[General Spine] Study finds ‘serious gaps’ in medical journals’ disclosure of surgeons' relationships with industry

[Justin]

Study finds ‘serious gaps’ in medical journals’ disclosure of surgeons' relationships with industry
BUSINESS OF ORTHOPEDICS
Posted on the ORTHOSuperSite September 14, 2010
Copyright © 2010 SLACK Inc. All Rights Reserved.

Nearly half the surgeons who made at least $1 million in payments from orthopedic device companies did not have that relationship published in their scientific articles, according to a recent study in the online edition of the Archives of Internal Medicine.

The findings show that readers are not being adequately informed about conflicts of interest, even when the funds involved are significant.

“The findings raise troubling questions about undisclosed payments or royalties and other fees from medical device companies that could lead to biased scientific conclusions,” stated senior author David J. Rothman, PhD, president of the Institute on Medicine as a Profession (IMAP), in a release.

A stake in transparency

The study, conducted by researchers at IMAP, is the first of its kind to use company records to check on the accuracy of disclosure information listed in medical journals. The five manufacturing firms investigated in the study disclosed in a public database the amounts they paid to consultants. Researchers combed through this database and compared the list to the financial disclosure information – if any – listed in the journal articles.

IMAP compared 2007 physician payment information from the five orthopedic device companies with the disclosure of company payments in journal articles. These five companies made a total of 1,654 payments amounting to $248 million for consulting, honoraria or other payments for services.

Analysis also found that payments to 41 orthopedic surgeon researchers ranged from just over $1 million to a high of $8.8 million, representing 62% of all company expenditures. Researchers with IMAP focused on these consultants, finding 95 articles published in scientific literature after payments were received. Fewer than half of the published articles disclosed a financial relationship between the author and the company.

In no case, the study goes on, did journal articles reveal how substantial the payments were to the authors.

“Patients have a real stake in transparency,” Rothman stated in the release. “You want to make sure that the surgeon is choosing the device that is best for you and that your doctor is not getting biased information.”

Acceleration of the process

The authors noted that journal editors typically do not check multiple databases that are now available, relying more on the honor system. Researchers are expected to disclose all of their conflicts but this information is not verified to be complete or accurate.

“These articles constitute a permanent scientific record that is used by practicing physicians, guideline committees, purchasers and patients to evaluate treatment options,” the authors wrote. “Journal editors, reviewers and readers must be fully informed about authors’ industry relationship to consider the potential for bias.”

Rothman added that editors and others need to start using company databases to get information about physician-industry relationships. No less than 15 drug and device companies are now putting payment information on their websites – a practice that will be accelerated by the Patient Protection and Affordable Care Act.

“The next generation of physicians should know that every nickel they take from industry is going to be made public,” Rothman stated.

References:

Chimonas S, Frosch Z, Rothman DJ. From disclosure to transparency: The use of company payment data. Arch Intern Med. Published online September 13, 2010. doi:10.1001/archinternmed.2010.341

Medical Professionalism | The Institute on Medicine as a Profession

[Metalneck07]

Thanks Justin very interesting article.My question would be how would a patient find out if his or her Doctor has a financial interest or Relationship with certain medical devices etc ? I would think this would have to be public knowledge but this article makes me think maybe not so.Thanks again.
Caitlin aka Metalneck07

[Hooch]

I expect they'd have to be a pretty well known doctor to have a role in this. Otherwise it's just the usual conferences and free pens.

The surgeon I've seen, he's very good, but I know he trained a lot of the other doctors in this country in using a certain artificial disc, I know he only uses one type of artificial disc, and I have no doubt he has some form of commercial arrangement.

Doesn't mean he's not the right man for the job, and you'd expect him to be very good at the operation by now, but I don't think any surgeon who is very conservative about surgery and ddd is likely to have such a commercial arrangement.

Medicine is business first and foremost, so it pays to be aware of that.

As for Justin's post, it's the norm and is a disgrace. Doctors are not just in any old business and their professoinal organisation should long ago have scrubbed out this sort of thing. But, you know, lurks and perks.

[KBear]

Caitlin, I signed a waiver acknowledging that there may be financial ties to the device(s) being used. I think at TBI there is a general one you sign when you go there, or to their surgical facility saying your doctor may have financial ties to the place being used/ product. I know I signed one in Miami too, but it was pretty obvious he would have a financial interest in the device, since he was the co-inventor.
As Carson said, I think most of the top dogs in the ADR surgical arena are going to have some financial ties to the companies selling them. Honestly, that does not bother me, because in my opinion they are going to have a higher incentive to do a great surgery on you, so their device is successful and doesn't get pulled from the market (the more in use, the more money for them). I also think most of the top docs are probably involved with more than one company, look at the places that are constantly doing trials, I'm sure they have financial ties to many of the new products. I know it's becoming very common in my area for hospitals to be doctor owned, we have a couple that have been built in the last few years. They aren't as large as traditional hospitals; but can still handle surgeries and overnight stays. Every time you use one of these, you sign a disclaimer stating your doctor may have a financial interest in the facility.

[Metalneck07]

Thanks Kathy Sorry I may have worded my thread wrong.I understand alot of doctors have financial ties with there hospital,products etc.But do they have disclose the exact products etc. to patient.(the actual names of the companies for products,devices etc.) And if they do so where would such information be available to the patient ? I know money is what makes the world go around it's a bad thing and a good thing .It's just the way it goes.My only concern is if a doctor stands to make big bucks he may be enticed to push certain devices,products etc. despite the concern of issues with them.Any way just my thoughts.What's your take on this?Thanks again for replying.
Thanks Hooch as well.
Caitlin aka Metalneck07

[KBear]

I'm assuming if you ask them if they have ties to the product they are recommending you they will have to tell you. However, most of the disclosures I have signed are very generic, not stating particular products.

[Hooch]

If a surgeon does not provide full and appropriate disclosure in a peer reviewed scientific journal, I thoroughly doubt he feels much need at all to disclose his financial interests to a patient.