Pharmaceutical company payments to medical school deans and university hospital directors in Japan: a nationwide cross-sectional study

Background Financial relationships between pharmaceutical companies and the leaders of academic medical institutions may generate institutional conflicts of interest, yet payments to medical school deans and university hospital directors have not been examined nationally. We assessed the magnitude, concentration, and specialty pattern of pharmaceutical company payments to the leaders of all Japanese academic medical centres. Methods In this nationwide cross-sectional study, we identified the deans and main-hospital directors of all 82 universities with a medical school in Japan for fiscal year 2023 (82 deans and 84 directors). Using payment disclosures from companies affiliated with the Japan Pharmaceutical Manufacturers Association, we aggregated personal payments (lecture, manuscript, and consulting fees) to each leader and described their amount, concentration, and distribution by specialty and payment category. Results Overall, 67 of 82 deans (81.7%) and 77 of 84 hospital directors (91.7%) received payments. Total payments were US$901,128 for deans (median US$4,894) and US$1,843,565 for directors (median US$14,031). Payments were highly concentrated: the top decile of recipients accounted for 43.9% (deans) and 36.4% (directors) of the total, and lecture fees comprised 85.2% and 88.5% of payments, respectively. The highest-paid specialties were orthopaedic surgery, urology, and pharmacology among deans, and respiratory medicine, urology, and haematology among directors. Conclusion Pharmaceutical payments to the leaders of Japanese academic medical centres were common, substantial, and concentrated among a small number of individuals and specialties, supporting the case for prohibiting personal promotional payments to institutional leaders while they hold office, with public disclosure as a minimum floor rather than an endpoint.