Beth Skwarecki
August 03, 2015
Pediatric professional organizations are not transparent enough about their relationships with pharmaceutical companies and comply with fewer than half of best practice guidelines, according to a study of nine influential organizations.
“Although issues of conflict of interest are relevant for all [professional medical organizations (PMAs)], they may be of particular importance for the PMAs of pediatric prescribers,” Matthew Siegel, MD, from the Maine Medical Center Research Institute, Portland; the Developmental Disorders Program, Spring Harbor Hospital, Westbrook, Maine; and the Departments of Psychiatry and Pediatrics, Tufts University School of Medicine, Boston, Massachusetts, and colleagues write. Drug trials are often exclude pediatric populations, leaving prescribers to work off-label and perhaps be more dependent on industry relationships, they note in their article published online August 3 in Pediatrics.
The Physician Payments Sunshine Act requires public disclosure of payments larger than $10 to physicians, but does not apply to professional medical organizations, which the authors describe as both representing and influencing prescribers. Industry relationships with organizations may include support such as funding of meetings, grants and fellowships, and publications.
Dr Siegel and colleagues studied organizations chosen by five “physician leaders” in pediatrics, child psychiatry, and developmental behavioral pediatrics; organizations that were named as influential by at least two of the physicians were included in the study. The nine organizations include groups not specific to pediatrics, such as the American Medical Association and the American Psychiatric Association, as they were judged to be influential among pediatricians.
Two research assistants without ties to any of the professional organizations (and who were blinded to each other’s work) assessed each organization’s website with a 36-item checklist derived from best practice guidelines published in JAMA in 2009. These guidelines were meant to help organizations work toward a ban on industry support other than clearly labeled advertising.
Organizations were considered “compliant” with a recommendation if there was publicly available evidence that were adhering to a recommendation. They were considered “transparent” if the information could be found on the organization’s website.
The investigators created an industry relationship index that awarded points for transparency and compliance for each item on the checklist, for a total of 66 points.
The scores ranged widely, from 8 to 51, with a mean of 30.2 and a standard deviation of 15.6. The highest scores went to the American Academy of Neurology (51) and American Academy of Child and Adolescent Psychiatry (49). The lowest were the American Psychiatric Association (18) and American Association of Nurse Practitioners (18) and the Society for Developmental and Behavioral Pediatrics (8). The American Academy of Pediatrics, which publishes Pediatrics, had a score of 46.
The investigators could not find a clear relationship between the score and the organizations’ size, budget, or other factors. However, they did note that the organizations with the largest budgets had medium scores, suggesting a large budget may help to meet some requirements but not allow enough separation from industry.
Organizations were least compliant with recommendations that promote financial separation from industry and most compliant with those that recommend disclosures, the authors write. “Although some organizations may assume that disclosure of potential conflicts is an adequate shield from the risks financial ties with industry pose to public perception, it is a distinction that may be unappreciated by the public and legislators.”
Limitations of the study include a reliance on websites as read by a small number of researchers (which may be a good way to measure transparency but may not give a complete view of compliance) and the equal weighting of all items in the checklist.
The authors have disclosed no relevant financial relationships.
Pediatrics. Published online August 3, 2015.