Full Disclosure

Do the financial relationships between oncologists and pharma affect clinical practice in inappropriate ways? It’s a question that continues to be debated, and has been even more prominent since José Baselga, oncologist and chief medical officer at the Memorial Sloan Kettering Cancer Center, resigned after the research papers he had published failed to disclose millions of dollars worth of funds provided to him by the pharmaceutical and healthcare industries.

According to Aaron P. Mitchell, a medical oncologist at the Memorial Sloan Kettering Cancer Center, financial conflicts of interests (COI) between physicians and the drug industry are very common in the US, and a significant proportion of these interactions are oriented toward the promotion of existing drugs. In a recent study, he found that 70 percent of oncologists had received financial payments and/or in-kind compensation from the manufacturer of one or more of the cancer drugs they used (1). The study found that “gifts” varied from food, travel and lodging expenses, consulting fees, and honoraria.

“The collaboration between physicians and industry can be advantageous, particularly in the context of the development of new treatments. However, questions arise about what these relationships mean for the treatment of patients,” says Mitchell.

The study found that the promotional nature of payments often resulted in oncologists using a particular company’s drug more than alternative medicines, compared with oncologists who had not received any money.

An example outlined in the study is that of dasatinib, a highly potent BCR-ABL kinase inhibitor used for the treatment of chronic myeloid leukemia (CML). The drug is often prescribed over imatinib, a similar drug found in generic form, even though head-to-head comparison in clinical trials found them to be equally effective in preventing death from chronic-phase CML (2).

“With this choice, oncologists are choosing treatment options with greater out of pocket costs to the patient, that are not superior to alternatives,” says Mitchell. “The financial consequences for patients are significant, and bring into question the ethical and moral acceptability of these relationships between oncologists and pharma companies. Physicians should be encouraged to rely on more independent sources of information when deciding which drugs to use.”

According to Mitchell, policy changes are needed that maintain physicians’ ability to work with the pharmaceutical industry for drug development purposes and prioritize areas of clinical need, while reducing ethically problematic relationships.