Some cancer doctors use Twitter to promote drugs manufactured by companies that pay them, but they almost never disclose their conflicts of interest on the social media platform, a new study shows.
"This is a big problem," said senior author Dr. Vinay Prasad, a professor at Oregon Health and Science University in Portland. "Doctors are directly telling patients about their views on drugs, and financial conflict plays a role. But they're not telling patients they have a conflict."
Prasad and his colleagues analyzed the tweets and income of blood cancer specialists who posted regularly on Twitter and received at least $1,000 US from drug manufacturers in 2014.
Of the 156 hematologist-oncologists in the study, 81 per cent mentioned at least one drug from a company that gave them money, and 52 per cent of their tweets mentioned the conflicted drugs, according to a study reported in a letter in The Lancet.
Only two of the doctors disclosed that they received payments from the drug companies whose products they mentioned on Twitter.
Cancer drugs tend to be toxic, produce debilitating side-effects and are frequently only marginally effective, Prasad said in a phone interview.
Inform audience of possible bias
Pharmaceutical companies routinely pay doctors to assess their products and to speak at conferences and seminars.
Bioethicist Susannah Rose, who was not involved with the study, said it "yet again shows the complex issues related to physicians' financial relationships with industry."
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She urged disclosure, possibly in physicians' Twitter profiles, about conflicts of interests.
Rose, who is scientific director of research for the Cleveland Clinic's office of patient experience in Ohio and was not involved in the study, suggested in email to Reuters Health that doctors should use a common abbreviation in their tweets to indicate conflicts of interest.
'Maybe we can learn something from celebrities here'
Celebrities use the hashtag #sponsored when they tweet about products from companies that pay them, Prasad said.
"Maybe we can learn something from the celebrities here," he said.
Genevieve P. Kanter, a professor of research at the University of Pennsylvania Perelman School of Medicine in Philadelphia, said she was surprised that hardly any of the studied doctors disclosed their payments from drug companies.
"If a doctor is promoting a drug — whether it's at a presentation, at a conference, through an op-ed or via a tweet — the audience should be informed of possible biases that might come from being financially supported by the company producing that drug," she said in an email.
Doctors, consciously or unconsciously, may be "shading their speech or their actions because of their dependence on certain income sources," said Kanter, who was not involved in the study.
Rose advises patients to ask their doctors about possible conflicts of interest. In the U.S., patients can look up physicians' relationships with drug manufacturers on a government website: http://bit.ly/2wVGWsS.
Kanter suggested that patients who learn their doctors have conflicts of interest consider getting a second opinion.
Prasad began thinking about conflicts of interest in tweets a few years ago, when he got into a Twitter dispute about whether physicians should engage in a debate over drug costs.
As the argument heated up, Prasad divided the dueling doctors into two camps — those in favour of discussing the price of drugs and those opposed. Then he looked up which ones took money from drug companies.
Of five physicians who argued that doctors should advocate for lower drug costs, only one had taken money from a drug company, and it was a single $400 payment. The five who argued that doctors should stay out of the discussion of drug prices had taken payments of between $20,000 and $30,000, Prasad said.
Earlier this year, Prasad published his first study on tweeting doctors. Nearly 80 per cent of more than 600 U.S. hematologist-oncologists who tweeted had a conflict, his report in JAMA Internal Medicine found.
Doctors should disclose possible conflicts in their Twitter profile biographies, possibly with a link to more complete
disclosure, Prasad and his colleagues wrote in the earlier study. When doctors tweet about products from companies with which they have conflicts, the researchers advised using the hashtag abbreviation for financial conflict of interest #FCOI.