Abstract
This analysis of data from pharmaceutical manufacturers assesses the extent and distribution of industry payments to the executive board members of professional medical associations in Japan.
Physicians often receive payments from pharmaceutical companies for purposes that include speaking and consulting.1,2,3 The Japan Pharmaceutical Manufacturers Association includes most companies that manufacture brand name drugs. In 2015, its members accounted for 80.8% of total pharmaceutical sales in Japan.4 In 2011, the association issued transparency guidelines, which call for disclosure of all payments to physicians, including fees for speaking, writing, and consulting as well as research funding, donations, meals, and other gifts.5 At present, only payments for speaking, writing, and consulting have been published with individual names and affiliations. Since 2013, annual payment data have been published on each company’s website.5 Compared with Open Payments6 data in the United States, these disclosures are often unclear and inconsistent: the disclosure format varies between companies, and the aggregated payment data are not readily available. We analyzed the extent and distribution of industry payments to the executive board members of professional medical associations in Japan.
Methods
We selected 19 major medical associations, 1 for each of the basic clinical medical fields, as categorized by the Japanese Medical Specialty Board. For 2016, we collected data on payments (fees for speaking, writing, and consulting) made to executive board members of these 19 associations from all 71 pharmaceutical companies belonging to the Japan Pharmaceutical Manufacturers Association. We obtained each company’s data individually through their websites and integrated the data into a single database. We then summed the payments made to each of 405 executive board members. We converted Japanese yen to US dollars using the exchange rate of ¥112 per $1 on September 21, 2018. We also reviewed the websites of the 19 medical associations to determine if the associations disclosed the payments to their executive board members to the public.
Results
Of 405 executive board members, 352 (86.9%) received pharmaceutical company payments (Table). The total amount paid was $6 468 585: $5 279 312 for speaking, $412 900 for writing, and $776 373 for consulting. The median payment was $7486 (interquartile range [IQR], $1767-$20 277). Of the payments, $2 960 928 (45.8%) went to the 40 executive board members who received the largest payments; 12 were on the board of the Japanese Society of Internal Medicine, 7 on the board of the Japanese Urological Association, and another 7 on the board of the Japanese Dermatological Association. The highest median payment was to the executive board members of the Japanese Society of Internal Medicine ($51 974; IQR, $33 900-$86 349). Payments to board members of the Japanese Society of Internal Medicine accounted for 20.8% of the total payments, followed by the Japanese Urological Association (14.9%) and the Japanese Dermatological Association (11.1%). We found no evidence that any of the 19 associations publicly disclosed the pharmaceutical company payments to their executive board members.
Table. Pharmaceutical Payments Made to Executive Board Members From 19 Professional Medical Associations in 2016, Japan.
| Professional Medical Association | Association Specialty | Executive Board Membersa | Total Payments | Value of Payments per Executive Board Member, $b | ||||
|---|---|---|---|---|---|---|---|---|
| Total No. | Receiving Payments, No. (%) | Records, No. | Total Value, $b | Mean (SD) | Median (IQR) | Highest Payments | ||
| Japanese Society of Internal Medicine | Internal medicine | 22 | 22 (100) | 1176 | 1 343 732 | 61 079 (45 523) | 51 974 (33 900-86 349) | 171 245 |
| Japan Pediatric Society | Pediatrics | 28 | 25 (89.3) | 212 | 206 861 | 7388 (7053) | 3853 (2734-11 552) | 23 387 |
| Japanese Society of Hospital General Medicine | Family medicine and general practice | 22 | 16 (72.7) | 152 | 133 440 | 6065 (8952) | 1647 (0-11 938) | 37 639 |
| Japanese Dermatological Association | Dermatology | 18 | 18 (100) | 671 | 722 150 | 40 199 (27 825) | 34 213 (20 625-56 909) | 97 676 |
| Japan Surgical Society | General surgery | 23 | 23 (100) | 371 | 385 328 | 16 753 (13 033) | 11 887 (7276-23 039) | 44 536 |
| Japan Neurosurgical Society | Neurosurgery | 23 | 22 (95.7) | 259 | 242 379 | 10 538 (6800) | 10 165 (5893-15 150) | 27 465 |
| Japan Society of Obstetrics and Gynecology | Obstetrics and gynecology | 32 | 30 (93.8) | 331 | 317 245 | 9914 (9101) | 8099 (2997-13 324) | 39 356 |
| Japanese Ophthalmological Society | Ophthalmology | 19 | 19 (100) | 437 | 514 321 | 27 070 (19 625) | 20 697 (11 470-47 120) | 72 710 |
| Japanese Orthopedic Association | Orthopedic surgery | 23 | 22 (95.7) | 432 | 436 479 | 18 977 (17 255) | 17 114 (4853-22 810) | 61 157 |
| Oto-Rhino-Laryngological Society of Japan | Otolaryngology | 24 | 20 (83.3) | 248 | 231 281 | 9637 (12 981) | 4870 (1406-11 297) | 46 463 |
| Japan Society of Plastic and Reconstructive Surgery | Plastic surgery | 17 | 9 (52.9) | 34 | 40 244 | 2367 (4959) | 497 (0-994) | 17 427 |
| Japanese Urological Association | Urology | 21 | 20 (95.2) | 846 | 965 081 | 45 956 (38 683) | 34 073 (19 543-55 358) | 122 967 |
| Japanese Society of Anesthesiologists | Anesthesiology | 27 | 21 (77.8) | 133 | 133 353 | 4939 (6079) | 3679 (497-6502) | 24 640 |
| Japanese Association for Acute Medicine | Emergency medicine | 15 | 13 (86.7) | 76 | 76 380 | 5092 (4903) | 4921 (1293-7251) | 17 199 |
| Japanese Society of Pathology | Pathology | 15 | 10 (66.7) | 64 | 62 083 | 4139 (4962) | 1915 (0-8746) | 16 283 |
| Japanese Society of Psychiatry and Neurology | Psychiatry | 20 | 19 (95.0) | 344 | 357 815 | 17 891 (20 805) | 8976 (1399-24 721) | 69 580 |
| Japan Radiological Society | Radiology | 18 | 17 (94.4) | 85 | 93 389 | 5188 (5475) | 4452 (1492-7358) | 24 293 |
| Japanese Association of Rehabilitation Medicine | Rehabilitation | 23 | 17 (73.9) | 186 | 181 575 | 7895 (9731) | 4572 (1023-7726) | 29 504 |
| Japanese Society of Laboratory Medicine | Examination | 17 | 8 (47.1) | 70 | 55 265 | 3251 (6600) | 0 (0-1084) | 21 492 |
| Total | NA | 405 | 352 (86.9) | 6100 | 6 468 585 | 15 972 (23 752) | 7486 (1768-20 277) | 171 245 |
Abbreviations: IQR, interquartile range; NA, not applicable.
Columns may not add to the total of all professional medical associations because the data were adjusted to account for 2 executive board members who each worked for 2 associations.
The value of payment is described based on the exchange rate on September 21, 2018: ¥112 to $1.
Discussion
In 2016, most of the executive board members of the 19 leading professional medical associations in Japan received payments from pharmaceutical companies, primarily for speaking and consulting. Executive board members of 3 medical associations—internal medicine, urology, and dermatology—accounted for 46.8% of all the payments. We found no evidence that any of these payments were publicly disclosed. The payments, as well as the lack of disclosure by the medical associations themselves, raise concerns about the potential influence of payments on professional activities.
Limitations of our study include possible inaccuracies in the payment information and the limited types of payments that were analyzed. Information about research funding, donations, meals, and other gifts was not available. Medical device companies were not included because their payments are not sufficiently disclosed.
It has been argued that no executive board members of professional medical associations should receive industry payments.1 Although this may remain an aspirational goal, it would be desirable if there were fewer and smaller payments and if all such payments were publicly disclosed by the associations themselves on their websites.
References
- 1.Rothman DJ, McDonald WJ, Berkowitz CD, et al. Professional medical associations and their relationships with industry: a proposal for controlling conflict of interest. JAMA. 2009;301(13):1367-1372. doi: 10.1001/jama.2009.407 [DOI] [PubMed] [Google Scholar]
- 2.Fabbri A, Gregoraci G, Tedesco D, et al. Conflict of interest between professional medical societies and industry: a cross-sectional study of Italian medical societies’ websites. BMJ Open. 2016;6(6):e011124. doi: 10.1136/bmjopen-2016-011124 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Tringale KR, Marshall D, Mackey TK, Connor M, Murphy JD, Hattangadi-Gluth JA. Types and distribution of payments from industry to physicians in 2015. JAMA. 2017;317(17):1774-1784. doi: 10.1001/jama.2017.3091 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Japan Pharmaceutical Manufacturers Association Data book 2018 [in Japanese]. http://www.jpma.or.jp/about/issue/gratis/databook/2018/. Published 2018. Accessed October 2, 2018.
- 5.Japan Pharmaceutical Manufacturers Association Transparency guideline for the relation between corporate activities and medical institutions [in Japanese]. http://www.jpma.or.jp/english/policies_guidelines/transparency_guideline.html. Published 2018. Accessed July 15, 2018.
- 6.Centers for Medicate & Medicaid Services Open Payments homepage. https://openpaymentsdata.cms.gov/. Accessed December 12, 2018.