Disclosure Of Payments Research Articles

Drug company methodologies used for reporting in the UK pharmaceutical industry payment transparency database between 2015 and 2019: A content analysis

Pharmaceutical companies spend hundreds of millions of pounds on marketing/R&D-related payments annually to healthcare organisations and healthcare professionals. UK pharmaceutical industry self-regulatory bodies require member companies who sign up to their code of conduct to publish details of their payments. They are also required to publish the methodologies underlying these payments, namely methodological notes. This study aimed to analyse UK pharmaceutical companies’ methodological notes and their adherence to the Association of the British Pharmaceutical Industry code of conduct and other relevant guidance. We conducted a content analysis of methodological notes for the years 2015, 2017 and 2019 and assessed companies’ adherence to self-regulatory bodies’ requirements and recommendations for methodology disclosure. Overall, 90 companies made payment disclosures in all three years, publishing 269 methodological notes. We found gaps in adherence to self-regulatory requirements. Only 3 (3.3 %) companies provided clear information for all self-regulatory body recommendations and regulations in all of their notes. Companies also varied in their approaches to important areas. For example, of the 244 notes with clear information on VAT management, 36.1 % (N = 88) included VAT, 30.3 % (N = 74) excluded VAT, and 33.6 % (N = 82) had multiple rules for VAT. There was evidence of widespread non-adherence to self-regulatory requirements. This suggests flaws with self-regulation and a need for greater enforcement of rules or consideration of a publicly mandated disclosure system.

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.

Characterizing industry payments to US teaching hospitals and affiliated physicians: a cross-sectional analysis of the Open Payments datasets from 2016 to 2022.

Industry payments to US teaching hospitals are common; however, little is known about whether these financial relationships influence affiliated physicians to engage in similar financial relationships with industry. Using national hospital, physician, and industry payment data we investigated trends in industry payments made to US teaching hospitals and affiliated physicians to characterize the magnitude and nature of payments. In addition, we assessed if physicians may be influenced to accept higher value industry payments depending on the value of promotional payments accepted by the teaching hospital they affiliate with. We found that physicians with a US teaching hospital affiliation are associated with accepting higher value industry payments as the total value of industry payments of the teaching hospital increases. Our findings varied by specialty, with surgeons accepting the highest value payments. These results highlight the need for greater public disclosure and awareness of payments to better manage and mitigate industry-biased clinical decision making.

Hospital and Surgeon Competition and Its Association with Disclosure of Payments for Major Joint Arthroplasty

Zhang, Gloria X; Peairs, Emily M BS; Zhang, Yuqi MD; Cerullo, Marcelo MD, MPH Author Information

International comparison of pharmaceutical industry payment disclosures in the UK and Japan: implications for self-regulation, public regulation, and transparency

BackgroundSelf-regulation of payment disclosure by pharmaceutical industry trade groups is a major global approach to increasing transparency of financial relationships between drug companies and healthcare professionals and organisations. Nevertheless, little is known about the relative strengths and weaknesses of self-regulation across countries, especially beyond Europe. To address this gap in research and stimulate international policy learning, we compare the UK and Japan, the likely strongest cases of self-regulation of payment disclosure in Europe and Asia, across three dimensions of transparency: disclosure rules, practices, and data.ResultsThe UK and Japanese self-regulation of payment disclosure had shared as well unique strengths and weaknesses. The UK and Japanese pharmaceutical industry trade groups declared transparency as the primary goal of payment disclosure, without, however, explaining the link between the two. The rules of payment disclosure in each country provided more insight into some payments but not others. Both trade groups did not reveal the recipients of certain payments by default, and the UK trade group also made the disclosure of some payments conditional on recipient consent. Drug company disclosure practices were more transparent in the UK, allowing for greater availability and accessibility of payment data and insight into underreporting or misreporting of payments by companies. Nevertheless, the share of payments made to named recipients was three times higher in Japan than in the UK, indicating higher transparency of disclosure data.ConclusionsThe UK and Japan performed differently across the three dimensions of transparency, suggesting that any comprehensive analysis of self-regulation of payment disclosure must triangulate analysis of disclosure rules, practices, and data. We found limited evidence to support key claims regarding the strengths of self-regulation, while often finding it inferior to public regulation of payment disclosure. We suggest how the self-regulation of payment disclosure in each country can be enhanced and, in the long run, replaced by public regulation to strengthen the industry’s accountability to the public.

The market response to mandatory disclosure of payments to foreign governments

This study examines how the equity market responds to the mandated disclosures made under the Canadian Extractive Sector Transparency Measures Act (ESTMA). We studied a sample of 1,559 company-year-country disclosures from 937 extractive firms listed, or conducting business, in Canada between 2016 and 2018, and controlled for corruption perception and bribe indices in the host country. We found that ESTMA disclosures are associated with a negative market reaction, implying that the market perceives a net loss to firms as a result of the costs of compliance and risks associated with ESTMA. It appears that the reaction is stronger and more negative for ESTMA reports that provide more information, as well as for firms that report higher payments than expected. Furthermore, we have found that the ESTMA disclosures garner a stronger market reaction for firms that are more prone to corruption or have weak governance. This study contributes to the important discussion regarding the use of transparency measures to address the issues related to human rights in the business environment. Our results confirm that transparency is costly for shareholders, and it is, therefore, important for policymakers to consider the costs, benefits, and potential unintended consequences of their measures.

The undisclosed disclosures: Conflicts of interest in studies related to robotics in hepatobiliary and pancreatic surgery

BackgroundThe use of robotics in hepatobiliary and pancreatic surgery has increased. With this increased collaboration, there has also been a push toward improving the transparency of conflicts of interest in terms of funding provided by robotics companies. MethodsStudies with ≥1 American author published between 2016 and 2020 discussing robotic hepatobiliary and pancreatic surgery were included in the analysis. The Centers for Medicare and Medicaid Services Open Payments Program was used to evaluate the accuracy of industry payment disclosures. Conflict of interest was defined as a lack of disclosure of ≥$100 funding from any robotics company in the United States. The primary outcome of this study was to determine the efficacy of the current standard conflict of interest reporting in surgery. ResultsA total of 355 studies (2,413 authors) were included. Of the studies that received robotics funding (n = 133), 20.3% did not disclose their conflicts of interest, whereas 79.7% had a conflict of interest disclosure. However, most of the disclosures (76.5%) were inaccurate. ConclusionThe findings of this study require an update in journal policies to ensure the accurate disclosure of conflicts of interest in robotic hepatobiliary and pancreatic surgery studies. Similarly, the investigators should ensure that their disclosures are accurate. Finally, surgeons must be more on top of their relationships with these companies and consider their vulnerability to bias.

Mandatory extraction payment disclosures and tax haven use: Evidence from United Kingdom

Research Question: Does public country by country reporting (CbCr) deter multinationals' tax avoidance practices operating in extractive industries? Motivation: Public CbCr has already been implemented for two specific sectors, namely the financial and extractive sectors. Prior studies have focused on tax avoidance of EU banks around the implementation of public CbCr requirement (Joshi et al., 2020; Eberhartinger et al., 2020; Overesch & Wolff, 2021). However, studies on how resource-extracting multinationals respond to the CbCr regulation are scarce. This study seeks to fill this gap by examining the effect of public CbCr on tax avoidance with a special focus on extractive industries. Idea: To improve fiscal transparency, Canadian and European legislators have adopted regulations requiring multinational corporations (MNCs) to provide, annually, their Extraction Payment Disclosures (EPD) (Public CbCr standard for extractive industries) to governments (EC, 2013; Natural Resource Canada, 2014). This study examines the effect of mandatory EPD adoption on the extent of tax haven use. Data: For a 10-year period surrounding the mandatory EPD adoption (2010-2019), we selected a sample of UK MNCs operating in the oil, gas, and mining sectors and listed on the London Stock Exchange. The analysis is mainly based on firm-level information taken from DATASTREAM database. Based on hand-collected data from annual reports, we measured the extent of tax haven use using the percentage of multinational subsidiaries located in tax haven jurisdictions/countries as listed in Dyreng and Lindsey (2009). An alternative list identified by the Organization for Economic Co-operation and Development (OECD) (2006) was also used in a robustness test. Tools: To examine our research question, we estimated a linear regression model with panel data using STATA software. Findings: The results show that the increased transparency resulting from public EPD does not appear to significantly affect the intensity of tax haven use. Contribution: This study extends and complements prior literature examining the effect of CbCr on tax avoidance and profit shifting by focusing on a specific setting i.e. extractive sector. To the best of our knowledge, apart from Johannesen and Larsen (2016) and Rauter (2020), no studies have provided empirical evidence on how resource-extracting multinationals respond to the EPD regulation.

Impact of the Affordable Care Act's Physician Payments Sunshine Act on branded statin prescribing.

ObjectiveTo evaluate the impact of the Affordable Care Act's Physician Payments Sunshine Act (PPSA), which mandates disclosure of industry payments to physicians, on physician prescribing of branded statins.Data SourcesAdministrative claims data from 2011 to 2015 from three large national commercial insurers were provided by the Health Care Cost Institute.Study DesignWe adopted a difference‐in‐differences and event study design, leveraging the control group of physicians in two states, MA and VT, which implemented state laws on disclosure of industry payments prior to the national PPSA. To further address potential confounding caused by differences in prescribing patterns across states, our analytical sample includes physicians practicing in border counties between the treatment (NH, NY, and RI) and control (MA and VT) states.Data CollectionWe restricted our sample to physicians who had at least 50 new‐fill prescription claims for statins during the five‐year study period, with at least one new‐fill prescription claim each year.Principal FindingsWe found that the PPSA led to a 7% (p < 0.001) reduction in monthly new prescriptions of brand‐name statin over the study period, with little change in generic prescribing. The reduction in branded prescriptions was concentrated among physicians with the highest tercile of drug spending pre‐PPSA, with a decrease of 15% (p < 0.001) in new branded statin prescriptions. The decline was most prominent after mandated reporting of industry payments began before the payment data was published.ConclusionsThe PPSA may have achieved its intended effect of reducing branded prescriptions at least in the short run, particularly among physicians most likely to have engaged in excessive or low‐value prescribing of branded drugs.

Physicians’ attitudes towards disclosure of payments from pharmaceutical companies in a nationwide voluntary transparency database: a cross-sectional survey

ObjectivesTo investigate German physicians’ attitudes towards and experiences with voluntary disclosure of payments by pharmaceutical companies in a public database and their impact on future decisions for or against disclosure.DesignA...

The Extractive Industries Transparency Initiative (EITI) and local institutions in Ghana’s mining communities: Challenges in understanding barriers to accountability

SummaryMotivationThe Extractive Industries Transparency Initiative (EITI) is a global standard that promotes transparency and accountability in resource‐rich countries to improve governance of the extractive sector. Despite improvements in the subnational disclosure of royalty payments, a significant problem is the failure of these efforts to improve accountability and benefits to mining communities.PurposeThe article asks how institutions of local governance affect national efforts to improve accountability to mining communities in Ghana on the use of mineral revenues for development. It contributes to the broader theoretical literature on EITI by clarifying what outcomes, if any, can be directly attributed to the disclosure of royalty payments.Methods and approachThis qualitative study employs a case‐study analysis of EITI adoption in Ghana, one of the first countries to join the initiative. The article contextualizes local governance institutions and dynamics in relation to the royalty disbursement process. It draws on original field research to analyse their role in impeding the expected benefits of royalty disbursements to mining‐affected communities.FindingsThe research identifies deficiencies in local governance structures and processes as they relate to the use of mineral royalties, but also instances of variation in how officials react to EITI. The range of individual actors, institutions, and complex processes on which the subnational disbursement of royalties depends, makes it problematic to attribute the absence of improvements directly to Ghana's EITI. The findings demonstrate that EITI's role in participating countries is best understood as facilitative and indirect when addressing development outcomes for mining communities.Policy implicationsDisclosure of royalty payments to local governments is unlikely on its own to result in improved development outcomes for local communities, even when the national government is committed to the goal. There is a need for policy interventions aimed at specific communities to ensure royalty payments reach the intended beneficiaries. These interventions should be tailored to the differences in national governance dynamics in countries participating in EITI, paying attention to contestation over the distribution and expenditure of royalties that disclosure helps bring to light.

Tip of the Iceberg? Country- and Company-Level Analysis of Drug Company Payments for Research and Development in Europe.

Creating new therapies often involves drug companies paying healthcare professionals and institutions for research and development (R&D) activities, including clinical trials. However, industry sponsorship can create conflicts of interest (COIs). We analysed approaches to drug company R&D payment disclosure in European countries and the distribution of R&D payments at the country and company level. Using documentary sources and a stakeholder survey we identified country- regulatory approaches to R&D payment disclosure. We reviewed company-level descriptions of disclosure practices in the United Kingdom, a country with a major role in Europe's R&D. We obtained country-level R&D payment data from industry trade groups and public authorities and company-level data from eurosfordocs.eu, a publicly available payments database. We conducted content analysis and descriptive statistical analysis. In 32 of 37 studied countries, all R&D payments were reported without named recipients, following a self-regulatory approach developed by the industry. The methodological descriptions from 125 companies operating in the United Kingdom suggest that within the self-regulatory approach companies had much leeway in deciding what activities and payments were considered as R&D. In five countries, legislation mandated the disclosure of R&D payment recipients, but only in two were payments practically identifiable and analysable. In 17 countries with available data, R&D constituted 19%-82% of all payments reported, with self-regulation associated with higher shares. Available company-level data from three countries with self-regulation suggests that R&D payments were concentrated by big funders, and some companies reported all, or nearly all, payments as R&D. The lack of full disclosure of R&D payments in countries with industry self-regulation leaves considerable sums of money unaccounted for and potentially many COIs undetected. Disclosure mandated by legislation exists in few countries and rarely enhances transparency practically. We recommend a unified European approach to R&D payment disclosure, including clear definitions and a centralised database.

Accessibility and quality of drug company disclosures of payments to healthcare professionals and organisations in 37 countries: a European policy review

ObjectivesTo examine the accessibility and quality of drug company payment data in Europe.DesignComparative policy review of payment data in countries with different regulatory approaches to disclosure.Setting37 European countries.ParticipantsEuropean Federation of...

Conflicts of Interest in Psychopharmacology Textbooks.

While most medical journals require disclosures of industry payments to authors and editors, there is no requirement for textbooks. In this study we evaluated nine well-known psychopharmacology textbooks to identify payments to their writers and editors. Two-thirds of the textbooks had at least one editor or author who received personal payments from one or more pharmaceutical companies, for a total of 11,021,409 USD paid to 11 of 21 editors/authors over a seven-year period. Much of this money was paid to a single author but 24% of the writers received over 75,000 USD each over this time period. There are several psychopharmacology textbooks authored by writers without apparent financial conflicts of interest. Just as with medical journals, medical textbooks should be transparent about payments made to their authors and editors.

Industry Payments to Adult Reconstruction-Trained Orthopedic Surgeons: An Analysis of the Open Payments Database From 2014 to 2019.

In recent time, there has been an increased push toward transparency in industry funding toward physicians. The Physician Payments Sunshine Act called for the creation of the Open Payments Database managed by the Centers for Medicare & Medicaid Services. To our knowledge, there have been no studies evaluating the trends in payments among adult reconstruction fellowship-trained orthopedic surgeons. The purpose of this study is to investigate trends in all payments to adult reconstruction-trained orthopedic surgeons from 2014 to 2019. Secondary outcomes included evaluating trends in yearly subpayment categories, regional variations, as well as characterizing the top 5 industry companies. A review of the Centers for Medicare & Medicaid Services Open Payments Database was performed to identify all payments to adult reconstruction-trained orthopedic surgeons. A total of 94,265 payments were made to 4911 surgeons accounting for a total of $258,865,231.20 during the study period. Our primary outcome was to assess the trend in median payment per year to individual surgeons. Secondary outcomes included evaluating payment trends with respect to subtype, location as defined by United States Census regions, as well as specifics concerning the top 5 companies. Over the study period, there was a nonsignificant increasing trend in median payment per surgeon (r= 0.49, P= .096). However, there was also a significantly increasing trend in the number of payments per year (r= 0.83, P= .014), as well as the number of surgeons receiving payments (r= 0.88, P= .019). With respect to subcategory payments, there were significantly increasing trends in the median payment per surgeon for education (1054%, r= 0.942, P < .001) and entertainment/food and beverage expenses (20.2%, r= 0.49, P= .020), as well as a significantly decreasing trend for median honoraria payments per surgeon (20.2%, r=-0.04, P= .005). No significant regional trends were identified. Of the top 5 companies, one demonstrated a significantly decreasing trend in median payment per surgeon (21.6%, r=-0.109, P < .001), whereas the others remained unchanged. In this study, we found a nonsignificant increasing trend in payments to adult reconstruction-trained surgeons as well as an increasing number of surgeons receiving payments. There were increasing trends in median payment per surgeon for education and entertainment expenses, but a decreasing trend for honoraria payments. No significant regional trends were identified. The majority of the top 5 companies had nonsignificant trends in their payments. Further studies are needed to characterize the disclosure of payments and the impact of industry payments on clinical outcomes. IV.

Pharmaceutical industry self-regulation and non-transparency: country and company level analysis of payments to healthcare professionals in seven European countries

The European pharmaceutical industry uses the alleged efficacy of self-regulation to question the need for transparency laws similar to the US Physician Payment Sunshine Act. We conducted a comparative analysis of 20 large companies’ payment disclosures in seven European countries in 2017–2019. The data was extracted as part of eurosfordocs.eu, a novel transparency project that scrapes and integrates publicly available databases and disclosures. Our analysis of EUR 735 million showed marked differences in country payment patterns. For example, payment totals per registered doctor were substantially larger in Spain and lowest in Sweden. There were significant country and company differences in individualized data completeness. Only 19% of totals were reported with recipient names in Germany, compared to Ireland (59%), the United Kingdom (60%), Italy (67%), Switzerland (73%), Sweden (79%) and Spain (100%), with little or no improvement over time. Payment data in Spain was particularly difficult to extract. Thus, in no country did self-regulation generate comprehensive individualized data allowing for building an accurate picture of financial relationships between the industry and healthcare professionals. We conclude that the cultures and policies of countries and companies create structural problems of data inaccessibility and incompleteness within the self-regulatory framework. Therefore, this study supports calls for a Europe-wide “Sunshine Act” to achieve real transparency of drug company payments.

Regulating Conflicts of Interest in Medicine Through Public Disclosure: Evidence from a Physician Payments Sunshine Law

Hospital and healthcare administrators name high prescription drug costs as one of their largest problems. A significant body of research demonstrates that meals and honoraria from pharmaceutical firms to physicians leads to higher prescribing of expensive, brand name drugs, despite little difference in efficacy. Some administrators and scholars have advocated for mandatory disclosure of these payments in order to reduce this conflict of interest, but many practitioners believe disclosure has little effect on prescribing, and the empirical evidence is mixed. This paper uses a quasi-experiment of a 2009 payment disclosure policy in Massachusetts to estimate the causal impact of public disclosure on prescribing. The comprehensive data set includes all retail prescriptions for 262 drugs in nine drug classes written by 5,730 physicians in five states over 48 months. We show a significant postdisclosure reduction in brand name drug prescriptions by Massachusetts physicians, relative to control physicians in other states. These effects are driven by heavy prescribers of brand name drugs in the prepolicy period, particularly for drugs with large prepolicy sales forces. Effects are also detected before the first data were released, implying that the effects are not because patients or administrators responded to the disclosed payments. Instead, some physicians may have changed their payments and prescriptions behavior to avoid appearing biased. Taken in tandem with the many studies showing that pharmaceutical industry payments influence prescribing, this study suggests a strong role for mandatory public disclosure in reducing conflicts of interest in medicine and costly prescribing of brand name drugs. This paper was accepted by Stefan Scholtes, healthcare management.

Conflict of interest disclosure in orthopaedic and general surgical trauma literature

SignificanceFinancial relationships between industry and physicians are a key aspect for the advancement of surgical practice and training, but these relationships also result in a conflict of interest with respect to research. Financial payments to physicians are public within the United States in the Open Payments Database, but the rate of accurate financial disclosure of payments has not previously been studied in trauma surgery publications. ObjectiveTo determine the rate of accurate financial disclosure in major surgical trauma journals compared with the Open Payments Database. Materials and MethodsThe names of all authors publishing in The Journal of Orthopaedic Trauma, Injury, and The Journal of Trauma and Acute Care Surgery between 2015 and 2018 were obtained from MEDLINE. Non-physicians, physicians outside of the United States, physicians without payments in the Open Payments Database, and physicians with payments types of only “Food and Drink” were excluded. Financial disclosure statements were obtained from the journal websites and manually compared against Open Payments Database entries the year prior to submission and during the year of submission up until 3 months prior to publication for each individual physician. Main outcomes were accuracy of disclosure published with each article, total amount of payments received (disclosure or undisclosed), surgical subspecialty of the reporting physician. Statistical comparisons were made using Chi-square testing with significance defined as p<0.05. ResultsBetween 2015 and 2018, 5070 articles were published involving 28,948 authors. 2945 authors met inclusion criteria. 490 authors accurately disclosed their financial relationships with industry (16.6%). The median value of undisclosed payments was $22,140 [IQR $6465, $77,221] which was significantly less than the medial value of disclosed payment of $66,433 [IQR $24,624, $161,886], p<0.001 Orthopaedic surgeons disclosed at a higher rate (26.3%, 479/1818) than general surgeons (4.8%, 47/971), p<0.001. ConclusionsPhysician-industry relationships are key for advancing surgical practice and providing training to physicians. These relationships are not inherently unethical, but there is consistently high inaccuracy of financial disclosure across multiple trauma surgery journals which may indicate the need for further education on financial disclosures during surgical training or active obtainment of publicly available financial disclosures by journals.

The Market Response to Mandatory Disclosure of Payments to Foreign Governments under the Extractive Sector Transparency Measures Act

This paper examines the equity market response to mandated disclosures made according to the Extractive Sector Transparency Measures Act (ESTMA). Using a sample of 1,559 company-year-country filings from 937 extractive firms between 2016 and 2018, we find that ESTMA disclosures are associated with a significantly negative market reaction. We also find that investors react more negatively to ESTMA disclosures from firms with lower perceived transparency, firms that make payments to more corrupt host countries, firms with higher information asymmetry, and firms with disclosures under the Extractive Industries Transparency Initiative (EITI). Consistent with results from prior studies of other transparency measures outside of Canada, ours indicate that the overall impact of ESTMA is negative for an average firm. Thus, we suggest that the costs of increased transparency that firms internalize from the enactment of ESTMA exceed the benefits. There is a global trend in which countries have adopted or plan to adopt transparency measures to combat corruption. These transparency measures differ widely in their approach and scope, therefore, our results provide an important insight to regulators, investors, and civil societies.

Financial conflicts of interest between pharmaceutical companies and the authors of urology clinical practice guidelines in Japan.

In Japan, the authors of urology clinical practice guidelines (UCPG) used in patient-centered care are often targeted by pharmaceutical companies with financial payments. However, the financial relationship between UCPG authors and pharmaceutical companies remains unclear. This study aimed to determine the characteristics of industry payments to physicians that may influence recommendations in UCPG and to assess the transparency of payment disclosure. We considered 193 UCPG authors receiving payments from 79 companies between 2016 and 2017 and the 13 UCPG published by the Japanese Urological Association between 2015 and 2018. We determined 2-year combined mean and median payments to authors, total company payments, and associations between author attributes and payment values using multivariate negative binomial regression. Also, we assessed the extent of the financial disclosure policies among the 13 UCPG. Overall, 171 (88.6%) authors received payments with a combined value of $6,169,333. Median and mean payments were $7147 (interquartile range, $1512-$44,807) and $31,965 (standard deviation, $51,684), respectively. University professors working on multiple UCPG with new drug approvals were associated with higher payments. Twelve (92.3%) UCPG failed to disclose financial conflicts. While it remains unclear whether financial entanglements improperly influence the contents of UCPG, most Japanese authors received substantial payments from pharmaceutical companies with little or no disclosure. Because insufficient transparency in disclosure of these financial entanglements may compromise the integrity of UCPG, more rigorous regulation and greater disclosure of financial conflicts of interest are needed.