This article is more than 5 years old. Information may no longer be current.
Study reveals ‘greatly concerning’ lack of financial disclosures among oncologists on Twitter
Click Here to Manage Email Alerts
The majority of U.S. hematologists–oncologists who use Twitter reported at least one financial conflict of interest made public through the federal Open Payments program, according to study results published in JAMA Internal Medicine.
More than 60% of tweets authored by medical professionals in the United States are health related, and approximately 14% mention commercial products or services, researchers determined.
“Our results raise the question of how financial conflicts of interest should be disclosed and managed in an age in which information, interpretation and criticism associated with cancer products and practices are increasingly available on social media,” Vinay Prasad, MD, MPH, assistant professor of medicine in the division of hematology oncology at Knight Cancer Institute and senior scholar in the Center for Health Care Ethics at Oregon Health and Science University, and colleagues wrote.
Prasad and colleagues assessed the potential financial conflicts of interest among 634 hematologists–oncologists active on Twitter. They determined 504 (79.5%) of these physicians had some type of financial conflict of interest; 397 (62.6%) received more than $100 in general payments; and 281 (44.3%) received more than $1,000 in general payments.
HemOnc Today spoke with Prasad about the potential implications of these findings, as well as his suggestions for ways hematologists–oncologists can disclose financial conflicts of interest on social media.
Question: How did the id ea for this study come about?
Answer: I enjoy being on Twitter. Other physicians may tweet about articles they have read or new treatments, and I learn from these tweets. A few months ago, I noticed something concerning. A few oncologists were saying some laudatory things about drugs that I considered objectively marginal drugs. Also, I got in a bit of a spat on Twitter with a few other oncologists regarding the cost of cancer drugs spiraling out of control in this country. There are a few of us on Twitter who are vocal about the fact that oncologists should speak up about this because it affects our patients, who often come to our clinics and cannot afford the copays. Some oncologists on Twitter actually argued that we should stay out of the discussion. I was astonished that there were oncologists who wanted us to ‘put our heads in the sand’ and stay silent on the issue of drug prices. As a final argument, I looked up six of those oncologists who said we should keep quiet and the five oncologists who said we should speak up about it. I then tweeted that the median financial conflict for those who said we should keep quiet was $65,000. For those who said we should speak up, it was $0. I was told this was the least classy move anyone could make, whereas I thought it was the only thing that cut to the heart of the issue. On Twitter, there is no rule on financial disclosures, and doctors are tweeting about drugs and devices all of the time. We decided to do this investigation to see how many of these physicians have financial conflicts.
Q: How did you gather the data?
A: There is not a list of all oncologists on Twitter, so we started with one oncologist. We picked someone who is known to have no conflicts — me. We looked at everyone who is an oncologist who follows me on Twitter, and everyone I follow who is an oncologist. This ended up being about 100 people. Out of these 100 people, we looked at everyone they follow. This ended up being nearly 55,000 people. We went through each one of these accounts by hand and pulled out all oncologists we could find. We identified about 650 oncologists.
Q: What did you find?
A: A surprisingly large number of oncologists on Twitter have financial conflicts. In some ongoing work that we are conducting, we are looking at what percentage of these oncologists with conflicts of interest tweet about drugs with which they have a conflict, and when they tweet, do they disclose the conflict? There is a very high percentage who tweet, and there are almost no disclosures. This is greatly concerning. Although there are many forums for physicians, Twitter is a public forum. Patients read what oncologists are tweeting, and they may be getting skewed ideas on a drug or treatment. At a minimum, the person who reads these tweets has the right to know if there is a financial conflict present.
Q: Were you surprised by what you found?
A: I was surprised the number was so high. I knew it would not be zero, but I did not think it would be more than 70%. In addition, it is important to understand we are not talking about small amounts of money that these oncologists are receiving. In one of the figures in the study, we show there are oncologists who are receiving more than $50,000 per year from pharmaceutical companies. These consultant fees are more than the average annual household income in the United States. This is not small money.
Q: How can physicians list their conflicts of interest on Twitter , and why is it important for physicians to disclose financial conflicts?
A: When a celebrity is paid by a company to use a product, they tweet about it but often also use the #sponsor hashtag. How is it that celebrities have a higher transparency standard than some of our oncologists? Any time someone tweets about a drug, and they are being paid by that company, they should add a hashtag — #paidbymaker — letting readers know that. People should disclose in their bio the drug companies from which they are receiving compensation. We also call on physicians who use Twitter to list key financial disclosures in their social media biographies, perhaps with links to more complete disclosure information.
Q: Do you have plans to conduct additional research on this topic?
A: We did conduct additional research on this. We looked at how many people specifically tweet about drugs with which they have financial conflicts of interest. The number is very high. The number who actually disclose that they have conflicts is very low. This study is under review now.
Q: Is there anything else that you would like to mention?
A: Many decisions in oncology are not black and white; they are gray. Gray decisions need an expert’s judgment, but bias is problematic because there is no clear answer. Financial bias is a bias, and this has been shown in hundreds of studies. Financial conflict of interest is to bias what smoking is to carcinogens. No one says we should encourage smoking because there are other carcinogens, but there are some who argue that — until we find all the other biases in medicine — why should we focus on financial conflict of interest? I say we should deal with what we know first, and then we can look at other biases. – by Jennifer Southall
Reference:
Tao DL, et al. JAMA Int Med. 2017;doi:10.1001/jamainternmed.2016.8467.
For more information:
Vinay Prasad, MD, MPH, can be reached at Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR 97239;email: prasad@ohsu.edu.
Disclosure: Prasad reports no relevant financial disclosures.