Nancy E. Epstein
  1. Professor of Clinical Neurosurgery, School of Medicine, State University of New York at Stony Brook, New York, and Chief of Neurosurgical Spine and Education, NYU Winthrop Hospital, NYU Winthrop NeuroScience/Neurosurgery, Mineola, New York 11501, United States.


Copyright: © 2019 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Epstein NE. Professional Medical Associations Exert Undue Influence Despite Conflicts of Interest. Surg Neurol Int 09-Aug-2019;10:163

How to cite this URL: Epstein NE. Professional Medical Associations Exert Undue Influence Despite Conflicts of Interest. Surg Neurol Int 09-Aug-2019;10:163. Available from:

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Are Professional Medical Associations (PMAs) increasingly failing to disclose conflicts of interest, thus supporting industry, and/or acting in their own self-interest? Here we looked at some of our medical peers’ opinions on this subject.

2008 Robertson: Neurosurgery and Industry

In 2008, Robertson wrote a short article on Neurosurgery and Industry.[ 3 ] He noted the “… purpose of the relationship between neurosurgery and industry must be to improve patient care and advance medical knowledge”. He further commented that this “… relationship is desirable and can be mutually beneficial.” [ 3 ] However, in order for this to work one must “… avoid financial conflicts of interest”.

2009 Rothman et al. Wrote About Professional Medical Associations and Their Relationships with Industry

In 2009, Rothman et al. (2009) noted that professional medical associations (PMAs) are often unduly influenced by “extensive funding from pharmaceutical and device companies, (and) it is crucial that their guidelines manage both real and perceived conflict of interests.”[ 4 ] In this article, the authors “…first identified and analyzed conflicts of interest that may affect the activities, leadership, and members of PMAs.” They noted: “ A contract with one or another company sullies the reputation of the PMA, implying that the PMA’s name apparently is purchasable by the highest bidder”. Under conflict of interest guidelines, PMA presidents, officers and board members, should therefore; “… be held to the highest standards in avoiding conflict of interest”. They further advocated that these individuals: “…should be conflict free ($0 threshold) during their tenure”.

Two Articles 2016 and 2018 by Ioannidis

Evidence-based Medicine has been Hijacked

In 2016, Ioannidis wrote: “Evidence-based medicine (EBM) has been hijacked”. He observed that, particularly in the US, “ Influential randomized trials are largely done by and for the benefit of the industry. Meta-analyses and guidelines have become a factory, mostly also serving vested interests. “[ 1 ] He further observed “…EBM (evidence-based medicine) still remains an unmet goal…” Other findings included that “…most major US institutions also did not pay close attention to EBM, and when they did, data were often churned out by industry-run randomized controlled trials.”[ 1 ]

2018 Ioannidis: Many Professional Society Documents Written by Insiders

In 2018, Ioannidis et al. wrote: “Cardiovascular Perspective: Many influential professional society documents are written exclusively by insiders.” [ 2 ] He noted this led to greater influence within these societies; “This creates a massive, clan- like, group self-citation network”. It promoted the careers of specialists involved in the writing of society documents, and thus supported industry and these organizations. Ioannidis questioned; “However, do they improve medicine or do they homogenize biased, collective, and organized ignorance?”[ 2 ] He discussed the multiple red flags found in most published guidelines: “…sponsoring by a professional society with substantial industry funding, conflicts of interest for chairs and panel members”. He further noted the problems of “…stacking of the panels with specialists who have overt preferences (even without overt conflicts)…” Additionally, he found many medical/surgical societies increasingly relied on industry to support their ever-increasing budgets. For example, “…the annual American Heart Association budget in the fiscal year 2016-2017 was $912 million, 20% of which came from corporate support”. Notably, “…77% of the 60 million Euro annual income of the European Society of Cardiology comes from industry”. Further, Ioannidis observed that it is difficult to avoid self-interest as “…securing objectivity is difficult when industry-manufactured interventions also procure much of the specialty income. Would a society advise its members to change jobs, if evidence proved their medical services a waste?”


Professional Medical/Surgical Associations should take all necessary measures to ensure they have no conflicts of interest and no ties to industry that unduly impact their actions/decision making processes.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management.


1. Ioannidis JP. Evidence-Based medicine has been hijacked: a report to David Sackett. J Clin Epidemiol. 2016. 73: 82-86

2. Ioannidis JPA.editors. Cardiovascular Perspective: Professional Societies Should Abstain Form Authorship of Guidelines and Disease Definition Statements. Circulation: Cardiovascular Quality and Outcomes. 2018. 11: e004889-

3. Robertson JH. Neurosurgery and Industry. J Neurosurg. 2008. 109: 979-88

4. Rothman DJ, McDonald WJ, Berkowitz CD, Chimonas SC, DeAngelis CD, Hale RW. Professional medical associations and their relationships with industry; a proposal for controlling conflict of interest. JAMA. 2009. 301: 1367-1372

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