23 Jan Textbooks Used to Train Physicians Lack of Conflict of Interest Transparency
MedicalResearch.com Interview with:
Brian Piper PhD
Department of Medical Education
Geisinger Commonwealth School of Medicine
Center for Pharmacy Innovation & Outcomes
Geisinger Precision Health Center
MedicalResearch.com: What is the background for this study?
Response: Disclosure of funding sources is standard practice for journal articles and clinical practice guidelines in order to alert readers to potential conflicts of interest (CoI). However, CoI disclosure is uncommon for textbooks. A new edition of Goodman and Gilman’s Pharmacological Basis of Therapeutics (GG-PBT) was recently published. This is affectionately known as “the blue bible of pharmacology” because it is widely used in the training of doctors, pharmacists, dentists, scientists, and nurses. This provided an opportunity to extend upon past research2,3 and determine whether the authors and editors had undisclosed CoIs.
MedicalResearch.com: What are the main findings?
Response: Twenty-seven of the contributors to GG-PBT received $3 million from pharmaceutical companies and medical device manufacturers which was undisclosed to readers. The highest compensated author received more than $700,000. An author of the dermatological pharmacology chapter had received almost $500,000 ($493,536) for ivermectin, a head lice treatment.
Three other findings were noteworthy.
- First, we also looked at how old the citations were. Citations in GG-PBT (11.5 ± 0.2 years) were significantly older than those of two other textbooks, Katzung’s Basic and Clinical Pharmacology (10.4 ± 0.2) and DiPiro’s Pharmacotherapy: A Pathophysiologic Approach (9.1 ± 0.1).
- Second, only one-fifth (20.9%) of the 115 GG-PBT authors were female (Figure). This was less than other books, especially those used for pharmacists.
- Third, even among another textbook where the authors self-reported their CoI, these were not always accurate. The author of an epilepsy chapter who listed “none” for conflicts of interest had received more than $500,000 ($533,633) for anti-epileptic drugs according to the Center for Medicare and Medicaid Service’s Open Payments database.
Figure 1. Percent of pharmacology textbook contributors who were female. * p < .05 versus Goodman & Gilman’s Pharmacological Basis of Therapeutics.
MedicalResearch.com: What should readers take away from your report?
Response: Disclosure of conflicts of interest is an important part of evidence-based medicine. There is much room for improvement in how this is reported by textbooks. This is important because these resources are widely used by health care providers, especially during their early formative years when their practice patterns are established. As it only takes about two minutes to access databases like Dollars for Docs4 and look up potential conflicts of interest, medical education resources should consider including the links to the authors so patients can be better informed.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: The Open Payments database has been expanded to include nurse practitioners and physician assistants. We would like to extend these studies1-3 to medical information written by NP and PA authors.
MedicalResearch.com: Is there anything else you would like to add?
Response: This type of applied bioethics research is relatively easy to do with tools like Dollars for Docs.4 There was a very high correspondence ( r = 0.99) between the amount received by authors as reported in Dollars for Docs and Open Payments. The three million in undisclosed conflicts of interest in GG-PBT is likely an under-estimate as half of authors were not reported by these databases
MedicalResearch.com: Any disclosures?
BJP is supported by Health Resources Services Administration (D34HP31025), the Fahs-Beck Fund for Research and Scholarship, and Pfizer and received an honorarium for reviewing a pharmacology textbook. DYK is now employed with a biotechnology company. The other authors have no disclosures.
- Piper BJ, Alinea AA, Wroblewski JR, Graham SR, Chung DC, McCutcheon LRM, et al. A quantitative and narrative evaluation of Goodman and Gilman’s Pharmacological Basis of Therapeutics. Pharmacy2019; https://www.mdpi.com/2226-4787/8/1/1
- Piper BJ, Telku HM, Lambert DA. A quantitative analysis of undisclosed conflicts of interest in pharmacology textbooks. PLoS One2015, 10, e0133261.
- Piper BJ, Lambert DA, Keefe RC, Smukler PU, Selemon NA, Duperry ZR. Undisclosed conflicts of interest among biomedical textbook authors. American Journal of Bioethics: Empirical Bioethics2018, 9, 59–68.
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