Discussion
This study represents the first comprehensive analysis of personal
payments to all neurology CPG authors from major pharmaceutical
companies in Japan. We demonstrated that over 80% of neurology CPG
authors received nearly $14.0 million in personal payments over five
years. These payments were for lectures at company-sponsored events,
consulting services, and supervising pamphlets about the companies’
products distributed to physicians and patients. Notably, all CPG
chairpersons and vice chairpersons had substantially financial ties with
pharmaceutical companies.
These close financial relationships between Japanese neurology CPG
authors and pharmaceutical companies raise concerns about the Japanese
Society of Neurology’s management of financial COIs for CPG authors.
This situation may also pose a risk to the credibility and integrity of
neurology CPGs in Japan. The high proportions of CPG authors receiving
personal payments and the substantial payments to CPG chairpersons
during the CPG development and/or a few years after CPG publication
indicate clear deviations from international COI policies. According to
recommendations by the U.S. National Academy of Medicine and the
Guidelines International Network,1,2 medical societies
and organizations responsible for producing CPGs should maintain a
majority of authors free from financial COIs and appoint chairpersons
without such conflicts. However, our findings reveal that none of the
CPGs developed by the Japanese Society of Neurology met these
recommendations.
The deviations of Japanese CPGs from international COI policies are not
unique to neurology but are also evident across specialties in Japan, as
previously reported.3-7,18,20-26 Studies have shown
that the proportion of CPG authors with financial COIs ranged from
86.4% in cardiology27 to 91.3-100% in
rheumatology.4,28 These high proportions may be
attributed to less transparent and rigorous COI management policies
among Japanese professional medical societies,4,5including the Japanese Society of Neurology. The Japanese Society of
Neurology only required authors to declare payments exceeding $4,682
(500,000 Japanese yen) per year per company for activities such as
lecturing, consulting, and writing. Thus, payments below this threshold
were not mandated to be declared, despite the majority of US and
European medical societies requiring disclosure of all payments
regardless of amount.14 Given the significant
influence of CPGs on clinical practice and patient care, more
transparent and rigorous COI management policies as well as enforcement
of the policies are essential for future CPGs developed by the Japanese
Society of Neurology.
This study has limitations. The payment data were extracted from a
secondary database maintained by an independent research organization.
As the organization acknowledged, the study cannot rule out the
possibility of errors or misreporting in the payment data reported in
the database. Additionally, payments from pharmaceutical companies not
affiliated with the JPMA were not disclosed, preventing assessment of
the full extent of financial relationships between CPG authors and
non-JPMA affiliated companies.