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A few days ago, Dr. Dheeman Futela from Yale University School of Medicine and his team members published a research paper on "Accuracy of Financial Information Disclosure for Radiology Journal Authors" in the Journal of the American Radiological Society "JACR", alleging that among the five well-known radiology journals, 186.6 million US dollars (about 1.347 billion yuan) of author funding sources have not been disclosed.
Taken from the research report's homepage
The study involved five top industry journals: JACR, Radiology, AJR, JVIR and AJNR. Dr. DheemanFutela's team selected a total of 4,076 authors and 3,406 independent authors from 643 articles published in these journals. The results showed:
There were 1388 authors who received industry payments in the last 36 months, with an average amount of $6,650 per author ($355 to $87,725 in quartiles).
Of the 1,388 authors who received the payment, only 61 (4.4%) disclosed all financial relationships with the industry, 205 (14.8%) only partially, and the remaining 1,122 (81%) did not report any financial relationships.
The total undisclosed payments amounted to USD 186,578,350, representing 67.2 per cent of the total payments. Based on this, the total amount of payments is estimated to be 277 million US dollars (about 2 billion yuan).
In addition, the survey revealed that the top industry partners paid by U.S. authors in the five journals include Pfizer ($42 million), GE Healthcare ($18 million), Merck ($15 million), AbbVie AbbVie ($13 million) and AstraZeneca ($11 million).
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Eighty-one percent of authors did not disclose the source of the amount
The fairness of the top journal is questionable
In fact, radiology fellows' links to other funding stakeholders are widespread, with 70 per cent of fellows receiving such remuneration at least once. As an expert has pointed out in the Journal of the American College of Radiology, "Partnering with providers can have a positive impact on patient care, but it can also expose radiologists to potential biases." ”
To corroborate this phenomenon, Dr. DheemanFutela's team organized this review. Financial disclosures from U.S. authors published in five journals in 2021, including original studies and review articles, were retrieved separately. Payments reports related to general categories, research, and ownership payment categories in the Public Payments Database (OPD) over the past three years were extracted, and each author was analysed individually to determine whether their disclosures were consistent with the results of the OPD.
The results showed that the "research" category accounted for the largest share of the total $277 million disbursed, with nearly $206 million paid to 544 authors. The largest payout was in the "General" category, with a total of $65 million paid out to 1,321 authors. Another nearly $6.9 million (16 authors) fell into the "ownership" category.
But of those, only 4.4 percent of U.S. journal study authors disclosed all financial ties to the industry, and nearly 81 percent reported no financial ties.
Taken from the research report's homepage
In addition, the research team conducted statistics on "disclosing the source of some or all of the authors of OPD reporting relationships", and the results showed that RSNA had the highest proportion of "Radiology" (32.3%), followed by JVIR (18.2%), AJNR (17.3%), JACR (13.1%), and AJR (10.3%).
The discovery has raised widespread concerns about academic integrity and transparency, while also casting doubt on the credibility of the five industry-leading journals.
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Additional revenue exceeded $370 million in five years
The Instrument House observed that in addition to the income of journal authors, radiologists in the United States received more than 370 million US dollars (about 2.67 billion yuan) in gifts, lecture fees and other preferential treatment unrelated to their routine reading work in the past five years.
But more than 91 percent of the money (about $338 million) went mainly to the pockets of a handful of doctors in the top 5 percent. The average amount received by these 5% physicians over a five-year period was $59,000, an average of nearly $12,000 per year.
By comparison, the bottom 95 percent of radiologists received an average of $172 over a five-year period, an average of $34 per year.
The data is derived from a sample of information collected by researchers at Yale University from CMS's public payments database, covering the entire year from 2016 to 2020, and contains six types of payments: consulting fees, education, gifts, research fees, and royalty/ownership of industry entities. The investigators included both diagnostic and interventional radiologists and radiation oncologists.
Among them, gifts were the most common type of payment, accounting for 76% (or 391,963) of the total 513,020 payments, mainly from entities such as professional medical associations, pharmaceutical companies, biotechnology companies or medical device manufacturers. However, these represent only about 5 per cent of the total disbursement amount, or $17.8 million.
Royalty/ownership payments accounted for 0.2 per cent of the payments (or 1,153) but were the most valuable, exceeding $118.5 million, or 32 per cent of the total payments. Only 179 radiologists received these payments, with an average of $6,042.
Other high-value industry payments include:
- Advisory fees totalled US$107.9 million (29% of the total), with 33,590 payments (6.5% of total);
- Presentations totalled $88.3 million (24% of the total) and 7,110 payments (25% of the total);
- Research fees totalled US$33.5 million (9% of the total), with 6,553 payments (1% of total);
- Education disbursements totalled nearly $4.7 million (1 per cent of the total) and 4,552 disbursements (0.9 per cent).
It can be found that the top 5% of radiologists have a higher share of the various payment items (except gifts), compared to the top 95% of radiologists who receive a lower percentage of payments.
For example, 73.5% of the 95% cohort of radiologists received payment for consulting work, compared to 5.6% in the rest of the population. The top 5 percent of radiologists also had a higher average of $1,927 for all types of payments, compared to $65 for the top 95 percent.
Royalties/ownership (usually payments based on the sale of a radiologists' intellectual property) are the biggest money-makers, with the top 5% of radiologists earning $75.1 million from them.
In addition, they received a considerable amount of payment from the presentation fee (27.9% of the total) and the consulting fee (18% of the total). In contrast, the top 95% of radiologists receive only about 8% of the presentation fee.
"There is a mutual value relationship between academia and industry," the study authors noted. In this relationship, physicians can transfer technology to the commercial realm and have the opportunity to receive financial support to advance medical research. The largest percentage of payments received by the top 5% of radiologists came from royalties/ownership (followed by consulting fees), demonstrating the importance of innovation in this field and not simply transactional relationships. Further research is needed that the top 5% of radiologists receive a lower percentage of gifts, which may mean that the concentration of payments may be linked to potential ethical issues. ”
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Comparison of radiology salaries in China and the United States
It is worth noting that the normal work income of radiologists in the United States (not counting additional income) has ranked in the top five of all clinical departments. In contrast, Chinese radiologists can only be classified as mediocre.
According to the U.S. Bureau of Labor Statistics (BLS), the average annual salary for radiographers in the United States in the May 2021 survey was $61,370. The bottom 10 percent of technicians earned less than $46,850, and the top 10 percent earned more than $94,880. According to the Payscale.com report, the national average annual salary for radiologists is $50,736, with an average of $22.49 per hour.
According to Boss Zhipin, the average annual salary of radiographers in China in the survey between 2022 and 2023 is 60,996 yuan, and the average hourly wage is 27 yuan. Among them, the salary of the bottom 10% of technicians is less than 37,000 yuan, and the salary of the top 10% of technicians is more than 105,000 yuan.
According to the analysis of the report, there is still a large difference in the salary of radiographers in China and the United States, and the possible reasons are as follows:
1. The level of economic development
The United States is the largest economy in the world, with a much higher per capita gross domestic product (GDP) than China. As a result, salaries in the healthcare industry in the United States are generally higher. Although China has become the world's second largest economy, its per capita GDP is still lower than that of the United States, which has affected the salary level of doctors to a certain extent.
2. Differences in healthcare systems
The healthcare systems of the United States and China are very different. The U.S. healthcare system is dominated by private hospitals, and physicians earn their income primarily from fees paid by patients and reimbursed by insurance companies. China's healthcare system, on the other hand, is dominated by public hospitals, where doctors earn their income mainly from government grants and fees paid by patients. This makes radiologists in the United States earn more.
3. Differences in education and training
Radiologists in the U.S. are required to complete rigorous education and training, including medical degrees, internships, residency training, and professional certification in radiology. Although China's medical education system is also improving, it still lags behind the United States in some aspects. This may affect the salary of radiologists.
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Of the five journals involved in the survey, JACR is the official journal of the American College of Radiology. Dedicated to informing readers about timely, relevant, and important topics affecting the practice of diagnostic radiologists, interventional radiologists, medical physicists, and radiation oncologists through health services research and policy, clinical practice management, data science, leadership, training, and education, among others.
Radiology is the official journal published by the Radiological Society of North America (RSNA). It has long been recognized as the most up-to-date, clinically relevant and authoritative journal with the highest quality research in the field of radiation medicine. He mainly publishes research articles on radiology, medical imaging frontiers and imaging.
AJR is currently the longest-running radiology journal in the world and is published by the American College of Radiology. It mainly publishes high-level original papers on all aspects of general and diagnostic radiology, including magnetic resonance imaging techniques, and is recognized by the industry as one of the most authoritative professional journals in the world.
JVIR is the official journal of the Society of Interventional Radiology and serves as a peer-reviewed journal for interventional radiologists, radiologists, cardiologists, vascular surgeons, neurosurgeons, and other clinicians.
AJNR is the journal of the National Society of Neuroradiology and is dedicated to the development of the field of neuroradiology and the advancement of the profession. The journal publishes original research, reviews, case reports, and reviews in the field of neuroradiology.
In fact, most academic journals require authors to disclose "conflicts of interest" related to their research, but some authors may feel that the industry payments they have received have not affected their research and may feel compelled to disclose this information.
But as Dr. Dheeman Futela highlights in his paper – failure to disclose financial relationships may be seen as unfair practice, and while making financial disclosures may not completely eliminate bias, as the data becomes publicly available, wider awareness and transparency will increase the credibility of the research/publication.