Almost half of surgeons who received $1 million or more in fees from orthopedic device companies failed to report those payments when publishing scientific articles, according to a new study.
The study, published online Monday by the Archives of Internal Medicine, for the first time cross-referenced a public database of companies' consultant payments with the disclosure information in medical journals and found significant shortcomings. That means doctors who rely on these studies are not being informed of potential conflicts of interest.
"The findings raise troubling questions about undisclosed payments or royalties and other fees from medical device companies that could lead to biased scientific conclusions," senior author David Rothman said in a statement.
Researchers with the New York-based think tank Institute of Medicine as a Profession looked at 2007 physician payment information from five orthopedic device companies (Biomet, DePuy Orthopedics, Smith & Nephew, Stryker and Zimmer). They then narrowed their focus to 41 surgeon researchers who were paid $1 million or more for consulting, honoraria and other services and found more than half of 95 articles they published after being paid did not disclose the financial relationship.
Even those that did report a relationship, the authors write, did not reveal how substantial the payments were — up to $8.8 million in one case. Almost all the studies were directly related to devices made by the companies making the payments. The authors point out that scientific journals often rely on the honor system and do not check multiple databases that are now available.
The new study comes at a time of increased transparency in the health sector. The healthcare reform law mandates that drug and medical device manufacturers report payments to physicians in a searchable public database by 2013. And the public has also become increasingly skeptical: Half of patients said they suspected that the choice of drugs their doctors recommended was influenced by corporate gifts, according to a recent study by Consumer Reports.
In June, the medical journal Anesthesia & Analgesia thoroughly revised its publication guidelines after one of its contributors pleaded guilty to healthcare fraud. Scott Reuben, former chief of the acute pain clinic at Bay State Hospital in Springfield, Mass., was sentenced to six months of imprisonment on charges of falsifying research funded by Pfizer and other drug makers and publishing results of studies he never conducted.
"Patients have a real stake in transparency," Rothman said. "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."