Payments by US pharmaceutical and medical device manufacturers to US medical journal editors: retrospective observational study

I would like to provide further data regarding payments to editors of pathology journals. Research into physician financial conflict of interest doesn’t often prioritize pathology. This may be in part due to a lower proportion of pathologists receiving payments from industry compared to most other specialties.[1] However, this lack of attention may also be due to the mistaken belief that these payments are not relevant. Pathologists play a pivotal role in test selection and interpretation. Through the use of companion diagnostics, pathologists directly influence treatment decisions for costly cancer drugs.[2]

I selected the pathology journals associated with the major American pathology societies. These journals are Archives of Pathology and Laboratory Medicine (College of American Pathologists), Modern Pathology, Laboratory Investigation (United States and Canadian Academy of Pathology), Journal of Molecular Diagnostics (Association for Molecular Pathology), Journal of the American Society of Cytopathology (American Society of Cytopathology), American Journal of Clinical Pathology (American Society for Clinical Pathology), and the American Journal of Surgical Pathology (Arthur Purdy Stout Society). These journals are influential in the clinical practice of pathology.

I retrieved all editors listed on the journal websites (September 2017). Junior editors and editorial board members were included. I removed all editors clearly designated as non-physicians or residing outside the United States. I removed duplicate names across journals. This resulted in a list of 818 unique editors. I downloaded the database of 2016 general payments for the specialty of pathology from the Open Payments website.[3] I retrieved payment information for these editors by matching first and last name. I generated descriptive statistics for payments to journal editors and all pathologists in these data.

203/818 editors (24.8%) received $1,449,999.02 general (non-research) industry payments in 2016 (mean per pathologist: $7,142.85, median per pathologist: $774.34, range per pathologist: $10.82- $111,293.18). Overall, 4,836 pathologists (26.9% using an 18,000 workforce estimate[4]) received $14,154,276.35 in industry payments (mean: $2,926.86, median: $88.97, range: $1.06-$683,102.53).

Editors were not more likely to receive payments than pathologists in general (p=0.195, Chi-Square), but among those editors who did receive payments, the average payment per pathologist was significantly higher (mean p=0.004, two-tailed t-test; median p<0.001, two-tailed Mann-Whitney).

Pathologists are an indispensable part of patient care and advancing biomedical science. The data show that the pharmaceutical and medical device industries are keenly aware of this. Despite some other specialties receiving a greater amount of industry payments, I hope we do not succumb to glib relativism by downplaying any conflict of interest. Pathologists should self-monitor our profession to ensure these potential financial conflicts do not interfere with clinical practice in matters of test purchasing, selection or interpretation, as well as in scientific endeavors.

[1] Tringale KR, Marshall D, Mackey TK, Connor M, Murphy JD, Hattangadi-Gluth JA. Types and distribution of payments from industry to physicians in 2015. Journal of the American Medical Association. 2017 May 2;317(17):1774-84.

[2] https://www.statnews.com/2017/10/30/cancer-diagnosis-pathologists/

[3] https://www.cms.gov/OpenPayments/Explore-the-Data/Dataset-Downloads.html

[4] Robboy SJ, Weintraub S, Horvath AE, Jensen BW, Alexander CB, Fody EP, Crawford JM, Clark JR, Cantor-Weinberg J, Joshi MG, Cohen MB. Pathologist workforce in the United States: I. Development of a predictive model to examine factors influencing supply. Archives of Pathology and Laboratory Medicine. 2013 Jun 5;137(12):1723-32.