What Your Doctor Isn’t Telling You on Twitter

Cancer doctors with Twitter accounts have something else in common: more than 70% of them receive funding from drug companies, according to a new research letter published in JAMA Internal Medicine.

In the study, researchers identified 634 hematologist-oncologists who were active on Twitter and looked up whether they received personal payments from drug companies, unrelated to research or grants, in 2014. Most of them did: 72% received payments from drug companies and 44% were paid more than a thousand dollars. Payments received by the doctors in the study ranged from $100 to more than $50,000 in a single year.

The topic has fascinated study author Dr. Vinay Prasad, an assistant professor of medicine at the Oregon Health and Science University, ever since he noticed that cancer doctors were tweeting about drugs and clinical trials. He and his team didn’t analyze the content of the tweets in this study, so they can’t show whether the doctors were tweeting about drugs from those companies—and whether the doctors’ conflicts of interest influence what they share on social media.

However, Prasad says his team is currently answering that question in a second study, and while the research is still ongoing, Prasad says the practice is prevalent. “It is 100% happening that doctors who have conflicts of interest are tweeting about those specific drugs,” he says.

Regulatory agencies have struggled to come up with rules on promoting prescription drugs through social media. In 2014, the U.S. Food and Drug Administration (FDA) introduced voluntary guidelines for companies on how to present the risks and benefits of a given product online, even with character restrictions. Among them are suggestions to post messages about risks with a hyperlink that can direct people to a more detailed listing of side effects. Currently there is no official guidance for doctors on social media.

The study authors say that their findings raise the important issue of whether, and how, a doctor’s conflict of interest should be disclosed on social media like Twitter. Prasad says he thinks doctors should disclose their conflicts in their social media bios and consider flagging them when tweeting about drugs or clinical trials by companies they are paid by.

“Although there are cancer drugs with tremendous benefits, most cancer drugs have marginal benefits and real risk and harms,” says Prasad. “People deciding what treatment is right for them are in a tough situation. If part of what’s shaping your view of these drugs is the opinion of thought leaders on Twitter, then I think you have the right to know if they are paid by drug companies.”