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By Michael Schulson
The American Academy of Pediatrics (AAP), with some 67,000 members, is the most influential pediatrics organization in the U.S., if not the world.
Among other roles, the AAP issues official recommendations — on everything from COVID-19 vaccines to infant sleep — that shape the way American children are cared for at home and at the doctor’s office.
Recently, new immunization recommendations from the AAP came under fire from U.S. Health Secretary Robert F. Kennedy Jr., who argued in an Aug. 19 post on X that AAP “should disclose conflicts of interest” in order to allow Americans to “ask whether the AAP’s recommendations reflect public health interest, or are, perhaps, just a pay-to-play scheme to promote commercial ambitions of AAP’s Big Pharma benefactors.”
Kennedy, who founded an organization that questions the safety of common vaccines and has participated in lawsuits against vaccine manufacturers, may carry his own conflicts of interest. And funding or consulting relationships between physicians and pharmaceutical companies are not unusual.
But Kennedy’s comments, even if ideologically motivated, do echo broader concerns about the influence that corporate funding might have at many U.S. medical societies, including the AAP — and about why the flagship pediatrics organization does not do more to disclose potential conflicts of interest in its guidelines and other official recommendations and endorsements.
In some cases, those published recommendations suggest that the authors have no potential pharma conflicts worth noting, even when authors have received consulting fees or research funding from companies that have a vested interest in the outcome.
Undark found, for example, that one author of 2018 AAP-endorsed guidelines on adolescent depression treatment has consulted for the makers of the antidepressants Zoloft and Lexapro — a detail that was disclosed in other papers he wrote around that time, but that goes unmentioned in the guidelines.
On a controversial 2023 guideline that opens the door to prescribing some younger children weight-loss drugs (alongside lifestyle changes and other treatment), a recent academic analysis found that several authors have financial relationships with the companies that make those medications. Those relationships, though, are not disclosed in the guideline.
Similarly, a draft policy statement published in August, recommending that many babies and some older children receive the latest COVID-19 shots, indicated that the authors had no potential conflicts of interest to disclose.
Public records, however, show that at least nine of the 16 members of the committee responsible for those and other immunization recommendations have received payments, research funding or perks in the form of meals, travel or lodging from vaccine manufacturers. Of those, five have financial ties to companies that market COVID-19 vaccines in the U.S.
Shortly after Undark sent questions about those potential conflicts of interest to the AAP, the public draft was updated to note that two committee members with financial relationships to COVID-19 manufacturers had not participated in developing the recommendations.
“Other disclosures of committee members were reviewed and determined not relevant to the work related to the statement,” the draft now adds.
In all of these cases, these financial ties may have had no bearing on the guidelines or policies, and those working to write them are likely to have disclosed potential conflicts of interest to the AAP as part of the vetting process. But the lack of transparency and disclosure from AAP, some experts said, departs from best practices.
The AAP’s closed deliberations also make it difficult to know the precise nature of consulting relationships between researchers and drugmakers — including whether the work involved a medication that might be indirectly supported by an AAP policy statement, or some unrelated matter.
In a statement forwarded by Susan Martin, the AAP’s vice president of public affairs, the organization insisted that its vetting process was rigorous.
The AAP routinely seeks out “additional information about the scope and purpose of any work that an author is doing with a company,” the emailed statement reads.
“For an individual with research funding, for example, that would include details about any specific product that is being investigated.”
If the AAP identifies a potential relevant conflict, the organization said, that would preclude the researcher from serving as a lead author on an AAP policy statement related to that product — “in most cases.”
Experts whose relationship with a company is focused on a different or unrelated product, the organization added, “may still be able to contribute.”
Authors of guidelines and other recommendations, the organization also told Undark, are subject to a policy that “includes annual disclosures, reporting of new conflicts, and a rigorous review process.”
Still, the precise nature and rigor of that review process, including how the organization adjudicated any particular case of potential conflict, typically remains opaque to the public. And none of the reviewed recommendations disclose that the AAP itself accepts donations from corporate sponsors.
On its website, the organization does publicize those partnerships, describing an annual “Corporate Summit” at its Illinois headquarters for donors of $50,000 or more — a status enjoyed by pharmaceutical companies Pfizer, Merck, Moderna and Sanofi, as well as Mead Johnson Nutrition and Abbott, two leading producers of infant formula.
Content for parents is branded, too: A 2020 webinar on sleep was sponsored by a company that makes melatonin supplements. A May 2024 newsletter about screen time lists the telecommunications company AT&T among its sponsors.
Whether these different kinds of financial relationships have any bearing on AAP’s policies is difficult to determine.
The organization told Undark that only around 4% of its revenue between July 2024 and June 2025 came from corporate funding, adding that “All external support is transparently reported, aligned with our mission and governed by strict engagement protocols.” That funding is not used for policy development, the statement said.
But several experts in conflict of interest and disclosure questioned why the AAP would not always disclose such financial relationships in its guidelines — or do more to separate itself from such corporate ties in the first place.
“The process here clearly is not in line with international gold standards for producing trustworthy guidelines,” said Quinn Grundy, a researcher at the University of Toronto who studies industry influences on health systems, after reviewing details of the AAP guidelines covering weight-loss medications.
But, she added, the organization was not an outlier: “The American Academy of Pediatrics, the members of its leadership, these guideline members, are also behaving in a way that is completely normal and acceptable within medical professional societies and the medical profession.”
In a statement to Undark, the CEO of AAP, Mark Del Monte, praised his organization’s approach.
“AAP is deeply committed to producing child health recommendations that clinicians and families can confidently rely on,” he wrote.
“AAP recommendations are scientifically sound, clinically relevant, and free from undue influence. Our goal is to serve pediatricians and the public with integrity and transparency.”
Often, pharmaceutical funding directed at doctors is used for research: A drug company, for example, might underwrite a physician’s study that involves a particular medication. An academic medical center may conduct clinical trials that are critical for bringing a lifesaving drug to market.
Other forms of payment are more nebulous: Pharmaceutical representatives may take physicians out for dinners, pay for travel and lodging or offer them speaking and consulting fees. To some, these are routine interactions that do not necessarily compromise the independence and integrity of scientific work.
In fact, overzealous policing of conflicts of interest can hamper medical innovation, the late Harvard Medical School professor Thomas Stossel argued in a 2008 article for The BMJ.
Such policies, he wrote, “exclude the best experts from providing education and advice, cost time and money, and are deeply disrespectful of physicians and researchers.”
Critics of the current system, however, say such interactions sometimes seem like little more than a quid pro quo — one that, some evidence suggests, does influence physician behavior.
“It’s the kind of institutionalized corruption and bribery that has been there for so long that nobody even bats an eye anymore,” said Carl Elliott, a bioethicist at the University of Minnesota and author of the 2010 book “White Coat, Black Hat: Adventures on the Dark Side of Medicine.”
“We wouldn’t really tolerate” that kind of conflict of interest “if you were talking about a journalist, or about a judge or a police officer,” Elliott said. “But somehow, with doctors, we just let them get away with it, as long as they disclose.”
Under federal law, those companies must report those payments to the federal government, which then makes the information available to the public via the Open Payments database.
The stakes are especially high for guidelines, in which relatively small groups of physicians and scientists write recommendations that can shape healthcare across a country or around the world. In response, organizations have developed processes for disclosing and adjudicating potential conflicts of interest.
The World Health Organization, for example, instructs guideline writers to declare all potentially relevant interests to independent reviewers. The published guidelines list those disclosures, and then note whether the reviewers determined them to pose significant conflicts of interest — and, if so, how the conflicts were managed.
The AAP’s process is considerably less transparent, according to Lisa Bero, a researcher at the University of Colorado who studies the impact of conflicts of interest on health.
She noted the issue around conflicts of interest is not unique to the AAP: “I can’t think of an example of a medical society with a good policy,” she wrote in an email to Undark, “but there may be one.”
In July, Bero and three colleagues published a paper in The BMJ analyzing the 2023 AAP guidelines on childhood obesity treatment, which diverged from peer guidelines that have been published or are under development in some other countries by endorsing the use of weight-loss medications for younger children.
“No financial conflicts of interest involving drug companies were disclosed in the AAP’s childhood obesity guidelines,” the authors wrote.
But, the team continued, they had “identified 11 developers of GLP-1 drugs that made corporate sponsorship payments during 2012-24” to the AAP.
And 10 people involved in producing the guideline had received gifts, perks or payments from such companies between 2017 and 2023, ranging from small food and beverage purchases to one author who had received more than $17,000 in consulting fees.
Whether or not those fees swayed the guideline in any way is unclear. But the lack of disclosure, some experts say, opens the door to questions. And the organization’s process for disclosing conflicts of interest, the authors wrote, “departed from international standards.”
Bero elaborated in an email to Undark: “They provide no information on what they actually reviewed in terms of disclosures from participants, or how they evaluated them to come to the no COI [conflicts of interest] judgement.”
Bero also pointed to international organizations that maintain more strict rules around conflict transparency, including Australia’s National Health and Medical Research Council, the National Institute for Health and Care Excellence in the U.K., and the Institute for Quality and Efficiency in Health Care in Germany.
Undark identified other examples in which authors of AAP recommendations or AAP-endorsed guidance had received funding from pharmaceutical companies that was not mentioned in the final product.
In a paper published in a non-AAP-affiliated journal in 2017, for example, child psychiatrist Graham Emslie reported consulting relationships with eight companies, including Pfizer, which makes the popular antidepressant Zoloft.
Less than a year later, he was listed as an author on AAP-endorsed guidelines, published in the Academy’s flagship journal, that discuss antidepressant prescribing. The paper did not list any conflicts for Emslie.
Those financial relationships may have involved products unrelated to the guidelines, and they could have had no influence on the final policy statement. But the lack of AAP disclosure creates trust issues related to the guidelines, some critics say. (Emslie did not reply to a request for comment.)
In August 2022, a policy statement recommending COVID-19 vaccines for children did not disclose any conflicts for its authors, noting that they had all filed conflict of interest statements with the AAP and any “conflicts have been resolved.”
The chair of the committee responsible for the policy, according to Open Payments records, received $17,590 in consulting fees from Pfizer, which manufactures one of the vaccines, between 2018 and 2022, in addition to substantial research funding.
Again, that financial relationship may not have impacted the recommendation, but critics say that more transparency would help bolster public trust.
In its statement to Undark, the AAP pushed back against the use of Open Payments data alone to assess conflicts of interest, saying the records “often lack detailed context” and are not independently verified.
The AAP described having “a comprehensive Conflict of Interest (COI) policy,” but did not make the policy available for review by Undark. The deliberations are not public, and it’s not clear how the AAP determines that some financial relationships with pharmaceutical companies don’t need to be disclosed on the final guideline or recommendation.
Whether any of this changes the way physicians and members of the public should understand these documents is more complicated. Physicians may feel confident that a research payment, or a free meal, won’t influence their judgment in reviewing the evidence.
The specific nature of industry relationships can vary widely. Large committees mean no single person necessarily determines a final conclusion. And guideline authors who carry conflicts of interest may be leading experts in their field, widely respected for their work and experience.
“I’m sort of conflicted,” said Kenny Lin, a professor of family medicine at Georgetown University who wrote about Bero and her colleagues’ paper for a medical blog.
The AAP, he said, “could have done a better job here.” But he added, he’s not sure “that you have to just throw the whole thing out.”
Knowing about the conflicts may give him pause, he said, but many parts of the document, like lifestyle recommendations, were unlikely to have been influenced by conflicts of interest. “The guideline itself,” Lin said, “is probably not fatally compromised.”
At a time of growing distrust in scientific institutions, some experts suggested, the AAP and other medical societies would benefit from making some changes.
Grundy, at the University of Toronto, reflected on the cost of accepting corporate sponsorships that ultimately make up only a fraction of the organization’s budget: “If it’s undermining your ability to create guidance, education, advice that is rigorous, accountable, trustworthy, then it would be possible to find levers for further independence there,” she said.
“I would ask them why they do not adhere to international standards for evaluating evidence and managing COI in the guideline process,” Bero, the Colorado researcher, wrote in an email to Undark.
“It would not cost them any more, so why not?”
Originally published by Undark.
Michael Schulson is a contributing editor for Undark. His work has also been published by Aeon, NPR, Pacific Standard, Scientific American, Slate and Wired, among other publications.
