Tip of the iceberg? The industry payments to medicines experts

A 2020 review led by Baroness Julia Cumberlege examined concerns raised by patients and families about the safety of medicines and medical devices.

The review described doctors in the 1950s to 1970s passing on free drug samples to patients, “often from a doctor’s desk drawer, without a prescription and often with no record-keeping”.

It also found “conflicts of interest in the selection of experts to form part of expert working groups, advisory committees or to agree guidelines”.

“An ideal expert would be an individual who is knowledgeable and respected in their field, but who has no personal, professional or financial links which might influence their position,” Cumberlege suggested in her report.

But she warned: “It may not be possible, or even desirable, for an expert to have no interest in a matter being reviewed.”^​1​

‘Normal and necessary’

More than five years after the Cumberlege review was published — and decades after the scandals it investigated first came to light — payments from the pharmaceutical industry to clinicians remain routine.

According to the Association of British Pharmaceutical Industry’s (ABPI) voluntary register of payments made by pharmaceutical companies, in 2025, approximately 18,367 named healthcare professionals received funding from pharmaceutical companies for contracted work, sponsorship to attend an event or associated expenses.

“Collaboration between industry and healthcare professionals is a normal and necessary part of how medicines are developed and evaluated safely,” says Graham Cookson, chief executive of the Office of Health Economics, which is a research charity founded and partly funded by the ABPI.

“Clinicians bring frontline expertise that industry would otherwise not have access to, all of which ultimately improves patient outcomes,” he tells The Pharmaceutical Journal.

Piotr Ozieranski and Emily Rickard, sociology researchers at the University of Bath, say that payments from pharmaceutical companies “do not ‘buy’ influence in the sense of simple ‘quid pro quo’”.

“Instead, companies perceive them as part of what sociologists call patterns of extended reciprocity. They are meant to create an implicit, unspoken obligation to return a favour in the future,” they tell The Pharmaceutical Journal.

“This may involve greater institutional access, collaborative activities or simply a positive disposition towards a company. This is a very powerful mechanism rooted deeply in human nature — and because of this even small ‘gifts’ to physicians, such as a free lunch or pens, have been found to significantly alter their prescription patterns.”

Among those who received the most from industry in 2025 was gastroenterologist Charlie Lees. According to Disclosure UK, he received £68,332.89 in professional fees for work, such as speaking, medical education, consultancy and advisory boards, as well as £35,801.18 in related expenses from pharmaceutical companies.

Lees says his prescribing decisions for individual patients “are based on the clinical evidence, relevant guidelines and the circumstances and preferences of the patient in front of me”.

“Decisions about which medicines are adopted or funded are made through formal local and national governance processes, rather than by any individual clinician. Where I contribute to relevant professional discussions, my interests are declared,” he adds.

It is those formal governance processes that concern Margaret McCartney, director of the Centre for Ethics and Values at the University of St Andrews, who says her worry is around industry payments being associated with the creation of guidelines themselves.

“If you work with industry, that’s fine, but that means you can’t serve in guideline committees, you can’t be somebody who’s in charge of making formulary decisions. Either you do one thing or you do the other thing. You can’t do both,” she says.

Conflicts of interest within guideline committees

The main safeguard against these conflicts sits with the National Institute for Health and Care Excellence (NICE). NICE was set up in 1999, as the National Institute for Clinical Excellence to make “unbiased and objective” recommendations on which medicines the NHS should use, based on “an assessment of population benefits and value for money”^​2,3​. Its guidance for England and Wales shapes formularies and prescribing across the NHS.

To manage this, all committee members and invited experts at NICE must declare any relevant interests — both annually and at each committee meeting they attend — as must any organisation that nominates specialists or makes a written submission^​4​. The committee chair or vice-chair then decides whether a member with a declared interest should take part in a particular appraisal.

However, declaring an interest does not necessarily mean giving up industry funding. Eight of the 90 members of NICE’s four technology appraisal committees (as of 24 September 2026) have disclosed payments from pharmaceutical companies in the past three years (2023–2025), totalling £20,658.81 (see Figure 1)^​5,6​.

Responding to those declarations of interest found on Disclosure UK, a NICE spokesperson told the Pharmaceutical Journal: “NICE is expected to achieve and maintain high standards of fairness in the way we conduct our business. Managing potential conflicts of interests is an important part of this process.

“Committee members are required to declare relevant interests when they are appointed and again in relation to individual topics being considered. Where a relevant conflict of interest is identified, NICE applies its published policy, which can include restricting or preventing participation in discussions.

“The minutes of each appraisal committee meeting explicitly list the attending members along with their declared interests, and these records are published openly on the NICE website.”

Figure 1: Transfers of value to current NICE technology appraisal committee members, as declared under Disclosure UK, 2023-2025

Ozieranski and Rickard say specific safeguards are needed “around roles such as chairing committees, leading evidence reviews, drafting recommendations or voting on final decisions”.

Jonathan Sive, now vice-chair of NICE’s technology appraisal committee C^​6​, received funding from pharmaceutical company Janssen-Cilag Ltd, a Johnson & Johnson Company, to attend a haematology conference in 2023 and 2025^​5​ — the latter of which coincided with his time as a NICE committee member.

This is allowed under NICE policies as long as the conflict of interest is declared, at which point it is up to the committee chair or vice-chair to decide whether the member should be removed from a particular appraisal.

When Sive took on that decision-making role himself later in 2025, he chose to stop receiving money from industry, he tells The Pharmaceutical Journal.

‘Webs of influence’

Sive’s attendance at the 2025 conference was one of 4,737 sponsored places paid for by pharmaceutical companies in 2025^​5​.

International conferences can cost at least £1,000 just to register, plus the cost of travel and accommodation.

Funding available from NHS employers might fund around one-quarter of this, leaving clinicians to fund anywhere from £4,000–£10,000 per conference themselves.

Officially, there are no strings attached to attending a conference on a pharma ticket. In practice, company representatives will host dinners and events, which the funding recipient is likely to attend.

Healthcare professionals may feel this is worth the opportunity to stay up to date with connections and the latest research in their field.

However, McCartney, Ozieranski and Rickard warn of industry funded events fuelling “webs of influence”.

Where “multiple key actors involved in a certain domain, for example, policymakers, regulators, experts, patient charities, are in one way or another involved financially with the industry or particular company”, this “risks normalising and amplifying industry perspectives, which are accepted as common sense”, Ozieranski and Rickard say.

McCartney suggests a “circular” relationship exists between pharmaceutical companies and clinical experts — with industry inviting specialists to work with them on new treatments and then those who have the experience of giving talks or working on trials with pharmaceutical companies being considered experts in the field.

“Everyone thinks because everyone else has said that someone is great, then they must be great,” she says.

Ozieranski and Rickard say that “conflicted experts may still contribute specialist knowledge”. There is a distinction between “drawing on the expertise of people with industry relationships and giving those individuals responsibility for making or voting on recommendations”, they add.

However, Ozieranski and Rickard suggest that industry payments are becoming “increasingly widespread within particular therapeutic areas, meaning it is becoming progressively harder to identify experts without such financial ties”. According to The Pharmaceutical Journal’s analysis, healthcare professionals in the specialties of oncology and haematology received the largest share of money from industry.

Visibility of conflicts of interest

Links to industry can also be hard to identify and understand.

Ozieranski and Rickard add that not all transfers of value are listed on Disclosure UK, while those that are, are “only the tip of the iceberg”.

According to the ABPI’s database, healthcare professionals received £51.8m from pharmaceutical companies in 2025 for non-research and development (R&D) payments, which are defined as payments that are “unrelated to research and development activities, such as commercial, non-commercial, educational, or advisory activities”.

“They may include donations and grants, sponsorship contributions to events such as conferences, fees for services, including consultancy, advisory boards and speaking engagements, and reimbursement of associated travel and accommodation expenses,” the ABPI says^​7​.

Fees may also include commercial arrangements known as “package deals” – where the purchase of a particular medicine is linked to the provision of certain associated benefits as part of the purchase price such as apparatus for administration of the medicine, the provision of training on its use or the services of a health professional to administer it^​8,9​.

Also in 2025, healthcare organisations, such as NHS trusts, GP practices and homecare providers, received almost £228.0m in non-R&D value transfers of this kind (see Table 1)^​5​.

Table 1: Non-R&D payments to healthcare organisations, Disclosure UK 2025

However, non-R&D payments “are dwarfed by payments related to research on drug company products, which are not attributed publicly to named individual recipients in the same way as non-research payments,” say Ozieranski and Rickard (see Figure 3).

Instead, such payments, which include research grants, are attributed to institutions such as universities or teaching hospitals. In 2025, these R&D payments totalled £647.3m — up from £467.0m in 2023 and £554.0m in 2024^​5,7​.

Figure 3: Total R&D and non-R&D value transfers declared under Disclosure UK in 2025 (£m)

The £647.3m in R&D payments represents just 10% of the total R&D investment in the UK made by pharmaceutical companies, according to the ABPI^​7​.

The way information is disclosed and presented can make it difficult for patients or decision-makers to decide whether the clinician is conflicted by their relationship with industry. Since R&D disclosures in particular are not attributed to an individual, this represents “a huge ‘known unknown’ of payment disclosure”, say Ozieranski and Rickard.

They add: “These R&D payments are likely to be particularly relevant for NICE experts as they involve payments for clinical research.”

In addition, the lack of detail beyond a sum of money can make disclosures “ineffective”, says McCartney.

She tells The Pharmaceutical Journal: “We don’t really understand what the meaning of those declarations is. They’re difficult to track down. They don’t always tell us enough information to actually make sense of them or make a judgment about them.

“Is this somebody that I can regard as somebody who’s at high risk of a conflict of interest or someone who’s effectively managing his conflict and is not getting involved with things where his judgement might be impeded by the fact that he’s got a financial relationship with this company?”

Conflicts of interest can also be difficult to find.

In addition to disclosures made by pharmaceutical companies under Disclosure UK, organisations might also be required to keep registers of gifts and conflicts of interest^​10​. But when McCartney analysed a sample of NHS trusts and Scottish health boards, she found that less than one-quarter published declarations of interest in line with national recommendations. Some in Scotland required access via a Freedom of Information request, and, where registers were available, many were out of date^​11​.

This means conflicts of interest may not be obvious at the point of receiving care, reading an educational article or making a decision about whether an expert giving evidence is conflicted.

Instead, McCartney says that patients and decision-makers are expected to somehow “magic that information into our minds and adjust everything that we’re doing on the basis of what that declaration might be”.

Charlotte Gurr

Solutions

Making disclosures mandatory — rather than voluntary as the ABPI’s scheme for industry currently is — could help, McCartney suggests.

The 2020 Independent Medicines and Medical Devices Safety Review (IMMDS) that investigated hormone pregnancy tests, pelvic mesh and sodium valproate, agreed that “the system of self-declaration has not been sufficient”.

In particular, it stressed the need for organisations to consider “whether it is appropriate to proactively check potential members’ interests prior to their appointment”.

In addition, it suggested that financial and non-pecuniary interests could be included on clinicians’ professional registers^​1​.

The IMMDS review also made recommendations relating to industry relationships with those considered experts in a particular field.

It noted that in academic journals, “reviewers’ rating of manuscript quality does not appear to be affected by disclosure of conflicts of interests”. The review also recommended that “the role of drug and medical device manufacturers in provision of financial support for research must be well managed to ensure evidence is trustworthy”.^​1​

However, McCartney thinks the separation between industry and clinical expertise should go further.

“There’s no reason why you can’t have experts who don’t have financial conflicts with industry,” she adds.

“We don’t have any evidence that we can successfully manage conflicts of interest… the only [systems] that seem to work are the ones where you exclude people [who have conflicts of interest].”

In fact, she suggests that the act of disclosing conflicts of interest might even worsen the problem.

“At the moment, people can just dump their data and run. They don’t have to engage with it on a moral ethical level. They just have to put it out there,” she continues.

“I’m not against industry, what I’m really against is people who’ve got a conflict of interest, making decisions about how we should be using medicines and healthcare. I think that’s a really bad idea [that] we know time and time again results in patient and healthcare system harm.”