Characteristics and Distribution of Scholarship Donations From Pharmaceutical Companies to Japanese Healthcare Institutions in 2017: A Cross-sectional Analysis

Background

Collaborations between pharmaceutical companies and healthcare professionals, healthcare institutions, such as regulatory bodies, hospitals or medical schools, and patient institutions are essential for understanding diseases and the development of novel drugs.^1,2 However, these collaborations often entail financial relationships leading to conflicts of interest (COIs). In addition to COIs affecting individual healthcare professionals, there are institutional COIs (ICOIs) arising at the level of recipient institutions or their subunits, such as hospital departments.³ The National Academy of Medicine in the United States states that “institutional COIs arise when an institution’s own financial interests or those of its senior officials pose risks of undue influence on decisions involving the institution’s primary interests.”³ ICOIs have received less attention than individual COIs as they are more difficult to identify and usually conform to legal norms because more stakeholders are involved compared to individual COIs. However, both individual COIs and ICOIs with pharmaceutical companies have repeatedly disturbed patient-centered care, leading to bias in research findings,⁴ influence on drug prescribing patterns^5-7 and recommendations of clinical guidelines.^8,9

One of the most substantial and widespread examples of ICOIs is “scholarship donations” (Shogaku-kifu in Japanese) unique to Japan. Scholarship donations are a traditional payment type that, to the best of our knowledge, does not exist outside of Japan.¹⁰ Although contracts between healthcare institutions and pharmaceutical companies typically undergo formal review at the administrative offices of recipient healthcare institutions, scholarship donations need not document specific purposes, usage, costs, or periods associated with payments. Namely, the term “scholarship donation” may be misleading, as it could imply a direct support for student tuition or training. While these donations may be presented with an educational purpose on the surface, they can also be used for non-educational purposes, such as hiring staff, holding social events, purchasing furniture, etc. Also, it differs from non-research payments for lecturing, consulting, and writing compensations. Unlike “unrestricted educational grants” or “unrestricted research grants,” “scholarship donations” do not necessarily imply a clear educational or research purpose, and their usage may be more flexible and open to potential COIs, underscoring the need to investigate this unique form of industry sponsorship in Japan. Due to these characteristics and flexibility in spending money obtained from pharmaceutical companies, scholarship donations have been vital in supporting the operation of many healthcare institutions in Japan.

On the other hand, scholarship donations can easily have implicit promotional purposes by pharmaceutical companies, mostly highlighted in adverse cases such as the recent bribery case at the Mie University¹⁰ and the Diovan scandal.¹¹ In the Diovan scandal, Novartis admitted paying about US$ 11 million scholarship donations for funding and honoraria to conduct five clinical trials. However, none of the trials disclosed that they were funded by scholarship donations,^12-17 nor did they explain to patients the source of funding for the trials.¹⁰ After this scandal, several pharmaceutical companies, foreign pharmaceutical companies in particular such as Janssen Pharmaceutical K.K., Bristol-Myers Squibb Company, and Celgene Corporation, have quitted or reduced donating scholarship donations. As another example, Astellas Pharma has stopped making scholarship donations and instead has donated to the government agency to allocate their research funds to healthcare institutions and healthcare professionals since 2020. Also, the recent scandal of scholarship donation in exchange for the increased prescription at the Department of Anesthesiology, Mie University has led to discussions about closing the door on scholarship donations in all pharmaceutical companies in Japan, because the scholarship donation was judged as a bribe by the adjudgment in the first instance at a Japanese District Court. Meanwhile, many university hospitals in Japan face difficulties in continuing research due to a decrease in public research funds from the Japanese government.¹⁰ Under these circumstances, it might be the case that the scholarship donations have been playing a role in supporting healthcare institutions and professionals at universities to continue research in Japan.

Inappropriately managed COIs between pharmaceutical companies and healthcare sectors have repeatedly triggered medical scandals in Japan.¹¹ To manage COIs in line with other developed countries, the Japan Pharmaceutical Manufacturers Association (JPMA) set a transparency guideline in 2011, and based on this guideline, since 2013, full details of scholarship donations and their recipients have been required to be disclosed annually by companies on their websites. We previously reported that the disclosure and collection of payment data from pharmaceutical companies elucidated that a total of $203 380 412 scholarship donations were paid to healthcare institutions from the 71 member companies of the JPMA in 2016, which was as large as the amount of payments to healthcare professionals ($235 958 130) for lecturing, consulting, and writing in 2016.¹⁸ However, scholarship donations have not yet been analyzed systematically, in contrast to individual-level payments.^11,19-27

This study aimed to elucidate the extent and distribution of financial relationships between pharmaceutical companies and healthcare institutions in Japan, using publicly disclosed payment data of scholarship donations from all pharmaceutical companies belonging to the JPMA in 2017.

Methods

Data Collection

Payment data for the member of the JPMA were published on the website of each company at the time of data collection in 2019. Pharmaceutical companies that adhere to the transparency guideline disclose the amount of their scholarship donations as part of their academic research support expenses. The transparency guidelines are not mandatory, and there is no reporting requirement or penalty for violations when disclosing them, but most companies belonging to the JPMA report in detail. We collected payment data concerning scholarship donations from the 73 companies which belonged to the JPMA in 2017. Using the collected data, we generated a unified single database, as described previously.^19,28 Our database included the names of hospitals or university departments, the names of pharmaceutical companies, the monetary amounts of the payments, and the frequency of the payments. The unified database was stored by Microsoft Excel, version 16.0 (Microsoft Corp).

Data Analysis

After structuring the payment database, each payment was categorized, based on additional web searches, by the type of institution (university, research institution, specialty hospital, other hospitals such as community-based or privately-established, or unknown institution), institutional jurisdiction (national, private, or public such as prefectural or municipal), type of pharmaceutical companies (domestic or international), and department specialty.

First, an individual investigator categorized the payments by the type of institution and institutional jurisdiction by searching the official websites of each institution and department. Second, the two investigators, AM and the investigator independently categorized the payments by specialty referring to the official website of each institution and department. Our original specialty category was based on the Japanese Medical Specialty Board. However, during the specialty classification, to capture the real picture of payments by specialty, the final specialty classification was discussed by AO, HS, and TT, and decided to specialize into 51 main categories including 28 clinical medicines, 12 basic medicines, 8 social medicine, and 3 other subjects related to the hospital sectors. Internal medicine and surgery were further divided into 14 internal medicine subcategories and 7 surgery subcategories.

As for a department providing both surgical and medical procedures, we categorized it as “general.” For example, a department concerning oncology, which provides both surgical and medical therapy, was categorized as “General Oncology.” For departments containing more than one specialty, multiple classifications were adopted. For departments that we could not find information on official websites or official information, we contacted pharmaceutical companies or affiliated institutions by email for detailed information on the payments and the department. We filled in the department based on the response we received with detailed information from pharmaceutical companies and the institution for all departments. There were cases where we could not identify specialties for multiple payments.

After the first specialty classification, the two data that AM and an individual investigator were each responsible for were integrated into one dataset. Then the integrated dataset was divided into three parts, and each part was scrutinized by three different reviewers (AM, an individual investigator, and one external research assistant) for the validity of the classification and discrepancies in the classification of departments with the same name. When discrepancies were found, we organized and cleaned the data to meet the final criteria of categorization. Finally, the three separate parts of the data were combined and used for analysis.

Then we conducted descriptive analysis for the payment data by the type of institution, pharmaceutical companies, and department specialty. Pharmaceutical companies were classified as foreign companies and domestic companies based on the location of the company’s headquarters. A foreign company was defined as a pharmaceutical company whose headquarters was outside of Japan, and a domestic one was vice versa. We calculated the payments at the level of department, institution, pharmaceutical company, and specialty. In the analysis by specialties, when payment was classified in more than one specialty, the payment value was divided according to the number of specialties in which it was classified. Japanese yen was converted into US dollars using the 2017 average monthly exchange rate of ¥112.1 per $1. We conducted all statistical analyses using Microsoft Excel, version 16.0 (Microsoft Corp), and Stata version 15 (Stata Corporation).

Results

We identified a total of 27 007 payments concerning scholarship donations worth $178 703 721 (¥20 032 687 112) from 67 pharmaceutical companies (67/73, 91.8%) to 4839 specific departments and laboratories at 251 different institutions in 2017.

Table 1 summarizes the characteristics of 251 institutions receiving scholarship donations and 67 pharmaceutical companies making scholarship donations. A breakdown of the institutions was as follows: 73 private universities (29.1%); 47 national universities (18.7%); 42 national hospitals (16.7%); 16 public universities (6.4%); 11 private research institutes (4.4%); 10 private hospitals (4.0%) and 52 other institutions (20.7%). All 82 medical schools in Japan received one or more scholarship donations (data not shown).

Table 2 shows the financial characteristics of scholarship donations. At the department level, each department or laboratory received scholarship donations worth of $36 930 on average (standard deviation [SD]: $58 073), and with the median of $16 503 (interquartile ranges [IQR]: $5 352‒$44 603). Similarly, the average and median scholarship donations were $711 967 (SD: $1 283 742) and $32 114 (IQR: $7136‒$1 219 224) per institution, respectively. Also, pharmaceutical companies made payments concerning scholarship donation worth of $2 666 827 (SD: $3 282 833) and $1 151 204 (IQR: $352 783‒$3 061 073) per company in average and median, respectively. 96.5% of payments are concentrated on university departments and laboratories.

Data on scholarship donations were collected from 67 of the 73 pharmaceutical companies. This includes 52 domestic companies (96.3% of the 54 total domestic companies) and 15 foreign companies (78.9% of the 19 total foreign companies) (Table 3 and Supplementary file 1). Of the total payments, domestic companies contributed 77.1%, amounting to $137 797 302. In 2017, four foreign companies — Janssen Pharmaceutical K.K., Bristol-Myers Squibb Company, Celgene Corporation, and Shire Japan — did not make payments related to scholarship donations. Similarly, one domestic company, Seikagaku Corporation, did not make such payments. Kyowa Kirin Co., Ltd. made a scholarship donation payment and disclosed it, but we missed collecting the data during its disclosure period. When we later attempted to collect their 2017 payment data, the company started disclosing the 2018 data and declined our request to once again disclose the 2017 data. Chugai Pharmaceutical Co. Ltd. made the largest payment of $13 445 495 to 1325 departments and institutions, followed by Astellas with $11 684 211, Takeda with $10 316 057, Daiichi Sankyo with $9 750 277, and Eisai with $9 365 745. Among the top ten pharmaceutical companies with the largest scholarship donations, eight companies were domestic pharmaceutical companies, while two foreign pharmaceutical companies, MSD and Pfizer made the eighth and ninth largest payments concerning scholarship donations, respectively.

As for specialty, 89.6% of scholarship donations concentrated on 28 clinical medicine specialties including internal medicine, surgery, orthopedic surgery, urology, dermatology, and ophthalmology (Supplementary file 2). Among them, internal medicine occupied 46.0% ($82 236 275) of the total scholarship donations from the pharmaceutical companies in 2017, followed by surgery ($18 430 776, 10.3%), orthopedic surgery ($9 055 291, 5.1%), urology ($8 544 900, 4.8%), and dermatology ($6 964 935, 3.9%). Among all 70 specialties including 14 internal medicine and 7 surgical sub-specialties, the amounts made to top-three specialties (endocrinology, cardiology, and gastroenterology) totaled $40 981 299, which was equivalent to 22.9% of the total scholarship donations in 2017. Of all scholarship donations, 6.2% were allocated to 12 basic medicine specialties, including pharmacology, oncology, biochemistry, and medical engineering. Meanwhile, 2.0% were distributed among eight social medicine specialties. (Figure).

Close

Figure. Amounts of the Scholarship Donations Across Major Specialties. While internal medicine and surgeries are presented as distinct subcategories, the 12 basic medicine categories and the 8 social medicine categories were grouped together, respectively. There were cases where we could not identify specialties for multiple payments.

Discussion

This study found that a total of $178 703 721 of scholarship donations, which is a major source of non-research ICOIs among Japanese medical society, were paid to 4839 specific departments and laboratories at 251 different institutions by 67, primarily domestic, pharmaceutical companies. The distribution of scholarship donations concentrated on several particular clinical medicine specialties such as endocrinology, cardiology, and gastroenterology. We firstly elucidated Japan’s scholarship donations, although such financial relationships between the pharmaceutical companies and healthcare institutions are different from those of the United States^29,30 and the United Kingdom.^31-33 Our previous study found that the scholarship donation accounted for 11.5% of all non-research payments and was equivalent to the payments to healthcare professionals in 2016.¹⁹ Our current study additionally clarified that a roughly equal amount of scholarship donations were made by pharmaceutical companies in 2016 ($179 937 555) compared to those in 2017 ($178 703 719). Our findings suggest that financial relationships between pharmaceutical companies and healthcare institutions in Japan may continue to persist, suggesting a deeply ingrained custom. It is true that a majority of the pharmaceutical companies are quitting this custom following the recent scandal in Mie University.¹⁰ However, further longitudinal studies are needed to understand the intentions and motivations of both players in maintaining these relationships.

First, we found that most of the major pharmaceutical companies in Japan, especially domestic companies, made substantial amounts of scholarship donations to healthcare institutions in 2017. Foreign companies typically conform to Western standards, while Japanese companies often follow traditional home-grown rules. This difference would be particularly relevant in the case of scholarship donations. By distinguishing between foreign and domestic companies, we elucidated the role of these donations in shaping industry payments and the implications for physician-industry relationships in Japan. Despite its unique feature where the scholarship donation does not specify its usage, we can partly analogize it to non-research payments to healthcare institutions in other countries. As for non-research payments to healthcare institutions in the United Kingdom, Ozieranski et al reported that 4028 healthcare institutions received $72 110 157 from 100 pharmaceutical companies in 2015.³¹ The pharmaceutical companies paid $36 487 990 in donations and grants in the United Kingdom. Similarly, Anderson et al found that 1170 US teaching hospitals, equivalent to 91.3% of all teaching hospitals in the United States, received $831 938 468 non-research payments from 529 pharmaceutical companies and medical device manufacturer companies in 2018.³⁰ Of all non-research payments made by the companies, 75.2% ($625 700 554) were made for royalty or licenses, and 12.2% ($101 642 765) were for educational purposes. Among the $831 938 468 non-research payments, $315 813 239 (38.0%) were related to biologics or drugs. Therefore, the amount of Japanese scholarship donations in 2017 was 4.90 times higher than the non-research payments from all UK pharmaceutical companies, and 1.76 times higher than the non-research payments from all pharmaceutical companies in the United States, even though the pharmaceutical market size of Japan was less than one-fifth that of the United States (US$ 87.3 billion in Japan vs US$ 508.7 billion in the United States). Given that the US Open Payments Database covers payments from all pharmaceutical and medical device companies and our payment database covered payments from only pharmaceutical companies belonging to the JPMA, the Japanese pharmaceutical companies made much more substantial payments to healthcare institutions as non-research payments than those in other developed countries.

Second, this study found that $172 512 024 (96.5%) of scholarship donations were distributed to the universities, and all 82 Japanese universities with medical schools received payments from pharmaceutical companies. Considering the nature of medical schools where medical students learn role models for the future, less transparent non-research payments that do not clarify the direct purpose of the payments, such as the scholarship donation, might bias and influence medical education in the universities, clinical practice by university clinicians, and result in less evidence-based treatment leading to wasteful medical spending. In the case of opioid prescription, Anderson et al suggested that the US teaching hospitals should voluntarily prohibit accepting non-research payments from pharmaceutical companies marketing opioids. Indeed, historically, Japan’s scholarship donations have been utilized as hidden research funds and bribes, as in the case of the Diovan scandal¹¹ and the Mie University.¹⁰

We found that most major domestic pharmaceutical companies paid scholarship donations to healthcare professionals. In this sense, it is also important to recognize that the debate on quitting scholarship donations without considering this current circumstance might lead to further difficulties in conducting research at Japanese universities. We acknowledge that scholarship donations, as described in our study, are a unique custom in Japan and may not be directly applicable to Western countries. However, we believe that understanding this custom and its implications can still provide valuable insights for the international community, especially for non-Western developing countries where similar customs might exist. By sharing the Japanese experience, our study can contribute to a broader understanding of the varied relationships between the pharmaceutical industry and healthcare institutions across different cultural and regulatory contexts including the importance of transparency, industry self-regulation, transparency codes, and regulation of payments from industry to healthcare institutions. Future studies should assess whether scholarship donations help healthcare institutions to promote research without playing a role of a bribe from pharmaceutical companies to promote their own products.

Limitations

This study included several limitations. First, the institution type, nationality of pharmaceutical companies, and specialties of the departments were manually categorized, so human error in the categorizations may be included. Second, since there was no penalty when the pharmaceutical companies did not disclose the payments correctly, the original payment data might have some errors. However, we believe that these issues would have a negligible effect on the overall trends and patterns observed in our study. Finally, the data of non-member companies were not included, but our data sources covered a large majority of the payments made within the industry including most major and influential pharmaceutical companies in the market, which we believe minimizes the potential impact of non-member companies on our findings. Although we cannot provide an exact figure for the number of non-member companies, we estimate that they would account for less than 20% of the market. Given their relatively smaller market share, the influence of these non-member companies on the overall trends observed in our study is likely to be limited.

Conclusion

This study unraveled that there were substantial scholarship donations from pharmaceutical companies to healthcare institutions in 2017, amounting to more than US$ 178 million in Japan. Most scholarship donations concentrated on universities with medical school, potentially influencing medical practice, accumulating evidence by conducting research, and medical education in favor of pharmaceutical companies. Further study should be conducted to indicate whether these scholarship donations help healthcare institutions and professionals to improve research and clinical practice.

Acknowledgements

This study was funded in part by the Medical Governance Research Institute. This non-profit enterprise receives donations from pharmaceutical companies, including a dispensing pharmacy, namely Ain Pharmacies, Inc., other organizations, and private individuals. This study also received support from Tansa, an independent non-profit news organization dedicated to investigative journalism. The authors also thank Kayo Harada for her dedicated work in obtaining the data. However, none of the entities providing financial support for this study contributed to the design, execution, data analyses, or interpretation of study findings and the drafting of this manuscript.

Ethical issues

This study was approved by the Institutional Review Board of the Medical Governance Research Institute. Informed consent was waived from the donated institutions and departments since all the data used in this study were publicly available and did not involve any privacy concerns.

Competing interests

HS received personal fees from Taiho Pharmaceutical Co., Ltd. outside the scope of the submitted work. AO receives personal fees from Medical Network Systems, Kyowa Kirin Co., Ltd., and Taiho Pharmaceutical Co., Ltd. outside the scope of the submitted work. TT receives personal fees from Medical Network Systems and Bionics Co. Ltd. outside the scope of the submitted work. The remaining authors declare no conflicts of interest.

Funding

This study was funded in part by the Medical Governance Research Institute. This non-profit enterprise receives donations from pharmaceutical companies, including a dispensing pharmacy, namely Ain Pharmacies, Inc., other organizations, and private individuals. This study also received support from Tansa, an independent non-profit news organization dedicated to investigative journalism. However, none of the entities providing financial support for this study contributed to the design, execution, data analyses, or interpretation of study findings and the drafting of this manuscript.

Supplementary files

References

1. Wouters OJ, McKee M, Luyten J. Estimated research and development investment needed to bring a new medicine to market, 2009-2018. JAMA 2020; 323(9):844-853. doi: 10.1001/jama.2020.1166 [Crossref] [ Google Scholar]
2. Rubin EH, Gilliland DG. Drug development and clinical trials--the path to an approved cancer drug. Nat Rev Clin Oncol 2012; 9(4):215-222. doi: 10.1038/nrclinonc.2012.22 [Crossref] [ Google Scholar]
3. Institute of Medicine. Conflict of Interest in Medical Research, Education, and Practice. Washington, DC: National Academies Press; 2009.
4. Tijdink JK, Smulders YM, Bouter LM, Vinkers CH. The effects of industry funding and positive outcomes in the interpretation of clinical trial results: a randomized trial among Dutch psychiatrists. BMC Med Ethics 2019; 20(1):64. doi: 10.1186/s12910-019-0405-7 [Crossref] [ Google Scholar]
5. DeJong C, Aguilar T, Tseng CW, Lin GA, Boscardin WJ, Dudley RA. Pharmaceutical industry-sponsored meals and physician prescribing patterns for Medicare beneficiaries. JAMA Intern Med 2016; 176(8):1114-1122. doi: 10.1001/jamainternmed.2016.2765 [Crossref] [ Google Scholar]
6. Fickweiler F, Fickweiler W, Urbach E. Interactions between physicians and the pharmaceutical industry generally and sales representatives specifically and their association with physicians’ attitudes and prescribing habits: a systematic review. BMJ Open 2017; 7(9):e016408. doi: 10.1136/bmjopen-2017-016408 [Crossref] [ Google Scholar]
7. Mitchell AP, Trivedi NU, Gennarelli RL. Are financial payments from the pharmaceutical industry associated with physician prescribing? A systematic review. Ann Intern Med 2021; 174(3):353-361. doi: 10.7326/m20-5665 [Crossref] [ Google Scholar]
8. Johnson L, Stricker RB. Attorney General forces Infectious Diseases Society of America to redo Lyme guidelines due to flawed development process. J Med Ethics 2009; 35(5):283-288. doi: 10.1136/jme.2008.026526 [Crossref] [ Google Scholar]
9. Steinbrook R. Guidance for guidelines. N Engl J Med 2007; 356(4):331-333. doi: 10.1056/NEJMp068282 [Crossref] [ Google Scholar]
10. Ozaki A, Murayama A, Harada K. How do institutional conflicts of interest between pharmaceutical companies and the healthcare sector become corrupt? A case study of scholarship donations between department of clinical anesthesiology, Mie University, and ono pharmaceutical in Japan. Front Public Health 2021; 9:762637. doi: 10.3389/fpubh.2021.762637 [Crossref] [ Google Scholar]
11. Sawano T, Ozaki A, Saito H, Shimada Y, Tanimoto T. Payments from pharmaceutical companies to authors involved in the valsartan scandal in Japan. JAMA Netw Open 2019; 2(5):e193817. doi: 10.1001/jamanetworkopen.2019.3817 [Crossref] [ Google Scholar]
12. Muramatsu T, Matsushita K, Yamashita K. Comparison between valsartan and amlodipine regarding cardiovascular morbidity and mortality in hypertensive patients with glucose intolerance: NAGOYA HEART Study. Hypertension 2012; 59(3):580-586. doi: 10.1161/hypertensionaha.111.184226 [Crossref] [ Google Scholar]
13. Uzu T, Sawaguchi M, Maegawa H, Kashiwagi A. Reduction of microalbuminuria in patients with type 2 diabetes: the Shiga Microalbuminuria Reduction Trial (SMART). Diabetes Care 2007; 30(6):1581-1583. doi: 10.2337/dc06-2493 [Crossref] [ Google Scholar]
14. Sawada T, Yamada H, Dahlöf B, Matsubara H. Effects of valsartan on morbidity and mortality in uncontrolled hypertensive patients with high cardiovascular risks: KYOTO HEART Study. Eur Heart J 2009; 30(20):2461-2469. doi: 10.1093/eurheartj/ehp363 [Crossref] [ Google Scholar]
15. Mochizuki S, Dahlöf B, Shimizu M. Valsartan in a Japanese population with hypertension and other cardiovascular disease (Jikei Heart Study): a randomised, open-label, blinded endpoint morbidity-mortality study. Lancet 2007; 369(9571):1431-1439. doi: 10.1016/s0140-6736(07)60669-2 [Crossref] [ Google Scholar]
16. Narumi H, Takano H, Shindo S. Effects of valsartan and amlodipine on cardiorenal protection in Japanese hypertensive patients: the Valsartan Amlodipine Randomized Trial. Hypertens Res 2011; 34(1):62-69. doi: 10.1038/hr.2010.186 [Crossref] [ Google Scholar]
17. Murata N, Ozaki A, Murayama A, Sawano T, Tanimoto T. The Diovan scandal in Japan; don’t let bygones be bygones. J Hum Hypertens 2022; 36(5):500-501. doi: 10.1038/s41371-022-00680-2 [Crossref] [ Google Scholar]
18. Ozaki A, Saito H, Senoo Y. Overview and transparency of non-research payments to healthcare organizations and healthcare professionals from pharmaceutical companies in Japan: analysis of payment data in 2016. Health Policy 2020; 124(7):727-735. doi: 10.1016/j.healthpol.2020.03.011 [Crossref] [ Google Scholar]
19. Murayama A, Hoshi M, Saito H. Nature and trends in personal payments made to the respiratory physicians by pharmaceutical companies in Japan between 2016 and 2019. Respiration 2022; 101(12):1088-1098. doi: 10.1159/000526576 [Crossref] [ Google Scholar]
20. Mamada H, Murayama A, Ozaki A. Observational study of financial and non-financial conflicts of interest among the Japanese government advisory board members concerning coronavirus disease 2019. Medicine (Baltimore) 2023; 102(4):e32776. doi: 10.1097/md.0000000000032776 [Crossref] [ Google Scholar]
21. Murayama A, Mamada H, Shigeta H. Financial relationships between pharmaceutical companies and rheumatologists in Japan between 2016 and 2019. J Clin Rheumatol 2023; 29(3):118-125. doi: 10.1097/rhu.0000000000001922 [Crossref] [ Google Scholar]
22. Murayama A, Saito H, Tanimoto T, Ozaki A. Financial conflicts of interest between pharmaceutical companies and executive board members of internal medicine subspecialty societies in Japan between 2016 and 2020. J Eval Clin Pract. 2023. 10.1111/jep.13877.
23. Hashimoto T, Murayama A, Mamada H, Saito H, Tanimoto T, Ozaki A. Evaluation of financial conflicts of interest and drug statements in the coronavirus disease 2019 clinical practice guideline in Japan. Clin Microbiol Infect 2022; 28(3):460-462. doi: 10.1016/j.cmi.2021.11.019 [Crossref] [ Google Scholar]
24. Murayama A, Ozaki A, Saito H, Sawano T, Sah R, Tanimoto T. Coronavirus disease 2019 experts appearing on Japanese television: their characteristics and financial conflicts of interest with pharmaceutical companies. Clin Microbiol Infect 2020; 27(5):805-807. doi: 10.1016/j.cmi.2020.12.002 [Crossref] [ Google Scholar]
25. Kida F, Murayama A, Saito H, Ozaki A, Shimada Y, Tanimoto T. Pharmaceutical company payments to authors of the Japanese clinical practice guidelines for hepatitis C treatment. Liver Int 2021; 41(3):464-469. doi: 10.1111/liv.14761 [Crossref] [ Google Scholar]
26. Murayama A, Yamada K, Yoshida M. Evaluation of conflicts of interest among participants of the Japanese nephrology clinical practice guideline. Clin J Am Soc Nephrol 2022; 17(6):819-826. doi: 10.2215/cjn.14661121 [Crossref] [ Google Scholar]
27. Kusumi E, Murayama A, Kamamoto S. Pharmaceutical payments to Japanese certified hematologists: a retrospective analysis of personal payments from pharmaceutical companies between 2016 and 2019. Blood Cancer J 2022; 12(4):54. doi: 10.1038/s41408-022-00656-y [Crossref] [ Google Scholar]
28. Murayama A, Kamamoto S, Murata N. Evaluation of financial conflicts of interest and quality of evidence in Japanese gastroenterology clinical practice guidelines. J Gastroenterol Hepatol 2023; 38(4):565-573. doi: 10.1111/jgh.16089 [Crossref] [ Google Scholar]
29. Anderson TS, Gellad WF, Good CB. Characteristics of biomedical industry payments to teaching hospitals. Health Aff (Millwood) 2020; 39(9):1583-1591. doi: 10.1377/hlthaff.2020.00385 [Crossref] [ Google Scholar]
30. Anderson TS, Krieger MS, Marshall BDL, Cerdá M, Hadland S. Financial payments to teaching hospitals by companies marketing opioids. J Gen Intern Med 2020; 35(10):3108-3110. doi: 10.1007/s11606-019-05596-1 [Crossref] [ Google Scholar]
31. Ozieranski P, Csanadi M, Rickard E, Tchilingirian J, Mulinari S. Analysis of pharmaceutical industry payments to UK health care organizations in 2015. JAMA Netw Open 2019; 2(6):e196253. doi: 10.1001/jamanetworkopen.2019.6253 [Crossref] [ Google Scholar]
32. Saghy E, Mulinari S, Ozieranski P. Drug company payments to general practices in England: cross-sectional and social network analysis. PLoS One 2021; 16(12):e0261077. doi: 10.1371/journal.pone.0261077 [Crossref] [ Google Scholar]
33. Moberly T. CCGs fail to declare pharma funding. BMJ 2018; 360:j5911. doi: 10.1136/bmj.j5911 [Crossref] [ Google Scholar]