{"id":626617,"date":"2026-10-10T18:34:29","date_gmt":"2026-10-10T18:34:29","guid":{"rendered":"https:\/\/www.newsbeep.com\/nz\/626617\/"},"modified":"2026-10-10T18:34:29","modified_gmt":"2026-10-10T18:34:29","slug":"tip-of-the-iceberg-the-industry-payments-to-medicines-experts","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/nz\/626617\/","title":{"rendered":"Tip of the iceberg? The industry payments to medicines experts"},"content":{"rendered":"

A 2020 review led by Baroness Julia Cumberlege examined concerns raised by patients and families about the safety of medicines and medical devices.<\/p>\n

The review described doctors in the 1950s to 1970s passing on free drug samples to patients, \u201coften from a doctor\u2019s desk drawer, without a prescription and often with no record-keeping\u201d.<\/p>\n

It also found \u201cconflicts of interest in the selection of experts to form part of expert working groups, advisory committees or to agree guidelines\u201d.<\/p>\n

\u201cAn ideal expert would be an individual who is knowledgeable and respected in their field, but who has no personal, professional or financial links which might influence their position,\u201d Cumberlege suggested in her report.<\/p>\n

But she warned: \u201cIt may not be possible, or even desirable, for an expert to have no interest in a matter being reviewed.\u201d\u200b1\u200b<\/p>\n

\u2018Normal and necessary\u2019<\/p>\n

More than five years after the Cumberlege review was published \u2014 and decades after the scandals it investigated first came to light \u2014 payments from the pharmaceutical industry to clinicians remain routine.<\/p>\n

Collaboration between industry and healthcare professionals is a normal and necessary part of how medicines are developed and evaluated safely<\/p>\n

Graham Cookson, chief executive of the Office of Health Economics<\/p>\n

According to the Association of British Pharmaceutical Industry\u2019s (ABPI) voluntary register of payments made by pharmaceutical companies, in 2025, approximately 18,367 named healthcare professionals received funding from pharmaceutical companies for contracted work, sponsorship to attend an event or associated expenses.<\/p>\n

\u201cCollaboration between industry and healthcare professionals is a normal and necessary part of how medicines are developed and evaluated safely,\u201d says Graham Cookson, chief executive of the Office of Health Economics, which is a research charity founded and partly funded by the ABPI.<\/p>\n

\u201cClinicians bring frontline expertise that industry would otherwise not have access to, all of which ultimately improves patient outcomes,\u201d he tells The Pharmaceutical Journal.<\/p>\n

Piotr Ozieranski and Emily Rickard, sociology researchers at the University of Bath, say that payments from pharmaceutical companies \u201cdo not \u2018buy\u2019 influence in the sense of simple \u2018quid pro quo\u2019\u201d.<\/p>\n

\u201cInstead, companies perceive them as part of what sociologists call patterns of extended reciprocity. They are meant to create an implicit, unspoken obligation to return a favour in the future,\u201d they tell The Pharmaceutical Journal.<\/p>\n

\u201cThis may involve greater institutional access, collaborative activities or simply a positive disposition towards a company. This is a very powerful mechanism rooted deeply in human nature \u2014 and because of this even small \u2018gifts\u2019 to physicians, such as a free lunch or pens, have been found to significantly alter their prescription patterns.\u201d<\/p>\n

Among those who received the most from industry in 2025 was gastroenterologist Charlie Lees. According to Disclosure UK, he received \u00a368,332.89 in professional fees for work, such as speaking, medical education, consultancy and advisory boards, as well as \u00a335,801.18 in related expenses from pharmaceutical companies.<\/p>\n

Lees says his prescribing decisions for individual patients \u201care based on the clinical evidence, relevant guidelines and the circumstances and preferences of the patient in front of me\u201d.<\/p>\n

\u201cDecisions about which medicines are adopted or funded are made through formal local and national governance processes, rather than by any individual clinician. Where I contribute to relevant professional discussions, my interests are declared,\u201d he adds.<\/p>\n

It is those formal governance processes that concern Margaret McCartney, director of the Centre for Ethics and Values at the University of St Andrews, who says her worry is around industry payments being associated with the creation of guidelines themselves.<\/p>\n

\u201cIf you work with industry, that\u2019s fine, but that means you can\u2019t serve in guideline committees, you can\u2019t be somebody who\u2019s in charge of making formulary decisions. Either you do one thing or you do the other thing. You can\u2019t do both,\u201d she says.<\/p>\n

Conflicts of interest within guideline committees<\/p>\n

The main safeguard against these conflicts sits with the National Institute for Health and Care Excellence (NICE). NICE was set up in 1999, as the National Institute for Clinical Excellence to make \u201cunbiased and objective\u201d recommendations on which medicines the NHS should use, based on \u201can assessment of population benefits and value for money\u201d\u200b2,3\u200b. Its guidance for England and Wales shapes formularies and prescribing across the NHS.<\/p>\n

To manage this, all committee members and invited experts at NICE must declare any relevant interests \u2014 both annually and at each committee meeting they attend \u2014 as must any organisation that nominates specialists or makes a written submission\u200b4\u200b. The committee chair or vice-chair then decides whether a member with a declared interest should take part in a particular appraisal.<\/p>\n

However, declaring an interest does not necessarily mean giving up industry funding. Eight of the 90 members of NICE\u2019s four technology appraisal committees (as of 24 September 2026) have disclosed payments from pharmaceutical companies in the past three years (2023\u20132025), totalling \u00a320,658.81 (see Figure 1)\u200b5,6\u200b.<\/p>\n

Responding to those declarations of interest found on Disclosure UK, a NICE spokesperson told the Pharmaceutical Journal: \u201cNICE is expected to achieve and maintain high standards of fairness in the way we conduct our business. Managing potential conflicts of interests is an important part of this process.<\/p>\n

\u201cCommittee members are required to declare relevant interests when they are appointed and again in relation to individual topics being considered. Where a relevant conflict of interest is identified, NICE applies its published policy, which can include restricting or preventing participation in discussions.<\/p>\n

\u201cThe minutes of each appraisal committee meeting explicitly list the attending members along with their declared interests, and these records are published openly on the NICE website<\/a>.\u201d<\/p>\n

Figure 1: Transfers of value to current NICE technology appraisal committee members, as declared under Disclosure UK, 2023-2025<\/p>\n

Ozieranski and Rickard say specific safeguards are needed \u201caround roles such as chairing committees, leading evidence reviews, drafting recommendations or voting on final decisions\u201d.<\/p>\n

Jonathan Sive, now vice-chair of NICE\u2019s technology appraisal committee C\u200b6\u200b, received funding from pharmaceutical company Janssen-Cilag Ltd, a Johnson & Johnson Company, to attend a haematology conference in 2023 and 2025\u200b5\u200b \u2014 the latter of which coincided with his time as a NICE committee member.<\/p>\n

This is allowed under NICE policies as long as the conflict of interest is declared, at which point it is up to the committee chair or vice-chair to decide whether the member should be removed from a particular appraisal.<\/p>\n

When Sive took on that decision-making role himself later in 2025, he chose to stop receiving money from industry, he tells The Pharmaceutical Journal.<\/p>\n

\u2018Webs of influence\u2019<\/p>\n

Sive\u2019s attendance at the 2025 conference was one of 4,737 sponsored places paid for by pharmaceutical companies in 2025\u200b5\u200b.<\/p>\n

International conferences can cost at least \u00a31,000 just to register, plus the cost of travel and accommodation.<\/p>\n

Funding available from NHS employers might fund around one-quarter of this, leaving clinicians to fund anywhere from \u00a34,000\u2013\u00a310,000 per conference themselves.<\/p>\n

[Where] multiple key actors involved in a certain domain\u2026 are in one way or another involved financially with the industry or particular company, [this] risks normalising and amplifying industry perspectives<\/p>\n

Piotr Ozieranski and Emily Rickard, sociology researchers at the University of Bath<\/p>\n

Officially, there are no strings attached to attending a conference on a pharma ticket. In practice, company representatives will host dinners and events, which the funding recipient is likely to attend.<\/p>\n

Healthcare professionals may feel this is worth the opportunity to stay up to date with connections and the latest research in their field.<\/p>\n

However, McCartney, Ozieranski and Rickard warn of industry funded events fuelling \u201cwebs of influence<\/a>\u201d.<\/p>\n

Where \u201cmultiple key actors involved in a certain domain, for example, policymakers, regulators, experts, patient charities, are in one way or another involved financially with the industry or particular company\u201d, this \u201crisks normalising and amplifying industry perspectives, which are accepted as common sense\u201d, Ozieranski and Rickard say.<\/p>\n

McCartney suggests a \u201ccircular\u201d relationship exists between pharmaceutical companies and clinical experts \u2014 with industry inviting specialists to work with them on new treatments and then those who have the experience of giving talks or working on trials with pharmaceutical companies being considered experts in the field.<\/p>\n

\u201cEveryone thinks because everyone else has said that someone is great, then they must be great,\u201d she says.<\/p>\n

Ozieranski and Rickard say that \u201cconflicted experts may still contribute specialist knowledge\u201d. There is a distinction between \u201cdrawing on the expertise of people with industry relationships and giving those individuals responsibility for making or voting on recommendations\u201d, they add.<\/p>\n

However, Ozieranski and Rickard suggest that industry payments are becoming \u201cincreasingly widespread within particular therapeutic areas, meaning it is becoming progressively harder to identify experts without such financial ties\u201d. According to The Pharmaceutical Journal\u2019s analysis, healthcare professionals in the specialties of oncology and haematology received the largest share of money from industry.<\/p>\n

Visibility of conflicts of interest<\/p>\n

Links to industry can also be hard to identify and understand.<\/p>\n

Ozieranski and Rickard add that not all transfers of value are listed on Disclosure UK, while those that are, are \u201conly the tip of the iceberg<\/a>\u201d.<\/p>\n

According to the ABPI\u2019s database, healthcare professionals received \u00a351.8m from pharmaceutical companies in 2025 for non-research and development (R&D) payments, which are defined as payments that are \u201cunrelated to research and development activities, such as commercial, non-commercial, educational, or advisory activities\u201d.<\/p>\n

We don\u2019t really understand what the meaning of those declarations is. They\u2019re difficult to track down. They don\u2019t always tell us enough information to actually make sense of them or make a judgment about them<\/p>\n

Margaret McCartney, director of the Centre for Ethics and Values at the University of St Andrews<\/p>\n

\u201cThey may include donations and grants, sponsorship contributions to events such as conferences, fees for services, including consultancy, advisory boards and speaking engagements, and reimbursement of associated travel and accommodation expenses,\u201d the ABPI says\u200b7\u200b.<\/p>\n

Fees may also include commercial arrangements known as \u201cpackage deals\u201d \u2013 where the purchase of a particular medicine is linked to the provision of certain associated benefits as part of the purchase price such as apparatus for administration of the medicine, the provision of training on its use or the services of a health professional to administer it\u200b8,9\u200b.<\/p>\n

Also in 2025, healthcare organisations, such as NHS trusts, GP practices and homecare providers, received almost \u00a3228.0m in non-R&D value transfers of this kind (see Table 1)\u200b5\u200b.<\/p>\n

Table 1: Non-R&D payments to healthcare organisations, Disclosure UK 2025<\/p>\n

However, non-R&D payments \u201care dwarfed by payments related to research on drug company products, which are not attributed publicly to named individual recipients in the same way as non-research payments,\u201d say Ozieranski and Rickard (see Figure 3).<\/p>\n

Instead, such payments, which include research grants, are attributed to institutions such as universities or teaching hospitals. In 2025, these R&D payments totalled \u00a3647.3m \u2014 up from \u00a3467.0m in 2023 and \u00a3554.0m in 2024\u200b5,7\u200b.<\/p>\n

Figure 3: Total\u00a0R&D and non-R&D value transfers\u00a0declared\u00a0under Disclosure UK in 2025 (\u00a3m)<\/p>\n

The \u00a3647.3m in R&D payments represents just 10% of the total R&D investment in the UK made by pharmaceutical companies, according to the ABPI\u200b7\u200b.<\/p>\n

The way information is disclosed and presented can make it difficult for patients or decision-makers to decide whether the clinician is conflicted by their relationship with industry. Since R&D disclosures in particular are not attributed to an individual, this represents \u201ca huge \u2018known unknown\u2019 of payment disclosure\u201d, say Ozieranski and Rickard.<\/p>\n

They add: \u201cThese R&D payments are likely to be particularly relevant for NICE experts as they involve payments for clinical research.\u201d<\/p>\n

In addition, the lack of detail beyond a sum of money can make disclosures \u201cineffective\u201d, says McCartney.<\/p>\n

She tells The Pharmaceutical Journal: \u201cWe don\u2019t really understand what the meaning of those declarations is. They\u2019re difficult to track down. They don\u2019t always tell us enough information to actually make sense of them or make a judgment about them.<\/p>\n

\u201cIs this somebody that I can regard as somebody who\u2019s at high risk of a conflict of interest or someone who\u2019s effectively managing his conflict and is not getting involved with things where his judgement might be impeded by the fact that he\u2019s got a financial relationship with this company?\u201d<\/p>\n

Conflicts of interest can also be difficult to find.<\/p>\n

In addition to disclosures made by pharmaceutical companies under Disclosure UK, organisations might also be required to keep registers of gifts and conflicts of interest\u200b10\u200b. But when McCartney analysed a sample of NHS trusts and Scottish health boards, she found that less than one-quarter published declarations of interest in line with national recommendations. Some in Scotland required access via a Freedom of Information request, and, where registers were available, many were out of date\u200b11\u200b.<\/p>\n

This means conflicts of interest may not be obvious at the point of receiving care, reading an educational article or making a decision about whether an expert giving evidence is conflicted.<\/p>\n

Instead, McCartney says that patients and decision-makers are expected to somehow \u201cmagic that information into our minds and adjust everything that we\u2019re doing on the basis of what that declaration might be\u201d.<\/p>\n

\"Zoomed<\/p>\n

Charlotte Gurr<\/p>\n

Solutions<\/p>\n

Making disclosures mandatory \u2014 rather than voluntary as the ABPI\u2019s scheme for industry currently is \u2014 could help, McCartney suggests.<\/p>\n

The 2020 Independent Medicines and Medical Devices Safety Review (IMMDS) that investigated hormone pregnancy tests, pelvic mesh and sodium valproate, agreed that \u201cthe system of self-declaration has not been sufficient\u201d.<\/p>\n

In particular, it stressed the need for organisations to consider \u201cwhether it is appropriate to proactively check potential members\u2019 interests prior to their appointment\u201d.<\/p>\n

I\u2019m not against industry, what I\u2019m really against is people who\u2019ve got a conflict of interest, making decisions about how we should be using medicines and healthcare<\/p>\n

Margaret McCartney, director of the Centre for Ethics and Values at the University of St Andrews<\/p>\n

In addition, it suggested that financial and non-pecuniary interests could be included on clinicians\u2019 professional registers\u200b1\u200b.<\/p>\n

The IMMDS review also made recommendations relating to industry relationships with those considered experts in a particular field.<\/p>\n

It noted that in academic journals, \u201creviewers\u2019 rating of manuscript quality does not appear to be affected by disclosure of conflicts of interests\u201d. The review also recommended that \u201cthe role of drug and medical device manufacturers in provision of financial support for research must be well managed to ensure evidence is trustworthy\u201d.\u200b1\u200b<\/p>\n

However, McCartney thinks the separation between industry and clinical expertise should go further.<\/p>\n

\u201cThere\u2019s no reason why you can\u2019t have experts who don\u2019t have financial conflicts with industry,\u201d she adds.<\/p>\n

\u201cWe don\u2019t have any evidence that we can successfully manage conflicts of interest\u2026 the only [systems] that seem to work are the ones where you exclude people [who have conflicts of interest].\u201d<\/p>\n

In fact, she suggests that the act of disclosing conflicts of interest might even worsen the problem.<\/p>\n

\u201cAt the moment, people can just dump their data and run. They don\u2019t have to engage with it on a moral ethical level. They just have to put it out there,\u201d she continues.<\/p>\n

\u201cI\u2019m not against industry, what I\u2019m really against is people who\u2019ve got a conflict of interest, making decisions about how we should be using medicines and healthcare. I think that\u2019s a really bad idea [that] we know time and time again results in patient and healthcare system harm.\u201d<\/p>\n

11.<\/p>\n

McCartney M, Bergeron Hartman R, Feldman H, et al. How are declarations of interest working? A cross-sectional study in declarations of interest in healthcare practice in Scotland and England in 2020\/2021. BMJ Open. 2022;12(11):e065365. doi:10.1136\/bmjopen-2022-065365<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"A 2020 review led by Baroness Julia Cumberlege examined concerns raised by patients and families about the safety…\n","protected":false},"author":2,"featured_media":626618,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[134,527,111,139,69],"class_list":["post-626617","post","type-post","status-publish","format-standard","has-post-thumbnail","category-healthcare","tag-health","tag-healthcare","tag-new-zealand","tag-newzealand","tag-nz"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts\/626617","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/comments?post=626617"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts\/626617\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/media\/626618"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/media?parent=626617"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/categories?post=626617"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/tags?post=626617"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}