eAppendix 1. Methodology
eAppendix 2. 2 Examples of Recipient Organizations in Each Coding Category
eAppendix 3. Coding Criteria
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Rothman SM, Brudney KF, Adair W, Rothman DJ. Medical Communication Companies and Industry Grants. JAMA. 2013;310(23):2554–2558. doi:10.1001/jama.2013.281638
Medical communication companies (MCCs) are among the most significant health care stakeholders, supported mainly by drug and device companies. How MCCs share or protect physicians’ personal data requires greater transparency.
To explore the financial relationships between MCCs and drug and device companies, to describe the characteristics of the large MCCs, and to explore whether they accurately represent themselves to physicians.
We combined data from the 2010 grant registries of 14 pharmaceutical and device companies; grouped recipients into categories such as MCCs, academic medical centers, disease-targeted advocacy organizations, and professional associations; and created a master list of 19 272 grants.
Main Outcomes and Measures
Determine the distribution of funds from drug and device companies to various entities and assess the characteristics of large MCCs.
Of the 6493 recipients of more than $657 million grant awards from drug and device companies, 18 of 363 MCCs received 26%, academic medical centers received 21%, and disease-targeted organizations received 15%. For-profit MCCs received 77% of funds (208 of 363). Among the top 5% of MCCs, 14 of 18 were for-profit. All 18 offered continuing medical education: 14 offered live and 17 offered online CME courses. All required physicians to provide personal data. Ten stated that they shared information with unnamed third parties. Eight stated they did not share information, but almost all added exceptions. None required explicit physician consent to their sharing policies.
Conclusions and Relevance
Medical communication companies receive substantial support from drug and device companies. Physicians who interact with MCCs should be aware that all require personal data from the physician and some share these data with unnamed third parties.
Quiz Ref IDMedical communication companies (MCCs) are among the most significant but least analyzed health care stakeholders. Supported mainly by drug and device companies, they are vendors of information to physicians and consumers and sources of information for industry.1 Known best for arranging continuing medical education (CME) programs, they also may develop prelaunch and branding campaigns and produce digital and print publications.
The MCCs’ relationships to industry and to physicians are not easily investigated. Industry contracts with MCCs are not publicly available and until recently neither were industry grant awards. Neither donors nor recipients made the data available. Then in 2010, 13 pharmaceutical companies and 1 medical device company posted grant registries on their websites.2 Some appeared as the result of legal settlements with the Department of Justice; others were posted voluntarily. The disclosures went beyond the stipulations of the Sunshine Act, which mandates reports of payments only to physicians and teaching hospitals.3 These registries include the names of all health care organizations, including the names of the MCCs that received at least 1 grant, the grant’s purpose, and the award’s precise dollar amount. The purpose of this study was to explore the financial relationships between MCCs and drug device companies, to describe the characteristics of large MCCs, and to explore whether they accurately represent themselves to physicians.
Quiz Ref IDOur database included the 2010 grant registries of 13 pharmaceutical and 1 device company. When we began data collection in the summer of 2011, these were the only companies that had reported complete 2010 data for all divisions. We sorted recipients into organizational categories and totaled the funding they received. We then explored the relationship between MCCs and the drug and device industry.4 Eleven of the drug companies ranked among the top 20 in the field by annual sales. The remaining 2 ranked in the top 30 (Table 1).5
We combined information from quarterly reports and grant registries (each uniquely formatted), removed any duplication of the data, and normalized recipient names (using a uniform name and spelling for each recipient) to create a master list of 19 272 grants totaling $657 643 322 awarded to 6493 recipients (eAppendix 1 in the Supplement). We grouped recipients into 7 categories, consulting master lists (such as Council on Teaching Hospitals and American Medical Association House of Delegates), and self-definitions: MCCs, academic medical centers and affiliated hospitals; hospital systems and independent providers; professional medical associations; professional associations organized by nurses, health administrators, and scientists; disease-targeted advocacy organizations established by laymen for patient education and advocacy; and research organizations such as the National Institutes of Health. The other category included community, faith-based, and non–health-specific organizations (eAppendix 2 in the Supplement). Two coders independently made the categorization; in case of disagreement, one of the authors (S.M.R.) resolved the difference.
Quiz Ref IDA grant was assigned to the MCC category when an organization’s website defined its primary mission as the dissemination of information on disease states, prevention, management, therapies, and drugs or medical devices and was not a subsidiary of other recipient organizations (such as an academic medical center) (eAppendix 3 in the Supplement). By these criteria, 363 grant recipients were identified as MCCs. To determine for-profit or nonprofit status, we examined the “About Us” page. When an organization defined itself as a nonprofit or as having a 501(C)(3) tax status, we verified the designation through GuideStar. When an organization defined itself as for-profit, we verified it through the owners’ business profiles and the parent company’s website.
We selected the top 5% of recipients (18) for in-depth analyses. These recipients received 58% of MCC industry funding and 30% of MCC industry grants. Because such a small group received such a large proportion of the funds and grants, we decided to focus on them. We relied on website content to examine the activities they pursued and the information they received from and gave to physicians. We devoted particular attention to CME because most registry grants were specified for “educational activities.” Fourteen provided CME courses at “live events” such as at medical conferences and grand rounds. Seventeen offered online CME courses, including webcasts, podcasts, interviews, case-based discussions, slide sets, journal articles, and interactive games. We studied the architecture and content of the websites, including privacy policies.
Medical communication companies received 26%, the largest percentage of funding ($170 803 675), from the 14 drug and device companies, followed by 21% awarded to academic medical centers ($140 928 767) and 15% to disease-target advocacy organizations ($95 769 466, Table 2). Of the 363 MCC grant recipients, 208 were for-profit and 155 were nonprofit companies. For-profit companies received 77%. Eighteen MCCs (5%) received more than $2 million each (total, $101 566 252; Table 3). Of these, 14 were for-profit and 12 were subsidiaries of larger entities (Table 4).
All 18 MCCs were approved by the Accreditation Council for Continuing Medical Education to deliver CME courses. Fourteen offered live and 17 offered online CME courses. The 2 MCCs receiving the most industry funding offered only online CME courses. Medical communication companies promoted online CME courses as a convenient and cost-free alternative to live CME courses. Physicians could access the site anywhere at any time.
Quiz Ref IDTo enroll in the CME course, physicians had to provide personal information, such as name, e-mail address, specialty, and license number. How MCCs might use the personal data and track physician web activity was described in the Privacy Policies sections of their websites.6 Fourteen stated that they used such tools as “cookies” and web “beacons.” Ten declared that they shared personal information with third parties, although none identified them. Eight stated that they did not share personal information, but almost all6 added exceptions for unnamed “educational partners” and companies with which they worked or might merge (Table 4).
Among the 14 companies that released data in 2010, MCCs received an aggregate of $170 million, more funds than any other recipient, including academic medical centers, professional associations, and research organizations. The top 5%, almost all for-profit companies, received 59% of the funds. Absent industry disclosures, none of this information would have become publicly available.
Quiz Ref IDIt appears that providing online CME courses is a common activity offered by MCCs, which allows them the opportunity to collect personal data and create digital profiles. Although MCCs did not elicit users’ explicit consent, they interpreted participating in a CME course and navigating the website as an implicit agreement to share information with third parties. It is possible that physicians using MCC websites do not appreciate the full extent of MCC-industry financial ties or are aware of data sharing practices.7,8
Our study has several limitations. The analysis was restricted to only 14 companies who made data available in 2010. It is possible that the distribution of funds from industry to various groups is different among those companies not included in this report. Although 10 of the 14 companies that released data ranked among the top 20 drug companies for sales, we focused on the top 5% of MCCs who received the majority of funding from industry. Other MCCs may have different characteristics than those we studied. We did not evaluate the content of MCC-offered CME programs for accuracy and bias nor did we assess how the MCCs were using the physician data they obtained.
The purpose of this study was to analyze the distribution of funds from pharmaceutical and device companies to various health-related organizations and then to detail the characteristics and activities of the leading MCCs. Medical communication companies receive substantial support from industry, and the majority are for profit, conduct CME programs, track website behavior, and may share information with third parties. Physicians who interact with MCCs should be aware that all require personal data from the physician and that some share these data with unnamed third parties.
Corresponding Author: Sheila M. Rothman, PhD, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, Center on Medicine as a Profession, College of Physicians & Surgeons, Columbia University, 630 W 168th St, PH15-25, New York, NY 10032 (firstname.lastname@example.org).
Author Contributions: Dr S. M. Rothman had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: S. M. Rothman, D. J. Rothman.
Acquisition of data: S. M. Rothman, Adair, Brudney.
Analysis and interpretation of data: S. M. Rothman, Adair, D. J. Rothman.
Drafting of the manuscript: S. M. Rothman, Adair, D. Rothman.
Critical revision of the manuscript for important intellectual content: Brudney, D. J. Rothman.
Statistical analysis: Adair.
Obtained funding: D. J. Rothman.
Administrative, technical, or material support: S. M. Rothman, Brudney, Adair.
Study supervision: S. M. Rothman, D. J. Rothman.
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. S. Rothman reported having served as consultant to the Office of the Attorney General of the State of Texas in litigation against Johnson & Johnson related to risperidone and receiving travel support from the North American Spine Society to attend the society’s board and ethics committee meetings. D. Rothman served as consultant and expert witness to the Office of the Attorney General of the State of Texas and as an expert witness to Sheller, P.C. in litigation against Johnson & Johnson related to risperidone and receiving travel support from the North American Spine Society to attend the society’s board and ethics committee meetings. No other disclosures were reported.
Funding/Support: This work was funded by the Selz Foundation and the May and Samuel Rudin Foundation.
Role of the Sponsors: The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: The authors benefited from the comments and insights of Eric G. Campbell, PhD (Institute of Health Policy, Massachusetts General Hospital), Sharon Levine, MD (Permanente Medical Group), and Victoria H. Raveis, PhD (College of Dentistry, New York University. None of these individuals received any compensation for their contributions.
Correction: This article was corrected on September 24, 2014, for the addition of the word “may” in the introductory paragraph.