Journals Urged to Tell Whole Story of Physician Compensation

A New York-based research firm is urging medical journals to enact strict new standards to both identify and publish the relationship between physicians and medical device companies.

In a new study published in the Archives of Internal Medicine, researchers with the Institute on Medicine as a Profession (IMAP) found that nearly half of surgeons who received at least $1 million from orthopedic device companies in 2007 did not disclose that financial relationship in the scientific articles they authored. The study looked at five companies - Biomet, DePuy Orthopedics, Smith & Nephew, Stryker, and Zimmer - who made 1,654 direct payments in 2007 to physicians, totaling $248 million.

In terms of compensation, the study notes that the companies paid its “consultants” about $13,850 each on average and that 40 individuals (38 physicians and 2 non-physician researchers with PhDs) received at least $1 million from a single manufacturer. One physician actually received more than $1 million from two companies.

Of the 41 individuals receiving $1 million or more in 2007, 32 published articles related to orthopedics between Jan. 2008 and Jan. 2009, with only 46 percent disclosing that financial relationship in the journal. Only seven of 95 journal articles provided any information regarding the amount of compensation received - all in a single journal with a guideline on disclosing payments in excess of $10,000.

The study acknowledges that different journals have different guidelines, hence the inconsistency among disclosure by physician authors.

Nonetheless, one of the lead authors of the research, IMAP President David Rothman, said the findings “raise troubling questions about undisclosed payments or royalties and other fees from medical device companies that could lead to biased scientific conclusions.”

The study itself notes that such scientific journal articles “constitute a permanent scientific record that is used by practicing physicians, guideline committees, purchasers, and patients to evaluate treatment options.” Therefore, the authors state, all those parties “must be fully informed about authors’ industry relationships to consider the potential for bias.”

To solve this issue, the IMAP researchers recommend several steps journals should take, including the first step of using readily available company databases to get the information about physician relationships. With that in hand, journal editors can then look at authors’ disclosures and clear up any discrepancy prior to the article’s review, researchers say.

Now Washington, D.C., will step into this fray in 2013 - that’s when a mandate of the Affordable Care Act will require industry companies, pharma, and other entities to report all payments to physicians greater than $10. That information will then be readily available through an online database.

The past year has brought greater scrutiny of physician payments from pharma, device companies, and others ranging from Harvard Medical School limiting its staff from certain financial relationships to other academia rebuffing funds for continuing medical education credits.

The Boston Globe has a story today looking at one Harvard Medical School physician’s creation of a new company to provide CMEs without the influence of any industry companies.

But for all those shunning gifts from the medical industry, there are likely just as many accepting them. I’m not saying this is a bad thing - I’m saying it should be made public.

Now I’m not suggesting physicians should go NASCAR and emblazon their white coats with the logos of companies they have relationships with, but at least they can disclose in a medical journal that they received some payment linked to their subject matter. Otherwise, with increasing studies like the one from IMAP, readers could likely assume one is present anyway, and read the data with a raised eyebrow.

Let’s clear up any appearance of a conflict of interest and ensure that any information - whether written in a journal or made in an exam room - comes with full disclosure.