One of the critical questions to ask whenever reading a medical journal article is, “Who funded the study?” In most journals, researchers are required to identify their sources of funding, so what’s the problem? Well, researchers can obscure the true origin of financial support: They can hide it, disguise it, or even launder the money through a front group. A case in point is a study downplaying the risks of lung cancer that was funded in part by the Foundation for Lung Cancer: Early Detection, Prevention, and Treatment. That doesn’t sound so bad until you realize it was underwritten by millions of dollars from a tobacco company. There’s no obligation to “disclose a funding source’s source of funding,” which allows “companies to evade financial disclosure requirements” and makes it harder to “follow the money trail.”

As I discuss in my video Disclosing Conflicts of Interest in Medical Research, why does the funding source matter? Every single one of eight reviews covering over a thousand studies found that research funded by industry is more likely to make conclusions that are favorable to industry. For example, why do some review articles on the health effects of secondhand smoke reach different conclusions than others? The only factor found was whether an author was affiliated with the tobacco industry. “This is a disturbing finding. It suggests that, far from conflict of interest being unimportant in the objective and pure world of science…it is the main factor determining the result of studies.”

Not that we’d even know, because 77 percent of authors failed to disclose the sources of funding. And that’s another problem: The responsibility to disclose funding sources is left entirely up to the authors. So, how many researchers divulge the truth? Evidently, a law was passed in Denmark requiring physicians to register any time they worked with industry, which allowed researchers to cross-reference the studies physicians published to see how honest they were. Forty-eight percent of the time, the conflicts of interest were not disclosed, “reinforc[ing] the perception that physicians simply don’t take conflict of interest seriously” (or at least Danish physicians don’t).

What about the United States? Historically, there had been “no means of confirmation or verification” when an American doctor said they had no conflict of interest. Then in 2007, hip and knee replacement companies were forced to pay hundreds of millions of dollars in fines for giving orthopedic surgeons illegal kickbacks. “[M]any orthopedic surgeons in [the] country made decisions predicated on how much money they could make—choosing which device to implant by going to the highest bidder….[W]e expect doctors to make decisions based on what is in the best interests of their patients,” said the Department of Justice’s U.S. Attorney of the District of New Jersey, “not the best interests of their bank accounts.” Part of the settlement was that the companies would have to make public all the payments they made to physicians. The release of those records offered a rare opportunity to see if physicians were telling the truth on disclosure forms. And, lo and behold, more than half of payments were not disclosed, totalling millions of dollars.

That was for surgeons and medical device companies. What about doctors and drug companies? The same thing happened: Drug companies were forced to disclose who they were paying off. In looking at the publications of the doctors who got the most money—at least $100,000—the study found that they were worse than the surgeons. In 69 percent of the cases, they failed to disclose their industry ties. The problem is that we just assume researchers are going to be honest and tell the truth, but these “findings suggest that the accuracy and completeness of [conflict-of-interest] disclosures cannot be assumed.” So, even when a paper says no conflict of interest, who knows if it’s really true.

A long-time editor-in-chief of the New England Journal of Medicine wrote a scathing piece on drug companies and doctors who failed to disclose hundreds of thousands of dollars from drug companies like GlaxoSmithKline, which has been fined literally billions of dollars for activities such as bribing and suppressing data. When GSK got results that were “commercially unacceptable,” the company just buried them. Billions of dollars in fines get assessed, but for drug companies, that may just be the cost of doing business. “As reprehensible as many [drug] industry practices are…much of the medical profession is even more culpable.” We can expect drug companies to prioritize the bottom line, but maybe we should expect more from the healing profession.

What else might your doctor not be telling you? See:

Good examples of conflicts of interest include:

Instead of just disclosing conflicts of interest, how about getting rid of them? That’s the subject of my video Eliminating Conflicts of Interest in Medical Research.

In health,

Michael Greger, M.D.