Experts with fewer financial ties to drug companies are noticeably more supportive of an inexpensive, off-patent drug.

A 2003 analysis lists three ways in which doctors earn money from drug companies. Some are hired to conduct research. Some get paid for referring patients to clinical trials. Others are incentivized to write more prescriptions.

These incentives can take the form of annual consultant’s fees. Or speaker’s fees at drug company events. Or expense-paid conferences in exotic locales (travel), dinners at fancy restaurants, tickets to sporting events, and tickets to music concerts.

Research suggests even small gifts and small amounts of money affect physician behaviour to a surprising degree, and that most physicians believe their colleagues are influenced by drug company promotions.

Which brings us to COVID-19. A very public conflict has arisen between those who favour treating patients with inexpensive, off-patent drugs such as hydroxychloroquine (HCQ), and those who favour the use of expensive, proprietary drugs such as remdesivir/veklury, which is manufactured by Gilead Sciences.

A recent paper examines what 98 French professors/physicians who specialize in infectious diseases have said publicly about HCQ. Titled Influence of conflicts of interest on public positions in the COVID-19 era, the case of Gilead Sciences, it reports that 54 of these academics have taken no public position on HCQ. 14 others have remained carefully neutral.

Which leaves 30 more. 14 have said favourable or very favourable things about HCQ. 16 have said unfavourable or very unfavourable things.

In France, drug companies are required to report, via a government website, how much financial support they provide to doctors. This paper reveals a startling difference between pro- and anti-HCQ academics. Generally speaking, doctors who are more favourable toward HCQ take less money from Gilead Sciences. And vice versa.

The paper treats the 14 pro-HCQ academics as two sub-groups (favourable and very favourable), rather than as identifiable individuals. Some of these people had no financial links to Gilead Sciences over the past seven years (2013-2019). The most any individual benefited was to the tune of €4,773.

All 16 of the (likewise unidentified) anti-HCQ academics were financially linked to Gilead during the same time frame. Those who’ve made unfavourable public comments received, on average, €11,085 (with individual cases ranging from €234 to €31,731). Those who’ve made very unfavourable comments received, on average, €24,048 (with individual cases ranging from €122 to €52,812).

In France, the less financially connected to Gilead Sciences experts happen to be, the more likely they are to support the use of HCQ. The greater the financial connection to Gilead, the greater the hostility toward HCQ.

The ‘Results’ section of this paper further reports that, of the 98 academics studied, only 13 had no financial links whatsoever to Gilead. Four of those 13 have taken no public position on HCQ. One has remained neutral. The majority (62%) are pro-HCQ – with one being favourable, and seven being very favourable.

This study tells us nothing, of course, about the circumstances in which HCQ might be an effective COVID treatment. But it reminds us that governments rely on the judgment of fallible human beings. Even in the midst of a pandemic, when everyone should be trying hardest to think clearly, infectious disease experts are prone to multiple kinds of bias.

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ADDITIONAL INFO:

• see my previous commentary: Hydroxychloroquine & the Judgment of History as well as Financial Conflicts & the Retracted COVID Research
• this discussion, published back in 2003, provides helpful, big picture detail: A Social Science Perspective on Gifts to Physicians From Industry
• The paper examining HCQ and financial links to Gilead Sciences is co-authored by Didier Raoult, an enthusiastic HCQ proponent. It was published online in June, and appears in the November 2020 edition of the academic journal, New Microbes and New Infections.
• Another chart included in that paper examines financial links to pharmaceutical companies overall, rather than to Gilead Sciences specifically.
• Those very favourable to HCQ benefited the least – receiving €6,649 on average (with individual cases ranging from €42 to €30,875).
• Those favourable to HCQ received €10,913 on average (with individual cases ranging from €42 to €24,840).
• Those unfavourable to HCQ received €61,519 on average (with individual cases ranging from €11,842 to €100,358).
• Those very unfavourable to HCQ received €157,939 on average (with individual cases ranging from €7,498 to €543,673).
• It’s important to notice that many professors who’ve received substantial drug company money have nevertheless taken no position.
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