While we often say that the medical profession is in hock to big Pharma, that statement is not usually backed by hard statistics, which are hard to come by, while qualitative evidence is a plenty. However, the leading British medical journal, The British Medical Journal (BMJ), went out and got some evidence. Royal medical colleges in the UK have received more than £9m in marketing payments from drug and medical devices companies since 2015. The Royal College of Physicians and the Royal College of General Practitioners were the biggest recipients of industry money. Of course, these payments have no effect upon the objectivity and working of the societies, it is just to pay for morning tea, and maybe the odd special cleaning session when things get a little messy. So to speak.

https://www.bmj.com/content/382/bmj.p1658

BMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p1658 (Published 26 July 2023)

Medical royal colleges do not always disclose publicly the millions of pounds they receive from drug and medical device companies. Critics say voluntary industry transparency initiatives don’t go far enough. Hristio Boytchev reports

Royal colleges in the UK have received more than £9m in marketing payments from drug and medical devices companies since 2015, an analysis by The BMJ has found. The Royal College of Physicians and the Royal College of General Practitioners were the biggest recipients of industry money, the investigation found.

The BMJ asked the colleges to disclose all payments from industry, campaign groups, or patient associations, including the specific amount received from each donor, but they all refused to do so, other than the Royal College of Anaesthetists. The colleges are not obliged to disclose these payments; they are not included in their annual reports and are only available through voluntary industry transparency initiatives, which experts say have severe limitations.

Industry payments have become controversial in recent years, even leading to one drug company being suspended from its representative association.5 Some colleges have already cut ties: since 2012 the College of Psychiatrists of Ireland has refused to take any sponsorship from drug companies, noting that research “overwhelmingly” shows that clinicians are influenced by industry marketing and that this affects prescribing.

“I can see no justification for anything but full and mandatory disclosure,” says Emma Hardy, Labour member of parliament and chair of the All Party Parliamentary Group on Surgical Mesh Implants. “Medicine is literally a matter of life and death, and patients must be confident they are receiving the best treatment available for the right reasons.”

“Even if we are told the information is independent, funding skews the types of education or information that gets made,” says Margaret McCartney, a general practitioner and former Royal College of General Practitioners trustee and council member. “It means that we become less independent, because we are not setting our own priorities, and that’s bad for the profession.”

The royal colleges told The BMJ that drug and medical device company payments make up a fraction of their overall budgets and that there are clear governance rules around industry payments (see box 1 for all responses from the royal colleges). The Royal College of GPs says that it will publish a full list of college sponsors from April 2024. The drug and medical device companies say that all payments to royal colleges were disclosed transparently and were given with the goal of improving patient care.

Box 1

Responses from the royal colleges

Royal College of GPs

“The college has committed to publishing an annual list of all college sponsors as of the 2023-24 financial year. Wherever possible and subject to any contractual and data handling restrictions that may exist, information on the financial bandwidths of sponsorship funding will also be included. We are not able to provide a list of past sponsors as we do not have the authorisation in place for historical agreements to make them public.”

Royal College of Physicians

“We are not financially dependent as a charity on income received from corporate partnerships, and no corporate partner has ever provided more than 1% of our annual income . . . Any continuing medical education work that has received funding includes a declaration of funding, and the [college] remains solely responsible for project design, development, and implementation. We also publish the names of corporate partners who provide more than £10 000 of support in our annual report.”

Royal College of Ophthalmologists

“We offer opportunities to sponsor our work and activities through collaborative partnerships. We only choose to work with potential funding partners who have the same shared aims as the [college].”

Royal College of Paediatrics and Child Health

“Since 2019, which was when we recorded information in that way, our received funds from pharmaceutical companies and med-tech companies have been considerably less than 1% of college income . . . We are mindful of the wide breadth of views from members and non-members around working with industry and have had many discussions in the college regarding this, hence our due diligence process.”

Royal College of Emergency Medicine

“Partnership and sponsorships form a vital part of the organisation’s fundraising mix . . . [The college] has policies and procedures, which ensure it retains its independence when working with sponsors or partners . . . In 2021 less than 1% of [the college’s] annual income came from pharmaceutical companies.”

Royal College of Obstetricians and Gynaecologists

“Since 2018, annual income from industry has remained below 2% of the overall [college] income . . . Industry involvement will be clearly listed on any [college] products or activities they have supported.”

Royal College of Surgeons of England

“Industry payments make up a small proportion of the Royal College of Surgeons of England’s total income. They are a pragmatic way of funding some of our activities without adding to the financial burden of our membership. We are keenly aware of conflicts of interest, and we do not accept funding that could undermine our reputation.”

The college said that much of the past data in the Disclosure UK database is incorrect, allocating funding to the royal college instead of organisations at the same address.

Royal College of Physicians and Surgeons of Glasgow

“By working with long-standing partners in business and industry, we are able to enhance our educational activities and drive innovation to ensure our members are able to deliver the best outcomes for their patients and inspire the next generation of healthcare professionals . . . Each partnership is considered individually to ensure the independence of the college, and must be in line with our values and ethos.”

Royal College of Anaesthetists

“We do not enter into partnerships where a commercial or industry partner seeks to influence the text of our materials in a manner favourable to its own commercial interests. Neither do we enter partnerships where financial support constitutes an inducement to recommend a particular medicine or medical device. Any new partnership with a financial value of £50 000 or more requires approval by the college’s Board of Trustees.” Data provided by the college show that industry income accounted for 0.28% of total turnover for 2015-22.

Royal College of Pathologists

“The Royal College of Pathologists has clear governance rules around corporate membership, donations, and sponsorship . . . We also have governance policies that cover conflicts of interest, declaration of interests and payments received for senior staff and trustees of the college.”

Royal College of Radiologists

“We work with partners, primarily to support events, ensuring lower costs to our members. Our sponsorship charter ensures that we consider each sponsor on its merits . . . Sponsorship of non-pharma companies amounted to £1m over five years.” The college had a lower figure for drug company payments than the one shown in the Disclosure UK database, probably owing to the college not invoicing a company or having received the payment in 2016, a college spokesperson told The BMJ.

Royal College of Surgeons of Edinburgh

“In an increasingly complex and challenging healthcare landscape, we believe working with partners, public and private, is the best way to support our profession and patients worldwide, but we do not endorse products or favour commercial parties.”

Royal College of Psychiatrists

“The college limits funding from pharmaceutical companies to a maximum of 5% of income. Actual income from pharmaceutical companies between 2015 and 2022 was significantly lower—averaging 0.31% of total income over this period . . . The college’s policy for accepting income from commercial organisations, including the pharmaceutical industry, is set out in Good Psychiatric Practice: Relationships with Pharmaceutical and Other Related Organisations.”

Royal College of Physicians of Edinburgh

“The Royal College of Physicians of Edinburgh will not accept support that could compromise who we are and what we do—or undermine our effectiveness in achieving our goals . . . As part of its ethical sponsorship policy, the college holds strict ‘avoidance criteria’ in order to avoid conflicts of interest in relation to partnerships, sponsorship, exhibitors, bequests, or gifts.”

Royal College of Nursing

“Most amounts of income that we receive from pharma are low level.” A spokesperson added that the college is “not a medical royal college . . . so suggestions of influence on training would be incorrect” and added that the payments concerned the RCN Group, of which the college is a part.

Royal College of Midwives

Declined to comment.

More than £9m in payments since 2015

Drug companies gave £7.5m to royal colleges in the years 2015 to 2022, for which data were available (figs 1-5). More than half of the sum went to the Royal College of Physicians and the Royal College of GPs, which received £2.8m and £2.4m, respectively. These data were compiled from Disclosure UK, an online database run by the Association of the British Pharmaceutical Industry (ABPI), where drug companies disclose payments to healthcare organisations, patient groups, and health professionals who have consented for these payments to be made public.”