocacy organizations: institutional conflicts of interest, trust, and trustworthinessLos Angeles, CASAGE Publications Sage CA:2013Google Scholar
  40. Moynihan R, Bero LToward a healthier patient voice: more independence, less industry fundingJAMA Intern Med 2017;177:3501.doi:10.1001/jamainternmed.2016.9179pmid:http://www.ncbi.nlm.nih.gov/pubmed/28114596 PubMedGoogle Scholar
  41. Charity Commission for England and Wales. Charities SORP (FRS 102)InAccounting and reporting by charities: statement of recommended practice2014Google Scholar
  42. Ozieranski PRickard EMulinari S, Ridley SHExposing drug industry funding of UK patient organisationsBMJ 2019;365:l1806.doi:10.1136/bmj.l1806pmid:http://www.ncbi.nlm.nih.gov/pubmed/31122928 FREE Full TextGoogle Scholar
  43. Charity Commission for England and Wales. Pain UK: regulatory compliance case conclusions2019Google Scholar
  44. Jones GCharities will not have to name donors, says SORP CommitteeCivil Society News2017Google Scholar
  45. Kanter GPExtending the sunshine act from physicians to patient advocacy organizationsAm J Public Health 2018;108:9789.doi:10.2105/AJPH.2018.304520pmid:http://www.ncbi.nlm.nih.gov/pubmed/29995484 PubMedGoogle Scholar
  46. Lin DHLucas EMurimi IBet alFinancial conflicts of interest and the centers for disease control and prevention’s 2016 guideline for prescribing opioids for chronic painJAMA Intern Med 2017;177:4278.doi:10.1001/jamainternmed.2016.8471pmid:http://www.ncbi.nlm.nih.gov/pubmed/28114444 PubMedGoogle Scholar
  47. Rosenthal MB, Mello MMSunlight as disinfectant–new rules on disclosure of industry payments to physiciansN Engl J Med 2013;368:20524.doi:10.1056/NEJMp1305090pmid:http://www.ncbi.nlm.nih.gov/pubmed/23718162 CrossRefPubMedWeb of ScienceGoogle Scholar
  48. Baggott R, Jones KThe big society in an age of austerity: threats and opportunities for health consumer and patients’ organizations in EnglandHealth Expect 2015;18:216473.doi:10.1111/hex.12185pmid:http://www.ncbi.nlm.nih.gov/pubmed/24602084 CrossRefPubMedGoogle Scholar
  49. Parker LFabbri AGrundy Qet al“Asset exchange”-interactions between patient groups and pharmaceutical industry: Australian qualitative studyBMJ 2019;367:l6694doi:10.1136/bmj.l6694pmid:http://www.ncbi.nlm.nih.gov/pubmed/31831471 Abstract/FREE Full TextGoogle Scholar
  50. Just Treatment. About2020. Available: https://justtreatment.org/about [Accessed 30 Mar 2020]. Google Scholar
  51. Zetterqvist AVMerlo J, Mulinari SComplaints, complainants, and rulings regarding drug promotion in the United Kingdom and Sweden 2004-2012: a quantitative and qualitative study of pharmaceutical industry self-regulationPLoS Med 2015;12:e1001785doi:10.1371/journal.pmed.1001785pmid:http://www.ncbi.nlm.nih.gov/pubmed/25689460 CrossRefPubMedGoogle Scholar
  52. PMCPA. About us2020. Available: https://www.pmcpa.org.uk/about-us/ [Accessed 30 Mar 2020]. Google Scholar
  53. Charity Commission for England and Wales. Do charity annual reports and accounts meet the reader’s needs? Accounts Monitoring Review2017Google Scholar
  54. OSCR. Annual monitoring2020. Available: https://www.oscr.org.uk/managing-a-charity/annual-monitoring/ [Accessed 30 Mar 2020]. Google Scholar
  55. Charity Commission for Northern Ireland. Getting it right. guidance to assist charities in complying with their legal obligations and explain how the charity Commission for Northern Ireland identifies and addresses non-compliance2019Google Scholar
  56. LIF. Etik: LeR2020. Available: https://www.lif.se/etik/samarbetsdatabaser/ [Accessed 30 Mar 2020]. Google Scholar

 

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