There are three different types of organizations for doctors in Canada: ones that license doctors to be able to practise and ensure that they are competent; ones that develop programs to train family doctors and specialists; and medical societies.
Medical societies are voluntary membership organizations primarily for doctors who share a common expertise in either a medical specialty (e.g., cardiology) or a common interest in a particular area of practice (e.g., rural medicine).
Societies serve important purposes: they provide continuing professional education to their members, they advocate to government and others on behalf of their members and the patients that they treat and they promote continual improvement in their area of knowledge.
Because of the nature of their work, medical societies are more likely than the other types of organizations to have interactions with companies that make drugs, medical devices or that develop medical technology. And they often receive money from these health-care companies.
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Relationships with industry
There have been reports that recommendations from societies have been influenced by financial conflicts-of-interest and calls for societies to transform their modes of operation to prevent the appearance or reality of undue industry influence on their actions.
In an article that I recently published, I looked into the relationship between Canadian medical societies and health-care companies. There are 65 specialty societies listed on the website of the Royal College of Physicians and Surgeons of Canada. Twenty-three of these societies get sponsorships from companies for their general activities and 25 get money for their annual conferences. None of the societies say how much money they get from individual companies and only two make public the total amount that they get through donations.
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When societies get money from companies, they usually feature the companies’ logos on their websites and doctors can also hyperlink to the websites of those companies.
Alarmingly, only 10 societies have public policies about how to deal with their interactions with companies. The absence of a policy about sponsorships is consistent with previous research about other aspects of the interactions between Canadian medical societies and health-care companies. Adrienne Shnier, a lawyer and adjunct professor at York University’s School of Health Policy & Management, and I found that these societies’ policies on industry involvement in continuing medical education were generally weak or non-existent.
Canadian medical societies are no different from those in other countries. Out of 131 Italian medical societies, 29 per cent had manufacturers’ logos on their web page, 4.6 per cent had an ethical code covering relationships with industry, 6.1 per cent published an annual financial report and 64.9 per cent received sponsorships for their last conference.
Industry influence
Does any of this really matter? Should we care about these relationships? There is good evidence that we should. When doctors hyperlink to company websites, they are directly exposed to information generated by those companies about their products.
A comprehensive review, of which I was one of the authors, examined the relationship between exposure to information from pharmaceutical companies and the quality, quantity and cost of physicians’ prescribing. In studies that found an association between pharma company information and prescribing, the result was either higher prescribing frequency, higher costs or lower prescribing quality. Some studies found no association, and no studies found an improvement in prescribing behaviour.
For medical societies, receiving money from companies is associated with taking actions that are favourable to the interests of those companies. Contraception guidelines released in 2011 by the Society of Obstetricians and Gynaecologists of Canada (SOGC) that endorsed the use of two oral contraceptives Yaz and Yasmin, were an almost identical copy of a consensus statement from a workshop sponsored by Bayer, the maker of these pills. The SOGC received funding from Bayer and its executive vice-president defended the guidelines.
In guidelines for prescribing opioids for chronic non-cancer pain, those produced by four organizations with conflicts of interest with opioid manufacturers had multiple “red flags,” meaning items known to introduce potential bias.
In 2009, the American Society of Hypertension partnered with its then largest donor, pharma company Daiichi Sankyo, to create a training program for the company’s sales representatives who visit doctors’ offices.
Disclosure and transparency
Medical societies need to demonstrate to their membership and to the patients they serve that their actions are not influenced by who gives them money. There are some simple measures they can undertake to help achieve that objective.
All societies should have detailed policies about interactions with commercial entities. They should publish the amounts they get from individual companies so that everyone can see what percent of their budget comes from sponsorships. Acknowledging sponsors is appropriate, but hyperlinking to their websites is not and should be stopped.
Medical societies perform valuable work, but if there are doubts about who that work benefits, that’s not good for anyone.
In 2019-2021, Joel Lexchin received payments for writing a brief on the role of promotion in generating prescriptions for Goodmans LLP and from the Canadian Institutes of Health Research for presenting at a workshop on conflict-of-interest in clinical practice guidelines. He is a member of the Foundation Board of Health Action International and the Board of Canadian Doctors for Medicare. He receives royalties from University of Toronto Press and James Lorimer & Co. Ltd. for books he has written.
