Industry Financial Support Research Articles

Payments to healthcare organisations reported by the medical device industry in Europe from 2017 to 2019: An observational study

ObjectiveMedical device industry payments to healthcare organisations (HCOs) can create conflicts of interest which can undermine patient care. One way of addressing this concern is by enhancing transparency of industry financial support to HCOs. MedTech Europe, a medical device trade body, operate a system of disclosure of education payments to European HCOs. This study aimed to characterise payments reported in this database and to evaluate the disclosure system. MethodsAn observational study of education-related payments to HCOs reported by the medical device industry in Europe was conducted. Data was manually extracted from transparentmedtech.eu. The primary outcome variable is the value of the payments, overall, and for each year, payment type, and country. The accessibility, availability and quality of the database was also analysed, using a proforma with 15 measures. ResultsOverall, 116 medical device companies reported education-related payments in 53 European and non-European countries, valuing over €425 million between 2017 and 2019, increasing in value between 2017 and 2019, from €93,798,419 to €175,414,302. Ten countries accounted for 94% of all payments and ten companies accounted for 80% of all payments. The accessibility, availability and quality of the database rated low for six measures, medium for six measures, and high for three measures. ConclusionThere is a large amount of education-related payments from medical device companies to European HCOs, creating substantial potential for conflicts of interest. MedTech Europe's disclosure system has many shortcomings. A European-wide publicly mandated disclosure system for both the medical device and pharmaceutical industries should be introduced. Public interest summaryThe medical device industry pay healthcare organisations (e.g. hospitals) large amounts of money. Industry states that this money is to help pay for healthcare professionals’ education. However, these payments can have a negative impact on healthcare professionals’ decision-making. This study sought to examine a website run by MedTech Europe, a representative body for the medical device industry, which outlines details of some of these payments (www.transparentmedtech.eu). Our analysis found that between 2017 and 2019 the medical device industry made ‘education’ payments valuing €425 million to healthcare organisations in Europe. We also assessed how comprehensive and user-friendly the database was and found a range of issues. For example, the database is not downloadable and some other important types of payments, such as payments for consultancy, are not included. We concluded that a mandatory database for both the medical device and pharmaceutical industry run by the European Union, would significantly improve transparency.

Research on the Development Trend and Prospect of the Pharmaceutical Industry under the Impact of COVID-19

The pharmaceutical industry has the function of ensuring people's livelihood and high technical barriers, provides drugs and medical devices, and accompany the people throughout the life process. The pharmaceutical industry, a high-tech sector, plays a significant role in reacting to public health emergencies and avoiding big unexpected diseases in addition to enhancing people's health levels. At the end of 2019, the sudden outbreak of COVID-19 occurred, and its influence continued to expand. It brought new opportunities and challenges to the global pharmaceutical industry. Since the COVID-19, the expanding demand has driven the steady growth of the pharmaceutical industry, powerful nations have led the world pharmaceutical development, new vaccine has become the global highlight. As for pharmaceutical industry to further development, there are several suggestions in this paper: make more basic researches and develop new technologies, pharmaceutical industry alliance seeking win-win cooperation, enhance the independent innovation research and development strength promote industry core competitiveness, follow the national policy guidance to strengthen the pharmaceutical industry financial support.

Industry support for dental implant research: A metatrend study of industry partnership in the development of new technologies

Statement of problemIndustry needs scientific knowledge to develop new products and services, and their financial support to dental implant researchers translates into commercial products. Therefore, identifying the relevant factors for a successful industry partnership is important. PurposeThe purpose of this study was to provide a 20-year bibliometric overview of industry-sponsored studies in implant dentistry to identify possible factors involved in industry partnership motivations. Material and methodsA hand search of 6 of the most established journals in the implant dentistry field was performed for articles published in 1999, 2004, 2009, 2014, and 2019. Information regarding the continent of origin of the corresponding author, interinstitute collaboration, type and topic of research, and the h-index of the corresponding author was recorded for each included article. Bivariate and multivariate logistic regression was used to determine statistical relationship between industry support and exploratory factors (α=.05). ResultsA 6% increase in the chance of industry investment was observed over the years (odds ratio [OD]=1.06; P<.001). Studies from North America (OD=4.87; P<.001) and Europe (OD=3.13; P<.001) were more likely to receive industry funding. Data also revealed a direct relationship between the increasing number of institutions involved in the study and the probability of industry funding (OD=1.21; P<.001). Animal studies (OD=2.26; P<.001) about surgical procedures and prosthodontic topics (OD=1.40; P=.044) stood out for having greater industry support. Researchers with an h-index between 31 and 40 were more likely to receive industry financial support (OD=2.46; P=.001). ConclusionsIndustry support for dental implant research was closely aligned with the continent of origin, interinstitute collaboration, type and topic of research, and the h-index of the corresponding author.

Evaluation on financial support efficiency of new generation high-tech industry in China

From the perspective of enterprises and regions, this paper selects the relevant data of 192 listed companies in China from 2015 to 2019, establishes a static analysis model DEA to evaluate the pure technical efficiency, scale efficiency and comprehensive efficiency of the new generation of high-tech industry financial support; At the same time, the dynamic analysis model DEA Malmquist is established to evaluate the change of financial support efficiency of the new generation of high-tech industry. The results show that: at the enterprise level, the overall efficiency of financial support is still at a low level, and the development is not stable, but the overall performance of the enterprise is good in the technical efficiency of financial support, and there is great volatility in the scale efficiency. At the regional level, the eastern region is the best in both the static and dynamic aspects of financial support efficiency, the western region is the second in the static aspect, and the central region is the second in the dynamic aspect. However, the development trend of the three regions is the same, that is, fluctuating development, and the overall trend is good.

Funding received from breastmilk substitute manufacturers and policy positions of national maternity care provider associations: an online cross-sectional review

ObjectivesMaternity care providers play an essential role in supporting women to breast feed. It is critical that their professional associations limit influence from breastmilk substitute (BMS) manufacturers. Aims of this...

Under the Background of Internal Economic Cycle, Wuhan Cultural and Creative Industry Financial Support for Innovation Research

The rise of the tertiary industry has played a great role in the development of the Chinese economy. As the pillar industry, the cultural and creative industry can realize the upgrading and transformation through strengthening the support of new technologies and financial resources, thus bringing higher economic benefits. Focusing on the background of the internal economic circulation, this paper analyzes the financial support status and existing problems of the cultural and creative industry in Wuhan, puts forward the innovative ideas of the financial support of the Wuhan cultural and creative industry in the future, and provides reference for the rapid development of the Chinese cultural and creative industry in the future.

Research on the Efficiency of China's Marine Industry Financial Support Based on DEA

Cao, Y.L., 2020. Research on the efficiency of china's marine industry financial support based on DEA. In: Bai, X. and Zhou, H. (eds.), Advances in Water Resources, Environmental Protection, and Sustainable Development. Journal of Coastal Research, Special Issue No. 115, pp. 217-219. Coconut Creek (Florida), ISSN 0749-0208.Financial support is the driving force and means for the development of marine industry. Improving the efficiency of financial support is the key to financial support. With the increasingly fierce market competition, only by relying on high-quality products and high customer satisfaction can enterprises survive in the fierce competition. Among many evaluation methods, Data Envelopment Analysis (DEA), as a non-parametric statistical method for effectively dealing with multi-input and multi-output problems, has received more and more attention in evaluating the relative efficiency of decision-making units. The adjustment and optimization of financial structure have been proved by theory and practice to promote economic growth, and financial support plays a decisive role in the development of marine industry. China's financial structure is still in the stage of scale expansion to promote the marine economy. In order to promote the improvement of marine industry, we should turn to the intensive mode of efficiency improvement. This paper extends from financial support to the study of financial support efficiency, and puts forward the method of using DEA model to evaluate and analyze the financial support efficiency of marine industry.

Industry payments to authors of Journal of Shoulder and Elbow Surgery shoulder arthroplasty manuscripts are accurately disclosed by most authors and are not significantly associated with better reported treatment outcomes

Author transparency in disclosing potential conflicts of interest when reporting outcomes for shoulder arthroplasty implants is important. Using the Centers for Medicare & Medicaid Services Open Payments Program (OPP) database, we analyzed articles in the Journal of Shoulder and Elbow Surgery to evaluate(1) discrepancies between the stated conflicts of interest and associated payments recorded in the database, (2) the magnitude and types of payments received, and (3) possible relationships between industry financial support and positive study outcomes. Articles reporting clinical outcomes of shoulder arthroplasty from 2016 and 2017 were reviewed. Articles identifying a specific shoulder arthroplasty implant and having at least 1 author based in the United States were included. Payment types, amounts, and sources were extracted from disclosure statements in the manuscript and considered relevant if they were received from the implant manufacturer. Published disclosure statements were compared against the OPP database. Study outcomes demonstrating a clinical benefit were considered "positive." Payments to authors reporting positive outcomes were compared with those reporting nonpositive outcomes. Implant manufacturers provided $16,051,261 to authors of shoulder arthroplasty publications over a 2-year period. Approximately half of senior authors (46%) received royalty payments, more than 90% of which ($14,910,873; 93%) were reported in disclosure statements. Although authors of articles with positive outcomes received greater payments than those reporting nonpositive outcomes, these differences were not statistically significant. The majority of author disclosure statements accurately reflected the OPP data. Payments were not significantly associated with positive outcomes reported for the specific implant.

When patient advocacy organizations meet industry: a novel approach to dealing with financial conflicts of interest

BackgroundMuch like academic-industry partnerships, industry financial support of patient advocacy organizations (PAOs) has become very common in recent years. While financial conflicts of interest (FCOI) between PAOs and industry have received more attention in recent years, robust efforts to mitigate these conflicts are still limited.Main bodyThe authors outline the possible benefits and ethical concerns that can result from financial interactions between biomedical companies and PAOs. They argue that the use of novel strategies, such as the creation of a standing ethics committee, could be helpful in managing FCOIs and ensuring the warranted trust of PAO’s constituents. Although ethics committees to address FCOIs are common in the academic context, its use by PAOs is still limited. The authors conclude by describing the process of development and implementation of such an ethics committee at the Crohn’s & Colitis Foundation.ConclusionsWhile collaborations with industry can result in conflicts of interest, PAOs can develop strategies to address those conflicts. One such strategy is the creation of a standing independent ethics committee to guide PAOs on new and/or existing programs and protocols as they pertain to their industry relationships.

What Proportion of Women Who Received Funding to Attend a Ruth Jackson Orthopaedic Society Meeting Pursued a Career in Orthopaedics?

Orthopaedic surgery has the lowest percentage of women residents and faculty of any medical and surgical specialty. Diversity in medicine has been shown to improve patient outcomes and satisfaction. Although some scholarships are designed to increase the exposure of women medical students to orthopaedic surgery, the impact of those scholarships is largely unknown. To determine the proportion of medical students who received a scholarship to attend the Ruth Jackson Orthopaedic Society (RJOS) annual meeting and later pursued a career in orthopaedic surgery. The RJOS scholarship was advertised through the RJOS website, current members, and newsletters. Any RJOS medical student member in good standing was eligible to receive the award. Eighty-one scholarship winners were selected from 2003 to 2016. From 2003 to 2010, there were two awards each year. Starting in 2011, 10 students were selected yearly, and these numbers increased annually secondary to increased industry financial support. Recipients received a check for USD 1500 and were able to attend both the RJOS and American Academy of Orthopaedic Surgeons annual meetings. We collected the names of all RJOS medical student scholarship winners from 2003 to 2016, and one author performed an internet search to determine whether these individuals are currently in an orthopaedic residency program or are orthopaedic surgeons. Secondary confirmation was performed to ensure accuracy by the RJOS administrative staff and the other two authors, independently, after the initial results were tabulated. Of the 81 scholarship winners, 65 women (80%) now either practice orthopaedic surgery or are in an orthopaedic surgery residency program. Of the applicants who were not selected as scholarship recipients from 2014-2016, 44.9% went on to pursue a career in orthopaedics. The RJOS scholarship may have helped young women decide to pursue careers in orthopaedic surgery, although it is also possible that some scholarship winners were inclined to do so before receiving the funding. Based partly on these results, the RJOS continues to award this scholarship. Future studies evaluating the impact of such scholarships and comparing them with alternative recruitment methods such as summer camps might be useful in determining the most effective way of increasing minority representation in orthopaedics, a factor that has been shown to be clinically relevant and one that can contribute to patient satisfaction. Level IV, therapeutic study.

Food engineering and food science and technology: Forward-looking journey to future new horizons

The overall objectives of this study were to assess the status of Food Engineering (FE), Food Science and Technology (FS&T) and related fields using a global web-survey and included: identifying the major challenges and opportunities; and making specific recommendations for future possible paradigm shifts. Respondents from academia, private research institutes, industry, government, consulting and others sectors participated. The most important topics selected were: ‘Innovation/open innovation,’ ‘Broad education and multidisciplinary capabilities,’ ‘Career development & prospects,’ and ‘Applied research.’ Lowest importance were ‘Basic science’ and ‘Salary.’ Highest possible impact on FE and FS&T future curricula were: ‘Food safety, waste reduction/management’ and ‘Environmental impact, food sustainability and security.’ Overwhelming majority (>68%) indicated that FE or FS&T should be integrated with other existing/evolving academic program. Principal component analysis yielded 3-new variables, offering insights on the relationships between geographical education location and sustainability, innovation and employability. The competitive landscape calls for reshaping of the domains vision. Basic research and salary were selected by the respondents to have a very low importance. Enhancing applied research, agility, attractiveness of the field and strengthen research relevance and collaboration with industry are required. Both government/state and food industry financial support is a clear indication of the significant role they play in the innovation ecosystem collaboration. Significant difference between North America & Canada and Europe on addressing innovation, soft skills and employability offer new insights on enhancing utilization of innovation, science, technology and impact. Innovation and open innovation offer FE and FS&T unique new horizons for spearheading change and opportunities to alleviate typical industrial and academic conservativeness and risk aversion.

A GRADUATE COURSE IN FIRE PROTECTIVE DESIGN AND BUILDING CODES AN INDUSTRY AND UNIVERSITY COLLABORATION

Since the fall of 2013, the Faculty of Engineering has offered a graduate course in Fire Protective Design and Building Codes based on Part 3 of the National Building Code of Canada. The course is made available to graduate students in architecture and to all branches of engineering. It is also offered to off campus practicing architects and engineers who wish to either take the course for credit or who would like to audit the course.Introduction of this course into the graduate studies program at the University of Manitoba was the direct result of collaboration between the university Centre for Engineering Professional Practice and Engineering Education and industry. Industry financial support for the course instructors was provided by the Winnipeg Construction Association and the Association of Professional Engineers and Geoscientists of Manitoba. (Engineers Geoscientists Manitoba).This paper provides an overview of the course objectives, the course content and the expected and realized outcomes. The course proved to be very popular, with course registration averaging between fourteen and eighteen graduate students each year. It was highly rated by the year end student course evaluations. It was particularly popular with international graduate students, many who came from countries where exposure to fire protective design and building codes was limited or non-existent. As a spin off from the course, in 2015, the Winnipeg Construction Association began offering a workshop/seminar series of five half day courses. These workshop/seminars have been oversubscribed and are attended by a very diverse group of construction practitioners that includes architects, engineers, building officials and contractors.

Patient perspectives on physician conflict of interest in industry-sponsored clinical trials for multiple sclerosis therapeutics

Background: Pharmaceutical industry financial support of physicians, physician practices, and academic departments involved in multicenter industry-sponsored clinical trials of novel therapeutic agents is a relatively new and infrequently acknowledged source of potential physician conflict of interest. Detailed disclosure of these relationships to study participants is not uniformly a part of informed consent and documentation practices. Objective: To understand attitudes of patients with multiple sclerosis concerning disclosure of potential physician–industry conflicts of interest created by clinical trials and how such disclosures may influence study participation Methods: An anonymous online instrument was developed. Results: 597 people with multiple sclerosis participated in the study. The study found that detailed disclosure of conflicts of interest is important to potential participants in industry-sponsored clinical trials for multiple sclerosis therapies and that the presence of these conflicts of interest may influence patients’ decisions to participate in these studies. Conclusions: Findings from this study support a call for uniform guidelines regarding disclosure of physician–industry relationships to prospective research participants for industry-sponsored clinical trials.

New Diabetes Nutrition Therapy Recommendations: What You Need to Know.

The American Diabetes Association (ADA) has long recognized the integral role of nutrition therapy in overall diabetes management and recommends that each person with diabetes receive an individualized eating plan that has been developed in collaboration with his or her health care provider (HCP).1 To ensure that members of the health care team are providing up-to-date, evidence-based clinical practice recommendations, the ADA issues official position statements on scientific or medical issues related to diabetes. Recently, the ADA published a position statement titled “Nutrition Therapy Recommendations for the Management of Adults With Diabetes.”2 These recommendations replace those in previous position statements. This article reviews the development process for the 2013 nutrition recommendations, shares highlights from those guidelines, and discusses priority topics in the publication. The 2013 ADA nutrition statement was written at the request of the ADA Professional Practice Committee. In August 2012, the ADA convened a committee of nutrition experts in clinical practice and research, as well as other members of the diabetes health care team (a registered nurse/advanced practice nurse practitioner, a physician, and a pharmacist) to review the scientific literature and develop recommendations. The multidisciplinary committee followed the Institute of Medicine (IOM) Standards for Trustworthy Clinical Practice Guidelines.3 Based on the IOM standards, conflict of interest disclosures were obtained before confirmation of appointment of the co-chairs and the members of the committee/writing group. Development of the position statement was funded from ADA general revenues and not with any corporate or industry financial support. The committee's work on the position statement began with an introductory conference call. The group reviewed an outline for the statement and assigned sections to specific members. Committee members were instructed to conduct thorough literature searches and create evidence tables for all of the topics included in the statement. Inclusion criteria for …

Editorial Input for the Right Price: Tobacco Industry Support for a Sheet Metal Indoor Air Quality Manual

Following legal action in the 1990s, internal tobacco industry documents became public, allowing unprecedented insight into the industry's relationships with outside organizations. During the 1980s and 1990s, the National Energy Management Institute (NEMI), established by the Sheet Metal Workers International Association and the Sheet Metal and Air Conditioning Contractors' National Association, (SMACNA) received tobacco industry funding to establish an indoor air quality services program. But the arrangement also required NEMI to serve as an advocate for industry efforts to defeat indoor smoking bans by arguing that ventilation was a more appropriate solution to environmental tobacco smoke. Drawing on tobacco industry documents, this paper describes a striking example of the ethical compromises that accompanied NEMI's collaboration with the tobacco industry, highlighting the solicitation of tobacco industry financial support for a SMACNA indoor air quality manual in exchange for sanitizing references to the health impact of environmental tobacco smoke prior to publication.

Psychiatric Resident and Faculty Views on and Interactions With the Pharmaceutical Industry

Sales visits, or detailing, by pharmaceutical industry representatives at academic institutions has been increasingly criticized. The authors surveyed psychiatric residents and faculty members on their views and interactions with representatives of the pharmaceutical industry. In 2007, a 46-item online survey measuring attitudes toward and interactions with pharmaceutical industry representatives was sent to 49 faculty psychiatrists and 40 psychiatric trainees (residents and fellows) at a Northwest academic medical center. Sixty-five percent (N=58) of surveys were completed. Two-thirds of respondents did not agree that pharmaceutical representatives have an important teaching role. Only 24% of faculty and 18% of trainees agreed that pharmaceutical representatives provide useful and accurate information on new drugs. Forty-one percent of faculty and 53% of trainees agreed that pharmaceutical representatives should be restricted from making presentations on campus. Trainees were less likely than faculty to agree that they would maintain contact with representatives if no gifts or food were distributed. Nevertheless, most respondents endorsed that pharmaceutical companies supported important conferences, and more than 90% had attended an industry-sponsored event in the previous year. In open-ended questioning, respondents revealed worries that bans would undermine the ability to secure national speakers and to support other activities that residents valued. Faculty and psychiatric residents and fellows do not view pharmaceutical representatives as having an important teaching role and mistrust the information they offer but believe that loss of industry financial support does adversely affect educational and other highly valued activities. They favor greater policy restrictions but do not support an outright ban on pharmaceutical support.

Funding of Educational Opportunities in Orthopaedic Surgery Residency Training

As funding for graduate medical education continues to decline, finding sources of funding for orthopaedic resident education is a major issue for residency programs, health systems, the American Academy of Orthopaedic Surgeons (AAOS), and the American Orthopaedic Association (AOA). The majority of funding for orthopaedic residency programs in the United States includes federal funding from Medicare and Medicaid to the academic health center, funding from faculty and endowments, contributions from individual hospitals and institutions, and industry financial support of courses and the provision of other educational resources1-10. With the continued decrease in federal government funding for graduate medical education and the decrease in funding from industry secondary to concerns about conflicts of interest, many residency programs may need to evaluate other sources of funding to meet the educational needs of their residents. We conducted a survey of residency program directors and chairs to better understand the funding sources for their educational programs. In addition, we sought to define the role of industry funding in resident education. The AAOS staff and the AAOS Washington Health Policy Fellows designed a survey regarding funding for orthopaedic graduate medical education and the impact of industry support in funding graduate medical education activities (see Appendix). A web-based survey was developed and administered to orthopaedic residency program directors or chairs in the AAOS database. Questions were formatted and the data collection tool was developed by the Department of Research and Scientific Affairs of the AAOS to ensure proper survey format and to minimize response bias11-13. In August 2008, residency program directors or chairs were contacted to apprise them of the survey. One week after the announcement, the survey link was distributed to 149 residency program directors or chairs (one contact per residency program). Three reminder e-mails were subsequently …

Pharmaceutical Industry Financial Support for Medical Education: Benefit, or Undue Influence?

Presently, the pharmaceutical industry funds about half of the costs of continuing medical education (CME) programs in the U.S. This contributes to the ethical problems that pervade the relationship between medicine and the pharmaceutical industry: trustworthiness and conflicts of interest. The problems are exacerbated by rationalizations prevalent on both sides that deny the ethical concerns. Commercialism and commercial bias are highly visible at large CME gatherings, and available data, while scanty, back up the view that physician attendees' subsequent prescribing practices are influenced by the commercial message. The industry believes that it will recoup $3.56 in increased sales for every dollar that it invests in CME. New guidelines instituted by the Accreditation Council for Continuing Medical Education (ACCME) in 2004 may succeed in reducing excessive commercial influence, especially since the Department of Health and Human Services has also warned the industry of possible anti-kickback violations if firewalls are not erected between CME funding and marketing of drugs. Critics counter that early indicators of improvement are lacking.

In whose interest? Relationships between health consumer groups and the pharmaceutical industry in the UK

This paper explores how health consumer groups in the UK disclose and manage links with pharmaceutical companies in the context of their growing involvement in the policy process. In particular, it examines claims that industry engages with groups in an attempt to capture the groups' policy agenda, thereby increasing industry's political influence. Drawing on theories of disclosure, analysis of group and industry websites revealed a varying level of detail on the nature and extent of relationships. Only 26 per cent of consumer groups known to be in receipt of industry financial or in-kind support openly acknowledged this. Interviews undertaken with representatives from consumer groups, industry and other health-care stakeholders, highlighted a coincidence of aims between the two sectors, an acknowledgement that collaboration was inevitable, and tacit support for policy guidelines to manage conflicts of interest. The paper concludes by arguing that while claims of organisational capture are over-stated, the shallow approach to transparency adopted by the majority of companies and groups strengthens critiques of undue influence. This may ultimately reduce policy makers' willingness to see consumer groups as the legitimate voice of patients, users and carers in the policy process.

Guest Authorship and Ghostwriting in Publications Related to Rofecoxib

Authorship in biomedical publication provides recognition and establishes accountability and responsibility. Recent litigation related to rofecoxib provided a unique opportunity to examine guest authorship and ghostwriting, practices that have been suspected in biomedical publication but for which there is little documentation. To characterize different types and the extent of guest authorship and ghostwriting in 1 case study. Court documents originally obtained during litigation related to rofecoxib against Merck & Co Inc. Documents were created predominantly between 1996 and 2004. In addition, publicly available articles related to rofecoxib identified via MEDLINE. All documents were reviewed by one author, with selected review by coauthors, using an iterative process of review, discussion, and rereview of documents to identify information related to guest authorship or ghostwriting. Approximately 250 documents were relevant to our review. For the publication of clinical trials, documents were found describing Merck employees working either independently or in collaboration with medical publishing companies to prepare manuscripts and subsequently recruiting external, academically affiliated investigators to be authors. Recruited authors were frequently placed in the first and second positions of the authorship list. For the publication of scientific review papers, documents were found describing Merck marketing employees developing plans for manuscripts, contracting with medical publishing companies to ghostwrite manuscripts, and recruiting external, academically affiliated investigators to be authors. Recruited authors were commonly the sole author on the manuscript and offered honoraria for their participation. Among 96 relevant published articles, we found that 92% (22 of 24) of clinical trial articles published a disclosure of Merck's financial support, but only 50% (36 of 72) of review articles published either a disclosure of Merck sponsorship or a disclosure of whether the author had received any financial compensation from the company. This case-study review of industry documents demonstrates that clinical trial manuscripts related to rofecoxib were authored by sponsor employees but often attributed first authorship to academically affiliated investigators who did not always disclose industry financial support. Review manuscripts were often prepared by unacknowledged authors and subsequently attributed authorship to academically affiliated investigators who often did not disclose industry financial support.