Undisclosed conflicts of interest among biomedical textbook authors

ABSTRACT

Background: Textbooks are a formative resource for health care providers during their education and are also an enduring reference for pathophysiology and treatment. Unlike the primary literature and clinical guidelines, biomedical textbook authors do not typically disclose potential financial conflicts of interest (pCoIs). The objective of this study was to evaluate whether the authors of textbooks used in the training of physicians, pharmacists, and dentists had appreciable undisclosed pCoIs in the form of patents or compensation received from pharmaceutical or biotechnology companies. Methods: The most recent editions of six medical textbooks, Harrison's Principles of Internal Medicine (_HarPIM), Katzung and Trevor's Basic and Clinical Pharmacology (_KatBCP), the American Osteopathic Association's Foundations of Osteopathic Medicine (_AOAFOM), Remington: The Science and Practice of Pharmacy (_RemSPP), Koda-Kimble and Young's Applied Therapeutics (_KKYAT), and Yagiela's Pharmacology and Therapeutics for Dentistry (_YagPTD), were selected after consulting biomedical educators for evaluation. Author names (N = 1,152, 29.2% female) were submitted to databases to examine patents (Google Scholar) and compensation (ProPublica's Dollars for Docs [PDD]). Results: Authors were listed as inventors on 677 patents (maximum/author = 23), with three-quarters (74.9%) to _HarPIM authors. Females were significantly underrepresented among patent holders. The PDD 2009–2013 database revealed receipt of US$13.2 million, the majority to (83.9%) to _HarPIM. The maximum compensation per author was $869,413. The PDD 2014 database identified receipt of $6.8 million, with 50.4% of eligible authors receiving compensation. The maximum compensation received by a single author was $560,021. Cardiovascular authors were most likely to have a PDD entry and neurologic disorders authors were least likely. Conclusion: An appreciable subset of biomedical authors have patents and have received remuneration from medical product companies and this information is not disclosed to readers. These findings indicate that full transparency of financial pCoI should become a standard practice among the authors of biomedical educational materials.

KEYWORDS:

• author
• dentist
• disclosure
• medical education
• pharmacist
• pharmacotherapy

Conflicts of interest

BJP has received travel support from the Wellness Connection of Maine and research support from the Center for Wellness Leadership, the National Institute of Drug Abuse, and is a Fahs–Beck Fellow. All other authors have no conflicts of interest.

Acknowledgments

Lillian A. Eckstein and Carly Lappas provided technical support. Melissa A. Birkett, PhD, and Joseph Fraiman, MD, provided feedback on an earlier version of this article. The ProPublica organization is acknowledged for the Dollars for Docs database. This report is based on the analysis of the authors and does not reflect the opinions of our respective institutions.

Author contributions

All authors (1) made substantial contributions to the conception or design of the work, or to the acquisition, analysis, or interpretation of data for the work; (2) were actively involved in drafting and revising the work; (3) gave final approval of the version to be published; and (4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Ethical approval

This study was approved by the institutional review boards at Husson University and Bowdoin College.

Additional information

Funding

Funding for this study came from the National Institute of Environmental Health Sciences. This study was conducted with software provided by Husson University School of Pharmacy and NIEHS (T32-ES007060-31A1) and supported by Bowdoin College. Funders had no involvement in study design; in the collection, analysis, interpretation of data; in the writing of the report; or in the decision to submit the article for publication.