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Just OUT in @JAMAInternalMed

People say pharma payments to docs don't matter b/c it pales in comparison to salary.

It turns out 20% of academics get >10% annual income from Pharma. ~4% get 50%!

This caps 5 yrs of work on FCOI
[Thread - reflections]…
For the last 5 years, a small part of our research
(strangely, the least popular part)
has been to studied the impact pharma payments to doctors.

This current paper caps off that work, which I will summarize here.
We first explored the conflicts among public speakers at FDA drug advisory meetings.

Not surprisingly they were numerous, and conflicted speakers spoke glowingly of new drugs…
Turns out this also occurs at the level of State Medicaid agency's Health Technology Assessment programs…
We got interested in how disclosure happens at ASCO, and found 38% of conflict of interest slides were flashed faster than humans can read.

What I call "token disclosure"
We don't want to fix the problem, but will say we will.…
We turned to heme onc docs on twitter and found that they were HEAVILY conflicted…
This appeared to influence the content of their tweets

if you are paid by the maker, you are tweeting more positively about the drug.

At the time of our study, nearly no one disclosed financial ties on twitter…
We looked at the hired academic experts at FDA drug advisory meetings, and found they were pocketing a median of 40k

Payments went hand in hand with impact factor and citations…
We also studied if financial ties to pharma help or hurt careers, and it appears it...…

We found editorialists in high impact journals often conflicted, and in some cases in violation of stated rules.…
We found that FDA reviewers most often, after leaving the FDA, go to work for pharma

"revolving door"…
Nearly everyone at FDA advisory meetings is conflicted past, present or future with pharma…
Putting this all together, I have come to see the great cancer inside cancer medicine-- consuming us-- is the financial ties from pharma to experts.

This poisons everything

Like campaign finance reform, it must be fixed first…
I map the course back to sensible medicine in Malignant, still coming soon…
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