Pharma Cash Creates Conflicts of Interest in FDA Testimony and Clinical Practice Guidelines

Research has documented numerous conflicts of interest (COI) in which pharmaceutical industry money is paid to researchers, APA board members, psychiatrists, and FDA regulators. A new systematic literature review published in Value for Health examines conflicts of interest for FDA advisory board committee members and public speakers, finding that public speakers with disclosed COI were between three to six times more likely to deliver favorable testimony for industry products compared to speakers that did not disclose COI. This research, led by Arianna Gentilini from Imperial College London, reports there is some evidence that COI have declined for voting committee members after the 2007 FDA amendments act. No such pattern was observed for public speakers.

A similar study published in Gaceta Sanitaria (Health Gazette) finds that only 16.9% of COI disclosures made by clinical guideline authors in Spain were reliable. This research, led by Sergio Martín-Benlloch from the Department of Public Health in Spain, also reports that 80% of clinical practice guideline authors received some form of industry payment.

Harms Associated with Industry Payments to Researchers and Medical Professionals

Past research has found that industry payments to physicians changes prescribing patterns and increases Medicare expenditures. One study reported that while two-thirds of patients in the US see physicians that take industry payments, only 5% were aware that their doctors accepted such payments. Research has linked COI to an overestimation of the efficacy of psychotropics and an underreporting of their negative effects, diagnostic inflation and bias in clinical practice guidelines, overprescribing and increased costs, and an erosion of public trust in medical professionals. Research produced by authors with COI disproportionately produces findings favorable to industry drugs and undermines clinical safety.

COI in FDA Committee Members and Public Speakers

The goal of this study was to investigate the the prevalence and influence of COI among FDA committee members and public speakers offering testimony about the efficacy of drugs pending approval. The authors decided on a systematic literature review to accomplish this goal. They examined past studies that reported quantitative data around the prevalence or influence of COI on FDA committee member voting or public speakers presenting testimony before the FDA.

Only articles published in English that provided original data or analysis related to COI and FDA advisory committees were included in the current review. Editorials, commentaries, conference abstracts, and non-peer reviewed articles were excluded. In total, the authors used data from 18 studies published between 2006 and 2022.

One included study found that 71% of committee meetings included at least one member with COI, while another reported just 15.2% of meetings included at least one voting member with COI. Overall, studies reported COI for between 13% – 16% of voting committee members. These COI most commonly included stock ownership, consulting and speaking fees, and research funding.

The link between COI and voting outcomes for committee members was mixed, with some studies linking COI to favorable votes for industry products and others finding no association. One included study found that voting members with COI were 49% more likely to vote in favor of approving industry drugs. Another reported those with a COI were 20% more likely to vote in favor of approval, but this difference was determined not to have statistical significance. Four studies did not find a link between COI and voting patterns. Two studies reported that COI among voting members had significantly declined over time.

Across multiple studies, 26% of public speakers offering testimony before the FDA had COI, with 24.8% reporting a financial COI. These COI most commonly included payments for travel and lodging, consulting roles, and organizational funding from pharmaceutical companies. Every study that examined FDA public speaker COI found that speakers with COI were more likely to give favorable testimony for industry drugs. Public speakers with COI were between three to six times more likely to provide favorable testimony compared to speakers without COI.

This study had 2 key limitations. The included studies used different methods and measures, limiting the ability of the authors to make comparisons between included studies. This research only looked at disclosed COI and did not assess undisclosed COI.

COI in Spanish Clinical Practice Guidelines

The aim of this research was to examine COI reported by authors of clinical practice guidelines in Spain. To achieve this aim, the authors compared COI statements by clinical practice guideline authors to transfer of value statements recorded on pharmaceutical company websites.

The researchers defined financial COI as a transfer of value made from a pharmaceutical company to an author of a clinical practice guideline. Only authors of clinical practice guidelines in Spain published between 2017 and 2023 were included in the current work. In total, the authors examined data on 60 clinical practice guidelines covering 704 individuals authors and 810 authorship instances.

Overall, 46.4% of authorship instances had no available COI statement. Seventy-nine percent of guideline coordinators did not submit a COI statement compared to 44.6% of other guideline authors. Of the authorship instances where COI statements were made, 51.6% reported no COI. The authors note there was a difference between men and women authors, with 30.2% of men reporting receiving industry payments compared to 20.7% of women. Overall, 80.1% of clinical practice guideline authors received an industry payment.

In 33.4% of authorship instances, no COI statement was made despite pharmaceutical company transfer of value records indicating these authors received payments. Ten-point-five percent of authors made a declaration that they had no COI despite records indicating that they received industry payments. Another 9% of authors disclosed some, but not all of their COI. According to the authors, just 16.9% of disclosure statements made by clinical practice guideline authors were reliable. Other disclosure statements were either inaccurate or missing altogether (60.1%), or not verifiable due to limits in the records (23%).

This study had three main limitations. The design of the study means the authors cannot say if hidden financial ties actually biased clinical practice guideline authors. The authors relied on self-reported data from pharmaceutical companies. This research only looked at clinical practice guideline authors in Spain, limiting generalizability to other populations.

COI and the Corruption of Evidence Based Medicine

COI due to the pharmaceutical industry making payments to medical professionals has led some experts to question “evidence based medicine.” Undisclosed COI have been found in top psychiatry journals, medical research, and the DSM-5. Disclosed COI have also been noted in medical journal commentaries, “unduly favorable” editorials, psychopharmacology textbooks, and continuing medical education. Internal pharmaceutical industry documents have revealed strategies that industry uses to corrupt the medical field, including ghost-management of research in which industry determines what research is funded and published, even enlisting agents to ghostwrite “research” in the names of complicit academics. Some experts have said that evidence-based medicine has become so corrupt that it is an illusion.

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Gentilini, A., Raymakers, A. J. N., & Rand, L. Z. (2026). Conflicts of interest in United States Food and Drug Administration Advisory Committees: A systematic literature review. Value in Health. (Link)

Martín-Benlloch, S., Morales-Garzón, S., Martín Fernández-Gallardo, Á. M., & Hernández-Aguado, I. (2026). Financial conflicts of interest among authors of clinical practice guidelines in Spain: A cross-sectional analysis. Gaceta Sanitaria, 40, 102582. (Link)