Twitter, the social media service that permits 140-character posts or “tweets,” is undergoing rapid uptake by physicians.1 Twitter allows physicians to communicate, interpret, highlight, and curate information as well as engage in discussion or debate with other physicians, patients, patient advocates, researchers, investors, and industry employees. More than 60% of tweets authored by medical professionals in the United States are health-related, and approximately 14% mention commercial products or services.2 Yet, to our knowledge, there has been no investigation of the prevalence of financial conflict of interest (FCOI) among these users.
We constructed a set of hematologist-oncologists who are active on Twitter and have primary affiliations in the United States. We then assessed their FCOIs occurring in 2014. This data set was created in 2 steps. First, we selected 1 hematologist-oncologist (who does not have FCOI [V.P.]) and searched all Twitter users who were followed by and was following that physician; this set consisted of approximately 50 people. Second, we used Google to identify hematologist-oncologists with primary appointments in the United States. We took this set of hematologist-oncologists and searched all of the Twitter users they followed using the same web search method; this set consisted of approximately 600 people. Then, we combined the sets.
Using FCOI data made public by the Open Payments provision of the Affordable Care Act,3 we determined the FCOIs of the hematologist-oncologists we identified. Specifically, we searched each name on ProPublica’s Dollars for Docs website (https://projects.propublica.org/docdollars/) and then clicked on the available link to view the individual’s 2014 Open Payments page on the Centers for Medicare & Medicaid Services Open Payments program website (https://www.cms.gov/OpenPayments/Explore-the-Data/Explore-the-Data.html). Two kinds of payments were received: (1) general payments, defined as payments not associated with a research study, which included consulting fees, travel, lodging, food, and beverage, and (2) research payments, which included research funding and associated payments as described by the Centers for Medicare & Medicaid Services.3
Descriptive statistics are reported in the Results. Conducted from June 1 to August 1, 2016, our study of publicly available information did not require institutional review board review and approval.
We examined 57 515 Twitter accounts to identify 642 US-based hematologist-oncologist Twitter users, of whom 8 (1.2%) are employees of the biopharmaceutical industry. Of the 634 hematologist-oncologists assessed for FCOI, 504 (79.5%) were reported on the Open Payments website for having at least 1 FCOI (Table).
Hematologist-oncologists on Twitter received a median of $1644.77 in general payments (interquartile range [IQR], $129-$13 744) and a median of $11 064.21 in research payments (IQR, $0-$175 164). Of the 634 hematologist-oncologists, 459 (72.4%) received general payments, 397 (62.6%) received more than $100, and 281 (44.3%) received more than $1000. Most general payments were less than $10 000 (Figure).
General payments seemed consistent regardless of the extent of Twitter use, while research payments appeared greatest among those who use Twitter the least (Table). One hundred ninety-seven (31%) of 634 hematologist-oncologists received only general payments, 45 (7.1%) received only research payments, 262 (41%) received both general and research payments, and 130 (20.5%) received no payments.
Our results show that 504 (79.5%) of the 634 hematologist-oncologists in the United States who use Twitter, including those who are most active users, have some FCOI, ranging from an FCOI of more than $100 (received by 397 [62.6%] physicians) to an FCOI of more than $1000 (received by 281 [44.3%] physicians). One limitation of this study is that many hematologist-oncologists using Twitter have minimal user activity. Physicians in the lower and middle tercile have a median of only 10.5 and 138 tweets; yet, we did find the FCOI is similar among physicians in the highest tercile. Some may worry our data set is not representative of hematologist-oncologists on Twitter as it began with a single user. However, we searched 2 levels out, involving more than 55 000 accounts, and identified more than 600 hematologist-oncologists, which would mean that approximately 4% of all practicing hematologist-oncologists in the United States are using Twitter.4 Another limitation of this study is that we were unable to examine use of Twitter over time, whether non–hematologist-oncologists are active on Twitter and have conflicts, whether physician tweets are associated with FCOI, and whether hematologist-oncologists are tweeting about products or companies about which they are conflicted. These limitations may form the basis of future work.
Our results raise the question of how FCOIs should be disclosed and managed in an age in which information, interpretation, and criticism associated with cancer products and practices are increasingly available on social media. As a minimum standard, physicians who are active on Twitter should disclose FCOIs in their 5-line profile biography, possibly with a link to a more complete disclosure. For tweets regarding specific products that cause an FCOI, we advise users to include the hashtag #FCOI. Policies beyond disclosure should also be considered.
Corresponding Author: Vinay Prasad, MD, MPH, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (email@example.com).
Published Online: January 17, 2017. doi:10.1001/jamainternmed.2016.8467
Correction: This article was corrected on August 13, 2018, to add missing conflict of interest disclosures.
Author Contributions: Dr Prasad and Mr Tao had full access to all 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: Tao, Boothby, Prasad.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Tao, McLouth, Prasad.
Critical revision of the manuscript for important intellectual content: Tao, Boothby, Prasad.
Statistical analysis: Tao.
Study supervision: Prasad.
Conflict of Interest Disclosures: Dr Prasad reports receiving royalties from his book Ending Medical Reversal; that his work is funded by the Laura and John Arnold Foundation; that he has received honoraria for Grand Rounds/lectures from several universities, medical centers, and professional societies and payments for contributions to Medscape; and that he is not compensated for his work at the Veterans Affairs Medical Center in Portland, Oregon, or the Health Technology Assessment Subcommittee of the Oregon Health Authority.
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