Brian J. Piper, PhD, MS Department of Basic Sciences Geisinger Commonwealth School of Medicine Scranton, PA 18509

Medical Textbooks Riddled With Undisclosed Conflicts of Interest Interview with:

Brian J. Piper, PhD, MS Department of Basic Sciences Geisinger Commonwealth School of Medicine Scranton, PA 18509

Dr. Piper

Brian J. Piper, PhD, MS
Department of Basic Sciences
Geisinger Commonwealth School of Medicine
Scranton, PA 18509 What is the background for this study?

Response: The authors of this study are biomedical scientists, health care providers and educators who teach medical and pharmacy students. It is a standard practice in reputable medical journals like the New England Journal of Medicine to disclose conflicts of interest (CoI). Reputable sources like the Cochrane Library also disclose CoIs and analyze for their potential impact on the evidence base. Unfortunately, textbooks, which can be highly influential in the training of medical professionals, usually do not disclose their conflicts of interest.

A prior study in this quantitative bioethics area found that more than one-quarter of a team-authored pharmacology textbook, Goodman and Gilman’s Pharmacological Basis of Therapeutics, had an undisclosed patent (PLoS One, 2015; 10: e0133261). The goal of this investigation was to determine whether there were undisclosed CoIs in textbooks used in the training and as a reference for allopathic physicians, osteopathic physicians, dentists, pharmacists, nurses and other allied healthcare providers. What are the main findings?

Response: None of the six textbooks, which had a combined 1,473 authors, disclosed their conflicts of interest. The authors and editors of one textbook in particular, Harrison’s Principles of Internal Medicine, had received more than $11 million in undisclosed compensation from pharmaceutical companies and medical device manufacturers. The authors of these six textbooks had collectively received $20 million and had 677 patents. The maximum compensation was $869,413 and one author had 23 undisclosed patents. What should readers take away from your report?

Response: Biomedical textbooks, particularly those used in the training of allopathic physicians, are riddled with undisclosed conflicts of interest. This has the potential to diminish the trust of future healthcare providers and the general public in these resources. This study did not examine whether the content of these textbooks was adversely impacted by their undisclosed CoIs.

Educators choosing textbooks should encourage publishers to improve their transparency. Publishers need to disclose the CoIs of authors and editors, provide a precise definition of what constitutes a “relevant” CoI and the timeframe, and, at a minimum, provide categories of compensation ( < $5,000 or > $500,000). What recommendations do you have for future research as a result of this work?

Response: Research in this empirical bioethics area requires minimal resources but is important to insure the integrity of evidence-based medicine. One follow-up study, which is ongoing, is to examine the conflicts of interest disclosure accuracy of point-of-care computerized resources. The adage in diplomacy of “trust, but verify” may also apply here as self-reported CoIs may not always be accurate. Is there anything else you would like to add?

Response: Two online tools, ProPublica’s Dollars for Docs, and Google Scholar, were used in this research. These databases, along with the Center for Medicare and Medicaid Services Open Payments, are publicly available and can be used to identify potential CoIs of healthcare providers and scientists.

An additional finding was that fewer than one-third of authors were female. Fewer than one-seventh of authors were female in the textbook used for dental education. This is unfortunate and having a more diverse author representation is needed.

Any disclosures?

This study was unfunded. Over the course of his career, the first author of this report has received research support from pharmaceutical companies, nonprofit organizations like the Fahs-Beck Fund for Research and Experimentation, the Department of Defense and the National Institutes of Health; a speaking fee from a complementary and alternative medicine organization and has an ongoing consulting relationship with a medical cannabis dispensary. The other authors have no disclosures.


AJOB Empir Bioeth. 2018 Apr-Jun;9(2):59-68. doi: 10.1080/23294515.2018.1436095. Epub 2018 Mar 5.
Undisclosed conflicts of interest among biomedical textbook authors.
Piper BJ1,2, Lambert DA3, Keefe RC4, Smukler PU5, Selemon NA5,6, Duperry ZR7.

Aug 1, 2018 @ 5:55 pm


The information on is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.