News and analysis
September 06, 2010
Ethics and Disclosure: How Health Nonprofits Handle Contributions From Medical Companies
Sen. Charles E. Grassley, the senior Republican on the Senate Finance Committee, asked 33 nonprofit groups that focus on health and medical care to tell him how much money they received from pharmaceutical, medical-device, and insurance companies and their foundations from 2006 to 2009, and how they disclose such information to the public. He requested details on how much each company gave and what the money paid for. He also asked the organizations to describe their policies on accepting industry money.
Following are key findings based on The Chronicle’s requests for groups to share this information. Unless otherwise noted, the percentage of income represented by contributions from medical companies was calculated for 2008 using total revenue figures on that year’s Form 990 tax returns.
Groups That Disclosed Most
These groups gave The Chronicle the list of payments from medical companies that they provided to Senator Grassley, along with other answers to the senator's questions.
Money from medical companies: $4.8-million
Percentage of revenue that represents: 4.8 percent (percentage calculated by the organization)
Disclosures and policies: Within six months of the close of its fiscal year, posts online any corporate contributions that must be disclosed on the Form 990 tax return (those amounting to at least 2 percent of revenues from one source).
American Academy of Dermatology/American Academy of Dermatology Association
Money from medical companies: $12.9-million (excludes revenue in form of product donations)
Percentage of revenue that represents: 44 percent
Disclosures and policies: Does not use brand names of drugs or other products to acknowledge corporate sponsors. Declines any money with “real or apparent expectation of reciprocity.”
Recent steps: In 2009 started posting on its Web site a list of corporate contributions by company name and activity supported. Over next six months, plans to create a committee to oversee industry relationships, make board-member disclosure forms publicly available, and tell key leaders they cannot have any direct financial ties to industry.
American Academy of Family Physicians
Money from medical companies: $20.2-million
Percentage of revenue that represents: 29 percent (estimate because industry contributions were calculated by calendar year, on cash-received basis, and Form 990 revenues by fiscal year, on accrual basis)
Disclosures and policies: Does not endorse products. Requires people involved in planning continuing-education courses to disclose financial links to pharmaceutical and other companies. Drug ads in group’s medical journal must be clearly distinguished from editorial content and not placed near articles with related content.
Money from medical companies: $15.4-million in 2009
Percentage of revenue that represents: 7.5 percent (percentage calculated by the organization)
Disclosures and policies: Does not accept money from companies that fail to comply with government health regulations, produce unsafe products, or make unsubstantiated health claims. Faculty and planning-committee members for educational events must disclose financial relationships related to the subject matter. Drug-company employees may not serve as instructors or on planning committees for accredited programs. Board members and senior employees may not accept meals or other gifts from companies that make products to treat diabetes.
Money from medical companies: $548,750
Percentage of revenue that represents: 1.7 percent
Disclosures and policies: Corporate sponsors must conform to the group’s positions and give the association complete editorial control of all materials that bear its name. Does not endorse brands or products.
Money from medical companies: $17-million from drug and device makers to national office in fiscal year beginning July 1, 2008; additional money goes to local affiliates
Percentage of revenue that represents: 3.6 percent of associationwide revenues. Total industry contributions, including those to affiliates, make up 27.9 percent of total revenues, but association was unable to say how much comes from medical companies. Figures taken from Web site.
Disclosures and policies: Declined to provide details about corporate revenue that were requested by Senator Grassley, but posts on its Web site donations from pharmaceutical and medical-device companies by fiscal year, back to 2006. Editors of its medical journals must not have significant relationships to pharmaceutical, biomedical, or other relevant companies; must divest of investments or place them in a blind trust. If editors do not take those steps, they are barred from reviewing certain articles. Board members and other volunteers may not accept gifts, honoraria, or other goods from corporate supporters. They may accept travel costs and meals, however, for charity-related business.
American Psychological Association
Money from medical companies: $150,000
Percentage of revenue that represents: Less than 1 percent
Disclosures and policies: Board in 2008 directed senior managers to review gifts of more than $25,000 in a calendar year from drug companies for possible conflicts of interest and report decisions about accepting such gifts to the board.
Children and Adults With Attention Deficit/Hyperactivity Disorder
Money from medical companies: $1.6-million for fiscal year beginning July 1, 2008 (including $412,500 in sales of educational materials)
Percentage of revenue that represents: 37 percent
Disclosures and policies: Posts aggregate revenue from pharmaceutical companies, including sales of magazines and advertising, on its Web site. Honoraria from drug companies to employees and board members must be paid to the charity. No more than 30 percent of revenue in a fiscal year may come from donations or grants from drug companies (advertising revenue excluded).
Recent steps: Conflict-of-interest policy revised in May 2010 to require board members to disclose all financial relationships with entities or individuals that do business with the organization, not just those they perceive might pose a problem.
Depression and Bipolar Support Alliance
Money from medical companies: $1.2 million
Percentage of revenue that represents: 38 percent
Disclosures and policies: Outlines specific steps for deciding whether to accept pharmaceutical money. For example, it asks whether taking money will damage the credibility of the alliance and potentially prevent future patients from seeking the alliance’s help. Will not promote any single way to treat mood disorders and will maintain sole control over any program that receives money from a drug company. Board decided in 2007 to limit pharmaceutical money to no more than 50 percent of revenue.
Heart Rhythm Society/Heart Rhythm Foundation
Money from medical companies: $7.3-million for fiscal year beginning October 1, 2008
Percentage of revenue that represents: 49 percent
Disclosures and policies: Posts list of industry contributions on its Web site. Medical-industry members may not serve as trustees, officers, or committee members. President and president-elect may not earn income from companies with a financial interest in heart-rhythm management. People with key roles in educational activities and publications must disclose all financial ties with such companies, including research grants. President and president-elect may not serve on business-related medical-industry boards but may serve on industry medical-advisory boards for no pay.
Recent steps: Board agreed in 2009 to post searchable copies of conflict-of-interest disclosure forms for trustees, committee members, and presenters on the alliance’s Web site.
Money from medical companies: $2.5-million in 2009
Percentage of revenue that represents: 78 percent
Disclosures and policies: Employee handbook requires new staff members to disclose outside employment, consulting contracts, and board memberships. Charity will not endorse a corporate sponsor’s products or services. Board agreed in 2006 to limit pharmaceutical money to 33 percent of revenue, a goal it projects to meet this year.
National Alliance for Research on Schizophrenia and Depression
Money from medical companies: $248,000
Percentage of revenue that represents: 1.2 percent
Disclosures and policies: Starting this year, requires board members and employees to file conflict-of-interest disclosure forms.
Money from medical companies: $5.4-million (includes some money from outside the pharmaceutical, medical-device, and insurance industries)
Percentage of revenue that represents: 48 percent
Disclosures and policies: Medical-device companies doing business with the charity must follow a mandatory code of ethics. Will not offer speakers for industry-sponsored commercial events. Corporations may not sponsor hotel keycards, registration-badge lanyards, welcome receptions, or meals at educational events. Web site includes a page containing all ethics and disclosure policies.
Recent steps: Group created a new position of board ethicist and hired an ethics consultant in 2009.
TeenScreen National Center for Mental Health Checkups at Columbia University
Money from medical companies: None
Disclosures and policies: Does not accept any support from the pharmaceutical industry and “does not advocate for any specific treatment.” Executive director is covered by Columbia University’s conflict-of-interest policy, which requires employees to disclose certain outside affiliations.
Groups With Limited Disclosure
Some of these groups gave The Chronicle information about their revenue from medical companies but not a list of payments. Some provided information about disclosure policies.
American Academy of Allergy Asthma & Immunology
Money from medical companies: $5.3-million
Percentage of revenue that represents: 30 percent
Disclosures and policies: Follows guidelines set forth by professional groups.
American Academy of Orthpaedic Surgeons/American Association of Orthopaedic Surgeons
Money from medical companies: Declined to disclose
Percentage of revenue that represents: The organization said the two affiliated groups receive about 2 percent of operating revenues in corporate grants.
Disclosures and policies: Posts corporate contributors, grouped by general giving levels, on its Web site.
All board members, editors, and participants in continuing-education programs must disclose relationships with orthopedics companies.
Money from medical companies: $10-million in 2009
Percentage of revenue that represents: 1.2 percent (percentage calculated by the organization)
Disclosures and policies: Posts on its Web site steps for reviewing potential conflict-of-interest disclosures, which must be made annually by all employees and volunteers. Screens individuals who help develop cancer-screening guidelines and other scientific materials for ties to industries that could be affected. Staff members must disclose financial ties to pharmaceutical, medical-device, or health-industry companies; may not work or consult for them. Board members may not get income from tobacco companies.
American College of Obstetricians and Gynecologists
Money from medical companies: Declined to disclose
Disclosures and policies: Executive board and committee members may not receive payments of any kind, accept anything worth more than $25, or consult for a pharmaceutical or medical-device company except for clinical studies conducted according to federal regulations; may not accept speaking engagements, serve on the boards, or have a financial interest of more than $5,000 in such companies.
Money from medical companies: Declined to disclose
Disclosures and policies: Posts corporate contributors to its foundation and general giving levels on its Web site.
Money from medical companies: Declined to disclose
Disclosures and policies: Products endorsed by the group publicized on Web site. Sponsors of events acknowledged during the activity.
American Society of Health-System Pharmacists
Money from medical companies: Declined to disclose
Disclosures and policies: Web site encourages corporate sponsorship but does not list industry contributors. Does not accept corporate money for its drug-information database, governance activities, strategic planning, policy development, advocacy, or major educational sessions. Maintains internal “firewall” to ensure employees who develop educational content do not get involved in discussions about a company’s marketing strategy. Advises board members to avoid accepting honoraria from, or consulting for, medical companies.
American Society of Hypertension
Money from medical companies: Declined to disclose
Disclosures and policies: Posts corporate members (those that pay a $50,000 initiation fee and $15,000 annual fee) on its Web site. Guidelines for corporate relations posted on Web. Advisory group must approve industry presentations of information or services to the society’s members.
American Society of Nephrology
Money from medical companies: Declined to disclose
Disclosures and policies: Posts corporate contributors and general giving levels on its Web site. Site includes a page with links to documents on conflict-of-interest issues, including a summary of the group’s response to Senator Grassley. People who plan educational content or public policy may not be involved in fund raising so their decisions are not influenced by the possibility of getting more industry money. Encourages reviewers to attend educational sessions to watch for commercial bias. Individuals who review journal manuscripts must disclose annually their industry ties. Moderators at educational sessions are told to disclose relevant financial ties of all speakers.
Money from medical companies: $21.9-million from pharmaceutical companies in fiscal year 2009
Percentage of revenue that represents: 8.1 percent (percentage calculated by the organization)
Disclosures and policies: Posts corporate contributors and general giving levels on its Web site.
National Organization for Rare Disorders
Money from medical companies: Declined to disclose
Disclosures and policies: Posts corporate contributors and general giving levels on its Web site. Does not include reports on rare-disease therapies supplied by companies in its database except for brief notices that clinical trials are in progress.
Money from medical companies: $100,000
Percentage of revenue that represents: 2 percent
Disclosures and policies: Pharmaceutical money accepted only for unrestricted educational grants. No product brands allowed on any of the group’s materials.
Groups With Little or No Disclosure
These groups declined to provide information to The Chronicle about their responses to Senator Grassley. Some post names of corporate donors on their Web sites.
The American Dental Association, the American Medical Association (lists grants and donations in report on annual meeting), the American Society of Anesthesiologists, the American Society of Colon and Rectal Surgeons (posts corporate contributors and general giving levels on its Web site), the American Society of Consultant Pharmacists (posts corporate contributors, but not how much given, on its Web site), the American Society of Plastic Surgeons (posts corporations that have given at least $25,000 on its Web site), and the National Association of Chain Drug Stores.
—Compiled by Lisa Marrs, Sheila V Kumar, Suzanne Perry, and Alex Richards