KEY TAKEAWAYS

• The medical product industry is deeply connected to all players in the healthcare ecosystem via financial and non-financial ties, which are seldom transparently reported.
• If left unregulated, these conflicts of interest can impact patient care.

The medical product industry has extensive relationships with virtually every player in the healthcare ecosystem, though these conflicts of interest are rarely described or quantified, according to a study published in The BMJ.

Dr Susan Chimonas and co-authors performed a scoping review of 538 publications covering 37 countries to identify and characterise ties between the medical product industry (pharmaceutical, medical device, and biotechnology companies) and individuals/organisations in healthcare. The latter represented a broad spectrum of constituents making up the healthcare ecosystem: government (eg, regulatory agencies), market supply chain (eg, purchase and distribution agents), healthcare profession (eg, medical schools, journals), and non-profits (eg, advocacy organisations).

A panel of experts was enlisted to validate the team’s findings and aid in mapping the complex relationships. The resulting network map demonstrated that industry players have permeated the healthcare ecosystem, both directly and indirectly, maintaining some level of influence across the following activities:

• research
• clinical care
• health professional education
• guideline development
• formulary selection.

Industry involvement was highest in research (disclosed in 56% of the publications) and lowest in formulary selection (1%).

Industry involvement was highest in research (disclosed in 56% of the publications) and lowest in formulary selection (1%).

Finally, the team assessed whether these conflicts of interest were regulated or documented systematically. While financial ties were sometimes subject to national and/or international oversight (such as the US government’s Open Payments website), non-financial ties were notably less transparent. For instance, the authors found no evidence of oversight for relationships between the industry and public officials, regulators, public health agencies, payers, or purchasing and distribution agents.

These complex, often undisclosed relationships trickle down to affect patient care. The article supplement offers a poignant example of how industry funding and non-financial pressure contributed to the opioid epidemic, which has to date resulted in hundreds of thousands of deaths.

“Medical product industry influence could undermine healthcare equity and sustainability by driving up costs for individual patients and the healthcare system overall”.

The authors cautioned that there are likely many more examples of harm caused by this kind of industry influence, and that without greater regulation, reduced healthcare equity and affordability are to be expected.

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