Tip of the Iceberg? Country- and company-level analysis of drug company payments for research and development in Europe

Piotr Ozieranski, Luc Martinon, Pierre-Alain Jachiet, Shai Mulinari

Research output: Contribution to journalArticlepeer-review

6 Citations (SciVal)


Background: Creating new therapies often involves drug companies paying healthcare professionals and institutions for research and development (R&D) activities, including clinical trials. However, industry sponsorship can create conflicts of interest (COIs). We analysed approaches to drug company R&D payment disclosure in European countries and the distribution of R&D payments at the country and company level.

Methods: Using documentary sources and a stakeholder survey we identified country- regulatory approaches to R&D payment disclosure. We reviewed company-level descriptions of disclosure practices in the United Kingdom, a country with a major role in Europe's R&D. We obtained country-level R&D payment data from industry trade groups and public authorities and company-level data from eurosfordocs.eu, a publicly available payments database. We conducted content analysis and descriptive statistical analysis.

Results: In 32 of 37 studied countries, all R&D payments were reported without named recipients, following a self-regulatory approach developed by the industry. The methodological descriptions from 125 companies operating in the United Kingdom suggest that within the self-regulatory approach companies had much leeway in deciding what activities and payments were considered as R&D. In five countries, legislation mandated the disclosure of R&D payment recipients, but only in two were payments practically identifiable and analysable. In 17 countries with available data, R&D constituted 19%-82% of all payments reported, with self-regulation associated with higher shares. Available company-level data from three countries with self-regulation suggests that R&D payments were concentrated by big funders, and some companies reported all, or nearly all, payments as R&D.

Conclusion: The lack of full disclosure of R&D payments in countries with industry self-regulation leaves considerable sums of money unaccounted for and potentially many COIs undetected. Disclosure mandated by legislation exists in few countries and rarely enhances transparency practically. We recommend a unified European approach to R&D payment disclosure, including clear definitions and a centralised database.

Original languageEnglish
Pages (from-to)2842-2859
Number of pages18
JournalInternational Journal of Health Policy and Management
Issue number12
Early online date15 Mar 2022
Publication statusPublished - 31 Dec 2022

Bibliographical note

Funding Information:
This work (SM as Principal Investigator and PO as Co-Investigator) was supported by the grant ‘Following the money: cross-national study of pharmaceutical industry payments to medical associations and patient organisations,’ awarded by The Swedish Research Council (VR), no. 2020-01822.

Funding Information:
PO’s PhD student was supported by a grant from Sigma Pharmaceuticals, a UK pharmacy wholesaler and distributor (not a pharmaceutical company). The PhD work funded by Sigma Pharmaceuticals is unrelated to the subject of this paper. LM and PAJ are members of Euros for Docs, a non-profit organization registered in France that seeks to promote transparency of drug company funding in the healthcare sector by making payment data accessible and complete across Europe. PAJ is employed by Haute Autorité de Santé, the French independent health technology assessment organisation. SM’s partner is employed by PRA Health Sciences, a global Contract Research Organization whose costumers include many pharmaceutical companies.


  • Conflict of Interest
  • Financialization
  • Payments
  • Pharmaceutical Industry
  • Research and Development
  • Transparency

ASJC Scopus subject areas

  • Leadership and Management
  • Health(social science)
  • Health Policy
  • Management, Monitoring, Policy and Law
  • Health Information Management


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