OPINION: Transparency in medical research as social policy: A personal view from our new research visitor from Tohoku University, Japan

Anju Murayama (left), Dr. Ozaki (right) with a colleague

Hi, I am Anju Murayama and a six-grade medical student at Tohoku University in Japan. I am going to visit to the Centre for the Analysis of Social Policy and Society (CASPS) for two months starting from February 2023 to conduct research on financial relationships between healthcare professionals and pharmaceutical industry with Dr Piotr Ozieranski. I am studying medicine, and outside of my medical course, I have been working on conflicts of interest between healthcare professionals and pharmaceutical companies in Japan under the supervision of Dr. Akihiko Ozaki, a renowned breast surgeon and a key expert for the Medical Governance Research Institute in Japan.

Since my first publication on the financial conflicts of interest among clinical practice guidelines authors in Japan ¹, I had researched mainly on the conflicts of interest among Japanese clinical practice guidelines authors. Clinical practice guidelines are developed by many experts based on the best available evidence and form a short set of “dos and don’ts” for doctors treating specific diseases. Guidelines make many recommendations to doctors on how to diagnose, treat, and manage diseases, and can be used as evidence of medical malpractice if a doctor treats a patient without following them².

Given how important are these guidelines, the drug manufacturers target experts involved in guideline development. There have been many documented cases in which conflicts of interest between senior doctors contributing to guidelines and drug companies, which may lead to biased recommendations, potentially harmful to patients³.

Transparency is at the heart of social policy. It is a key factor for maintaining cohesion in society by building and maintaining trust in institutions and evidence-based practices for the public good. In this context, as a medical student, I believe that the financial relationships I described above should be transparent in order to prevent and recognize their impact. I have sought to address this issue by co-authoring 13 papers reported what were substantial financial relationships between the guideline authors and pharmaceutical companies in Japan^{1, 4-7}.

Additionally, I’m researching the extent of financial relationships between medical experts and the pharmaceutical companies. I found that majority of physicians accepted personal compensations for giving lectures, writing pamphlets, and consulting services from the pharmaceutical companies, and the amounts of payments are relatively small, typically £‎1000-2000 per physician per year ^{8, 9}. Physicians in leading positions who should be fair and unbiased, such as medical society board members, clinical practice guideline authors, and society journal editors, received substantial amounts of personal payments for the reimbursement of lecturing and consulting of more than tens of thousands of pounds each year from the pharmaceutical companies^{8, 9}.

My current interest is to elucidate how different the extent of financial relationships is between Japan and other major pharmaceutical markets such as the United States and the United Kingdom, and how they are regulated. So, during my research visit to Bath, I am planning to lead two research papers using data on payments to healthcare professionals and organisations disclosed by the pharmaceutical industry in the UK. I will be focusing on financial relationships between drug companies and hospital departments in England as well as trends in undisclosed payments in the UK more broadly. This research will contribute to the ongoing collaboration between the Centre for Social Policy Analysis and Society (CASPS) at Bath and the Medical Governance Research Institute.

Outside of the research, I like to travel the world and backpacking. Before the COVID-19 pandemic, I had backpacked alone through several countries, including India, the Philippines, Hong Kong, and Taiwan for a few months. I aim to spend a few days visiting other parts of Europe during my research visit, so please let me know your recommendation! I am very much looking forward to seeing you soon.

Anju Murayama

References

1. Murayama A, Ozaki A, Saito H, Sawano T, Shimada Y, Yamamoto K, Suzuki Y, Tanimoto T. Pharmaceutical company payments to dermatology Clinical Practice Guideline authors in Japan. PLoS One. 2020;15(10):e0239610. Epub 2020/10/14. doi: 10.1371/journal.pone.0239610.
2. Institute of Medicine. Clinical Practice Guidelines We Can Trust. Graham R, Mancher M, Wolman DM, Greenfield S, Steinberg E, editors. Washington, DC: The National Academies Press; 2011. 290 p.
3. Steinbrook R. Guidance for guidelines. N Engl J Med. 2007;356(4):331-3. Epub 2007/01/26. doi: 10.1056/NEJMp068282.
4. Murayama A, Yamada K, Yoshida M, Kaneda Y, Saito H, Sawano T, Shrestha S, Shrestha R, Tanimoto T, Ozaki A. Evaluation of Conflicts of Interest among Participants of the Japanese Nephrology Clinical Practice Guideline. Clin J Am Soc Nephrol. 2022;17(6):819-26. Epub 2022/05/28. doi: 10.2215/CJN.14661121.
5. Murayama A, Kamamoto S, Murata N, Yamasaki R, Yamada K, Yamashita E, Saito H, Tanimoto T, Ozaki A. Evaluation of financial conflicts of interest and quality of evidence in Japanese gastroenterology clinical practice guidelines. Journal of Gastroenterology and Hepatology. doi: https://doi.org/10.1111/jgh.16089.
6. Mamada H, Murayama A, Kamamoto S, Kaneda Y, Yoshida M, Sugiura S, Yamashita E, Kusumi E, Saito H, Sawano T, Tanimoto T, Vassar M, Ozieranski P, Ozaki A. Evaluation of Financial and Nonfinancial Conflicts of Interest and Quality of Evidence Underlying Psoriatic Arthritis Clinical Practice Guidelines: Analysis of Personal Payments From Pharmaceutical Companies and Authors’ Self-Citation Rate in Japan and the United States. Arthritis Care & Research. doi: https://doi.org/10.1002/acr.25032.
7. Murayama A, Kamamoto S, Shigeta H, Saito H, Yamashita E, Tanimoto T, Akihiko O. Undisclosed financial conflicts of interest with pharmaceutical companies among the authors of the Esophageal Cancer Practice Guidelines 2017 by the Japan Esophageal Society. Diseases of the Esophagus. 2022;35(10). doi: 10.1093/dote/doac056.
8. Murayama A, Mamada H, Shigeta H, Yoshinaga T, Saito H, Yamashita E, Tanimoto T, Ozaki A. Financial Relationships Between Pharmaceutical Companies and Rheumatologists in Japan Between 2016 and 2019. JCR: Journal of Clinical Rheumatology. 9900:10.1097/RHU.0000000000001922. doi: 10.1097/rhu.0000000000001922.
9. Kamamoto S, Murayama A, Kusumi E, Yoshida M, Saito H, Sawano T, Yamashita E, Tanimoto T, Ozaki A. Evaluation of financial relationships between Japanese certified pediatric hematologist/oncologists and pharmaceutical companies: a cross-sectional analysis of personal payments from pharmaceutical companies between 2016 and 2019. Pediatric Blood & Cancer. 2022;69(10):e29891. doi: https://doi.org/10.1002/pbc.29891.