• A terrific piece bringing some much-needed perspective to discussions about mental illness, especially in the wake of recent murders. By Dr Tanya Ahmed, a registrar in psychiatry and a principal of the health and communications consultancy RaggAhmed.

• More than a million premature deaths across 30 OECD countries could be prevented each year if income inequality was reduced. That’s the best guess of a meta-analysis of studies involving around 60 million people, reported in the BMJ. The authors note that there are many caveats to their findings, including a lack of evidence from developing countries, but say their results have “potentially important policy implications for population health”. Meanwhile, I’m heartened to read that a fellow Crikey blogger is also putting inequality on the public agenda.

• When the law meets public health – Simon Chapman, professor of public health at the University of Sydney, considers the implications of a recent High Court judgment. It dismissed a duty of care negligence claim against a Tasmanian hotel owner who handed back motorcycle keys lodged for safe-keeping to an insistent, belligerent patron who on leaving the pub was killed in a crash while showing a blood alcohol level of 0.253.

• Investigating the ties between drug companies and doctors – A group of researchers from Australia, Canada and the US have done an indepth analysis of disclosures of pharmaceutical sponsorship of gifts and educational events, as has been required of Medicines Australia members since 2007. They conclude that the disclosure does not go far enough and also give some interesting examples of how companies are wooing doctors. Novartis, for example paid flights, accommodation, food, beverages, and conference registration fees for six ophthalmologists to attend a two-day conference in Spain, at a cost of AUD$10,993 per person. For those who follow this field, it will come as no surprise that the researchers include Ray Moynihan, Lisa Bero and David Henry. The other authors are Jane Robertson and Emily Walkom from the University of Newcastle.

Of course, it’s not only Croakey who follows such matters – conflict of interest has been one of the big and important ongoing stories of health and medical research, practice and policy for some years now. Much more detail is available from the Institute of Medicine in the US which has recently published a landmark report addressing these issues.

But Croakey has been living in something of a glass-house. We haven’t had a formal policy to help readers assess the conflicts of our contributors and also of the Coakey moderator (that’s me, Melissa Sweet).

So if you’ve time to have a quick read of the draft Croakey Conflict of Interest Policy below, your feedback would be appreciated. Much of the material has been adapted from the World Association of Medical Editors (WAME) statement on this topic.

Draft Croakey Conflict of Interest policy

Why do conflicts of interest matter?

The World Association of Medical Editors notes that everyone has conflicts of interest of some sort, and that this does not, in itself, imply wrongdoing. But if these are not managed effectively, they can cause authors and editors to make decisions that, consciously or unconsciously, tend to serve their competing interests.

What are conflicts of interests?

The World Association of Medical Editors notes that there are many kinds of competing interests.

These include:

• Financial ties

Examples of financial ties to industry include payment for research, ownership of stock and stock options, as well as honoraria for advice or public speaking, consultation, service on advisory boards or medical education companies, and receipt of patents or patents pending.  Also included are having a research or clinical position that is funded by companies that sell drugs or devices. Competing interests can be associated with other sources of research funding including government agencies, charities (not-for-profit organizations), and professional and civic organizations.  Clinicians have a financial competing interest if they are paid for clinical services related to their research —for example, if they write, review, or edit an article about the comparative advantage of a procedure that they themselves provide for income. Financial competing interests may exist not just on the basis of past activities but also on the expectation of future rewards, such as a pending grant or patent application.

• Academic commitments

Participants in the publications process may have strong beliefs (“intellectual passion”) that commit them to a particular explanation, method, or idea.  They may, as a result, be biased in conducting research that tests the commitment or in reviewing the work of others that is in favor or at odds with their beliefs.

• Personal relationships

Personal relationships with family, friends, enemies, competitors, or colleagues can pose COIs.  For example, a reviewer may have difficulty providing an unbiased review of articles by investigators who have been working colleagues.

• Political or religious beliefs

Strong commitment to a particular political view (eg, political position, agenda, or party) or having a strong religious conviction may pose a COI for a given publication if those political or religious issues are affirmed or challenged in the publication.

• Institutional affiliations

A COI exists when a participant in the publication process is directly affiliated with an institution that on the face of it may have a position or an interest in a publication.  An obvious concern is being affiliated with or employed by a company that manufactures the drug or device (or a competing one) described in the publication.  However, apparently neutral institutions such as universities, hospitals, and research institutes may also have an interest in the results of research. Professional or civic organisations may also have competing interests because of their special interests or advocacy positions.

How does Croakey manage conflicts of interests?

• Contributors to Croakey are expected to declare any potential conflicts of interests at the bottom of their posts. Ideally, these should also be declared on comments but we acknowledge that this is difficult to enforce, given that many comments are anonymous.

• If you are not sure whether to declare something, please ask. You may wish to consider the World Medical Association of Editors prompt that, “if my competing interest becomes known to others later, would I feel defensive or would others in the publication process, readers or the public think I was hiding my other interests or could they feel I misled or deceived them?”

• If Croakey subsequently discovers that relevant conflicts of interest have not been declared, they shall be published at a later stage.

The Croakey moderator Melissa Sweet has many conflicts of interests, including:
• contributor to Australian Rural Doctor and Pharmacy News(Reed Business), Australian Nursing Journal, British Medical Journal, The Worker (published by ACP for The Worker magazine), Inside Story (Swinburne University), and the Medical Journal of Australia. She has had books published by Pan MacMillan, Allen & Unwin, and ABC Books. She is occasionally asked to review articles for the Medical Journal of Australia and the Australian and New Zealand Journal of Public Health. She is a founding member of the Foundation for Public Interest Journalism, based at the Institute for Social Research at Swinburne University.
• she has honorary appointments with the University of Sydney School of Public Health and the University of Notre Dame’s medical school (Sydney campus). She is not paid for these appointments but the networks and information she obtains through these appointments do have an influence upon her thinking and work.
• she does occasional paid work for not-for-profit organisations, writing and editing reports. Clients have included the Canadian Health Services Research Foundation, the Milbank Memorial Fund in the US, the Sax Institute, the NHMRC, Research Australia, VicHealth, and the Centre for Primary Health Care and Equity at the University of NSW.
• she is a member of the Media, Entertainment and Arts Alliance, and the Australasian Medical Writers Association, and has an ongoing association with the Dart Centre for Journalism and Trauma. More details about her affiliations and associations are available here.

In Crikey today, a leading US consumer advocate as well as an international expert on influenza vaccines from the Cochrane Collaboration raise several questions for Australian health authorities, while former Federal Health Minister Dr Michael Wooldridge argues strongly in support of the vaccination program.

Meanwhile, a regular Croakey contributor, Dr Trevor Kerr, has been watching the media coverage of the campaign, and believes it’s been too uncritical.

He writes:

“Geoffrey Barker’s essay for the latest Griffith REVIEW on the death of Australian journalism (’The crumbling estate’) concludes:

Free, independent, muck-raking journalism is more important than ever in a world dominated by political, bureaucratic and corporate authoritarians supported by armies of flim-flam communications advisers whose mission is to conceal and mislead, and who are delighted to see readers distracted with a fast-food diet of sex, sport and celebrity scandal.

On page three, Barker reflected on an episode of intensive marketing for a pharmaceutical product. “Recent disclosures about the intrusive role of PR flacks in a court case over the withdrawn anti-arthritis drug Vioxx offers alarming evidence of how far they are prepared to go to intimidate reporters. It is hardly surprising that young journalists are tempted to get among the big bucks rather than to struggle thanklessly to develop independent reportage, for it is easier and more congenial to be a massager of messages than a raker of muck.”

We could see reasons for Barker’s denunciations in the item for last night’s (Sept 29th) 7.30 Report on the H1N1 influenza vaccine. The academy (University of Melbourne’s Terry Nolan), government (Health Minister Nicola Roxon) and commerce (CSL’s Rachel David) were lined up to refute rational objections to the vaccination policy (Canberra Hospital’s Peter Collignon). Nolan even trotted out the coup de grace “We could wait and we could allow people to die”.

It would be helpful in this debate if interviewers asked medical experts and researchers to declare their conflicts of interests and associations with pharmaceutical companies. That tactic, however, despite seeming to be in the wider public interest, does not always meet with approval.

Peter Sandman, risk analyst, in his latest update on H1N1 vaccination, comments “Worst case: The seasonal vaccine turns out not only unnecessary this year, or not only ineffective against the most virulent seasonal flu strain – but actually dangerous, by increasing vaccinees’ susceptibility to pandemic H1N1. This could cause a fiasco (like the 1976 swine flu vaccination campaign) that shadows all influenza vaccination for a generation or more. And, most important, it could kill people.”

Well, at least the New York Times is willing to publish divergent views. In the context of Nicola Roxon urging pregnant women to be among the first to be vaccinated against H1N1, NYT ran ‘Don’t Blame Flu Shots for All Ills, Officials Say’ and ‘Pregnancy Is No Time to Refuse a Flu Shot’ in the last few days. There’s more to be said about this unseemly rush to expose the unborn to the unproven.

There are reports today (eg, NPR) that CDC will be reporting in its Morbidity and Mortality Weekly Report that significant numbers of people dying after H1N1 infection had pneumococcal pneumonia.

Will this provide fuel for another roll-out campaign to be spearheaded by Nicola, Terry and Rachel? If so, CSL shareholders will be most pleased.

Finally, the proponents for universal vaccination could help themselves by watching the file shots used in last night’s 7.30 Report. For about the fourth occasion on the H1N1 vaccine, the ABC has used video of that vaccinator with appalling long, false fingernails.

That is clearly not world’s best practice and at a time when prudent and careful context ought to be tempering the haste.”

Trevor Kerr is a retired medical microbiologist, now working part-time for a community health service

Healthy Skepticism is hosting the panel discussion, at the Women and Children’s Hospital, to examine questions such as:

• Do partnerships with industry (as set out in Australia’s National Medicines Policy) bring about better health  outcomes?

• What are the strengths and deficiencies of our current system of regulation?

• Do the Therapeutic Goods Administration and state regulatory authorities have the political support and resources necessary to maintain objectivity?

• Is public access to regulatory processes and decisions sufficient to properly evaluate the operation of the policy?

The panellists will be:

• Hon Mark Butler MP, Parliamentary Secretary for Health
• Emeritus Prof Lloyd Sansom, AO, Chair, Pharmaceutical Benefits Advisory Committee
• Assoc/Prof Chris Doecke, Director of Pharmacy Services, Royal Adelaide Hospital
• Emeritus Prof Peter McDonald, AM, retired Infectious Diseases physician
• Dr Agnes Vitry, Senior Research Fellow, School of Pharmacy and Medical Sciences, Uni SA
• Dr Ken Harvey, Senior Research Fellow, School of Public Health, La Trobe University
• Dr Jon Jureidini, Head, Department of Psychological Medicine, Women’s & Children’s Hospital, and Chair, Healthy Skepticism
• Dr Peter Mansfield, OAM, GP and Director, Healthy Skepticism

The session will be facilitated by Prof Anne Tonkin Director, Medicine Learning & Teaching Unit, Adelaide University.

And here is the statement announcing the forum:

Healthy Skepticism, the international campaign against misleading health marketing, today called for a major review of government controls of medicines in Australia.

“Vioxx killed more Australians than the Victorian bushfires. Just as we re-think bushfire preparedness, it’s time we re-examined how well the public is protected by pharmaceutical regulation,” said Dr Peter Mansfield, the organisation’s director.

Australian regulatory processes failed to prevent the Vioxx disaster a few years ago because of failure on several fronts: “Drug regulators did not warn prescribers appropriately about potential cardiovascular risks. The Pharmaceutical Benefits Scheme did not limit unjustified drug expenditures. … Drug companies ran intense and misleading promotional campaigns. … Independent drug information was insufficient to counter the effects of the millions of dollars spent on advertising.”1

Dr Agnes Vitry (School of Pharmacy and Medical Sciences, University of South Australia) says that although Australia has a strong National Medicines Policy compared to most other countries, there are concerns that Australian regulators’ dependence on fees paid by drug companies might create a situation where they are more focused on serving the industry rather than prioritising the interests of public health e.g. by fast-tracking assessments without appropriate data to assess safety issues. The medicines agency requires more power and resources to ensure that safety is actively monitored after drugs are approved.

There are also concerns about Australia’s reliance on industry “self-regulation” to control the advertising and promotion of medicines. As Dr Ken Harvey (School of Public Health, La Trobe University) says, “The focus on self-regulation has produced a plethora of industry codes and complaint systems which makes it difficult for complainants to know where to send a complaint. There are gross inconsistencies between various codes.”

Healthy Skepticism would like to see much more streamlined and effective system, capable of meaningful constraint of companies like Pfizer, whose inappropriate marketing recently prompted US courts to order payment of $2.3 billion.

By contrast, as Harvey says, “Pfizer Australia has had 17 complaints against Medicines Australia (MA) Code of Conduct upheld during 2005-09. Although one of these complaints received the maximum fine of $200,000, over this time the fines only averaged $50,000. There is no evidence that such modest fines have reduced Code violations by Pfizer or other member companies. “

1. Vitry A, Lexchin J, Mansfield PR. Is Australia’s national medicines policy failing? The case of COX-2 inhibitors.  Int J Health Serv. 2007;37:735-44.

More details are available here.

Instead, he seems to have added fuel to the fire – at least, according to Dr Ken Harvey, who argues that the Government and TGA are making things all too cosy for the industry, at the expense of the public interest.

Harvey writes:

“Australian Medicines Policy is meant to be based on partnership with all the players, including consumers and health professionals. It is not meant to be a bilateral relationship between the Therapeutic Goods Administration and industry.

Yet, once again (see Mark Butler’s press release):

“The TGA is meeting with all the therapeutic industry associations next week to discuss their respective codes and consider potential strategies for a way forward.”

and Mr Butler said:

“I look forward to receiving advice on industry agreed options for working together to strengthen codes of conduct, provide a level playing field, and ensure that self-regulation retains public and Government confidence.”

In my opinion, these bilateral consultations between the TGA and industry are not in accord with the spirit of Australian Medicines Policy and the debate on ethical promotion must be opened up to include health professional and consumer groups as well.

Self-regulation is ultimately self-serving and these matters should not be left solely to the pharmaceutical industry.

If you agree, I suggest you communicate your concern to Mark Butler (as I have done).”

• Dr Ken Harvey is Adjunct Senior Research Fellow, School of Public Health, La Trobe University

“Ophthalmologists again are demonstrating what most people involved in health policy have known for decades: no Health Minister should ever dare stand between a medical specialist and their hard-earned Medicare entitlement.

What is particularly disappointing about the latest campaign from ophthalmologists (here and here) is the way they are using marginalised health consumers as cannon fodder in a public campaign to maintain their substantial tax payer-funded incomes.

The ophthalmologist’s story last night on the 7.30 Report adopted the following script: Take a struggling, older truck driver with limited employment options and limited income. Tell him he is going blind. Tell him the government has cut the rebate for the eye surgery he needs so now it will cost him hundreds of dollars to save his sight. He doesn’t have a spare few hundred dollars. Watch him struggle to hold back tears, this salt-of-the-earth Aussie battler now facing blindness because of the callous and ignorant actions of this government. But all is not lost. An ophthalmologist mounts the white horse of compassion and offers to do the operation for free! Wow, these ophthalmologists are wonderful people, and this government doesn’t seem to understand or care if some older people to go blind!

In my view, exploiting a vulnerable health consumer is unethical behaviour for a professional group campaigning to maintain their high incomes.

Perhaps just as annoying is the lack of factual information about this campaign. No one mentions that the ophthalmologist who performs the miracle cataract surgery will receive a minimum $300 rebate and that the operation will take less than 30 minutes.

And that is not all that goes unsaid.

Make no mistake; this is a campaign about the level of tax-payer contributions to the income of ophthalmologists. It is only reasonable then that their incomes be on the table as part of the discussion. Like most people in the health sector, I want to know why ophthalmologists cannot afford to charge only the new scheduled fee of $300 for cataract surgery? Why do they have to charge above this fee? Is their economic viability now under threat? Does this mean their average income would drop below the level of our PM? Each time an ophthalmologist talks publicly in this campaign, I would like them to be honest about their income, from Medicare and private fees.

As I understand it, the top 10% of ophthalmologists make well over $1 million a year in Medicare rebates alone, more than twice the income of our Prime Minister. Even these high rebates have not prevented ophthalmologists charging substantial gap fees to health consumers, making their services less accessible while increasing their income.

One of the real barriers to health reform is skyrocketing Medicare payments. No government can afford to let costs continue to spiral upwards without seeking to impose some limitation on the amount paid for each procedure. There are very real inequities in the incomes that medical specialists with similar levels of training derive from Medicare for their work.

Governments need to be supported in imposing some measure of work value on Medicare, despite the self-interested campaigns from groups such as pathology companies, obstetricians and ophthalmologists.

Perhaps, more importantly, the media and others need to acknowledge that many of these campaigns against Medicare reform represent exploitative, self-interested attempts to maintain a very substantial tax-payer supported income.”

The 1000 plus pages of the House of Representatives tri-committee health care reform bill (available here) contains an extraordinary number and range of provisions, written in incredibly detailed legislative language.

One provision that has been lost in the debate around costs and financing is one headed “Physician Payments Sunshine Provision”.

This requires manufacturers or distributors of medicines, medical devices, biologicals and medical supplies which are covered by Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) to make an annual electronic report to the Department of Health and Human Services about any payment, services or items above $5 in value made to doctors and health care professionals, hospitals and other entities that receive Medicare funding.

These requirements apply to just about everything that could conceivably be provided to a doctor or a health care service, including drug samples and medicines and devices used in clinical trials and studies.  There are penalties of up to $150,000 a year for non-compliance.

The reporting, to be implemented by March 2011, is quite detailed:

• The recipient’s name, business address, physician specialty, and national provider identifier
• A description of the payment, item or service, its value and the date it was delivered;
• The name, number, date, and dosage units of any drug samples.

This provision also requires a report to the Secretary of any ownership shares held by a physician in a hospital or other health service.  Elsewhere in the bill there are provisions that limit doctors’ ability to refer patients to hospitals in which they have a direct financial interest.

All this information, with the exception of that about drug samples, but including any enforcement actions taken, is to be made publicly available on a Departmental website that is searchable and in a format that is clear and understandable.

It’s interesting to speculate how such a requirement would be viewed in Australia.

And it’s worthwhile noting that here in the US, the pharmaceutical industry is showing their support for this bill by providing $100 million in advertising, and the American Medical Association has publicly stated their support for the bill in a letter to the Chairmen of the relevant House Committees.

• Dr Lesley Russell is the Menzies Foundation Fellow at the Menzies Centre for Health Policy.  She is currently a Visiting Fellow at the Center for American Policy in Washington DC.

“The Croakey posting on Conflict of Interest points to both the diversity of views and the complex nature of this issue and Baker IDI welcomes a healthy and well informed debate by way of contributing to industry best practice in this area.

Baker IDI takes its ethical commitments very seriously. We are fully compliant with The Australian Code for the Responsible Conduct of Research and, of course all our research is approved by independent ethics committees.

Much of our work is at the forefront of medical research, and is affected by constantly changing scientific and communication technologies. Codes of conduct can not stand still. They should constantly evolve to respond to the changing needs of society and the challenge of innovation -  an opportunity we should not shy away from.

In the instance of our collaboration with Astra Zeneca, it is worth noting that the particular contract governing the Total Cholesterol Study, was the result of an agreement entered into more than four years ago. The study was independently designed and conducted by Baker IDI and was compliant with the Medicines Australia Code of Conduct for clinical trials with full transparency around the funding body. The content of the publication was entirely educational and no products were mentioned.

The Institute is constantly reviewing its policies and procedures to reflect the changing environment within which we operate. As a result, we have changed our organisational policy on staff involvement in industry-sponsored advertorials.

We are fully supportive of the establishment of a conflict of interest committee as well as national guidelines in this area.  Moreover, we welcome the NHMRC’s consideration that researchers publicly declare conflicts of interest online.

Our recommendation is that the most effective forum for declaring conflicts of interest is a national, non-partisan registry that takes account of the full spectrum of activity rather than the specific contracts of a single organisation in isolation.

The challenges outlined are shared by the medical research community at large and deserve industry-wide attention to ensure effective design and implementation of reflective national guidelines. We embrace the opportunity to contribute to this important process.”

No word yet from the Baker, but Professor Warwick Anderson, ceo of the NHMRC, sent this comment:

“The Australian Code for the Responsible Conduct of Research (issued jointly by NHMRC, the Australian Research Council and Universities Australia) applies to all institutions receiving NHMRC funding, and includes a chapter on conflict of interest, aimed at all disciplines (not just health research).

As far as relationships between clinical researchers and the biotech and pharmaceutical industries are concerned, NHMRC Council’s advice will be sought in September on the ideas that arose at the NHMRC workshop on conflicts of interest, held in June. This will include advice on the need for national principles to help guide ethical relationships between clinical researchers and private sector organisations, such as biotech and pharmaceutical companies.”

For those interested in knowing more about the NHMRC workshop, held in Canberra last month, here is a short report I filed for the British Medical Journal about it.

Australian researchers, universities and other research institutions are likely to face new measures aimed at ensuring conflicts of interest are managed more effectively.

The National Health and Medical Research Council (NHMRC) will consider recommendations that it require researchers to publicly declare conflicts of interest on university and other institutional websites.

The Council has also been asked to consider establishing its own conflict of interest committee to provide advice internally and to act as a reference for other bodies, and to require research institutions to establish similar committees.

The suggestions were made by senior researchers and NHMRC members attending a “transparency and conflict of interest” workshop convened by the Council in Canberra on June 3.

“The ideas that came up are all worth consideration and we will take those ideas to our Council over the next six months, “ the NHMRC CEO Professor Warwick Anderson told the BMJ after the workshop.

The Council is also developing new standards for management of competing interests in clinical practice guideline development, and has evidence these are poorly managed at present.

A broad-ranging survey of clinical practice guidelines, involving 313 produced in Australia between 2003 and 2007, found 79 per cent did not mention whether the authors had competing interests.

None of those declaring conflicts gave information about how these were managed or the dollar-value of the financial relationship.

Dr Heather Buchan, an NHMRC advisor who conducted the survey, said a US study had found most guideline authors had competing interests, and that the new standard was likely to require documentation of how conflicts were declared and managed.

Professor James Best, chair of the NHMRC research committee, said many of the arrangements binding researchers and industry – such as industry-funded trials, education, advisory boards and guidelines – were marketing tools.

“Today’s meeting is an example of NHMRC’s commitment to good practice in this area,” he said.

Professor Bruce Neal, a Senior Director at The George Institute for International Health, which receives significant industry funding, said the issue was bigger than simply researchers’ previous conflicts of interest.

Researchers’ chances of obtaining future industry funding could be influenced by how they reported the results of their independent, investigator-driven research, he said.

Professor John Hopper, of the University of Melbourne, said measures to address conflicts also needed to consider issues such as professional patch protection by authors and reviewers.

An independent nutritionist, Dr Rosemary Stanton, said effective management of conflicts of interest was essential for food and nutrition research and guidelines as this was an area rife with conflicts.

Dr Agnes Vitry, a Senior Research Fellow from the University of SA and a member of Healthy Skepticism, said she was concerned the NHMRC had not committed to implementing the recent Institute of Medicine’s report on conflicts of interest. “Compared to the relevant IOM proposals for institutions such as NHMRC, we are far behind,” she said.

The workshop follows recent controversies in Australia over commercially-funded clinical practice guidelines for venous thromboembolism prevention, and a sponsorship deal between Sanofi-Aventis and the Baker IDI Heart and Diabetes Institute which was in breach of the Medicines Australia code of conduct.

On the issue of health and medical writers, herewith two recent snippets that may be of interest, both from emails recently sent to members of the Australasian Medical Writers Association.

• The Nucleus Group, which includes the medical communications agencies MediTech Media and Health Interactions, and the medical publisher International Medical Press, recently advertised that it is seeking a medical writer. Among the competencies sought is an “ability to interpret scientific information according to the commercial requirements”. That could, perhaps, be read a number of ways but it did ring some immediate alarm bells for me.

• AMWA members also received a note encouraging us to apply for the Luminous Award Australia 2009 which recognises “Enlightened, Intelligent and Inspiring Cancer Reporting”.

The note said: “The Luminous Award Australia recognises outstanding journalism in the field of oncology. Hosted by the Clinical Oncological Society of Australia (COSA), the Luminous Award Australia honours journalists who serve their readers/viewers by providing responsible, accurate and timely information on advances in cancer prevention, research, treatment and patient support.

The Luminous Award Australia offers a cash prize of AU$5,000 in each of two categories – print and broadcast. The Luminous Award Australia is judged by an independent panel who is represented (sic) by the following organisations:

•    Asbestos Diseases Foundation of Australia
•    Australian Medical Writers Association
•    Brain Foundation
•    Cancer Council Australia
•    Cancer Voices Australia
•    Clinical Oncological Society of Australia
•    Leukaemia Foundation Australia
•    National Breast and Ovarian Cancer Centre
•    National Breast Cancer Foundation
•    Prostate Cancer Foundation of Australia
•    The Australian Lung Foundation.”

It is only when you go to the COSA website that you discover the award is funded by Eli Lilly.

I’ve been banging on for years about the dilemmas of sponsored journalism awards (examples are here and here), but still they proliferate and still journalists apply for them. I don’t suppose there will be any shortage of applicants for the National Press Club’s health journalism awards (sponsored by Medicines Australia).