Doctors' disclosure list less complete than industry's
By Elizabeth Cooney, Globe Correspondent
Doctors who receive money from drug or medical device makers are expected to reveal those payments when speaking at professional meetings or submitting a manuscript to a medical journal. A new study led by Boston researchers found that the accuracy of physicians' disclosures fell short when compared to what orthopedic device makers reported.
Dr. Mininder Kocher of Children's Hospital Boston and his New England Journal of Medicine co-authors took a list of payments made to surgeons by five companies that develop and market knee and hip replacement implants. The information was published on company web sites in late 2007 as part of a settlement with the US Department of Justice, as this Globe story reported.
Before the March 2008 annual meeting of the Academy of American Orthopedic Surgeons, physicians who were making presentations or serving on committees for the meeting were asked to list payments they received that could indicate potential conflicts of interest. About seven out of 10 physicians disclosed financial relationships that the device manufacturers had already made public, the authors concluded.
"The thrust has been voluntary disclosure from the physicians," Kocher said in an interview. "Our study would suggest that that may not be so accurate and is difficult to validate."
The disclosure rate was higher for payments directly related to the topic the doctor was addressing at the meeting and lower for indirectly related topics. A talk about knee replacement results would be directly related to a physician's royalty payments for knee implants while a discussion of physical therapy regimens would not, Kocher said.
The authors sent a survey to physicians who did not disclose payments and found that the most common reasons for not reporting them was that they didn't think the payment was related to their topic or they misunderstood the questions about disclosure.
Financial relationships with industry have been the subject of debate in medicine and politics. The conflict-of-interest issue is the subject of a bill in Congress sponsored by Senator Charles Grassley of Iowa, who is calling for mandatory disclosure from drug and device companies.
"I don't think these relationships are necessarily bad," Kocher said. "Certainly a lot of innovative medicine and development of techniques and implants have come about because of a positive collaboration between physician innovators and industry. But they do have the potential to threaten research findings and the trust that underlies the doctor-patient relationship."
Dr. Jerome Kassirer, a professor at Tufts University School of Medicine and a former editor of the New England Journal, said the disclosure rate in the Journal article was "not perfect, but it's pretty good."
He was not involved in the research and said the paper's analysis will be irrelevant if the Grassley bill passes or if more companies follow the lead of drug makers Merck & Co. and Eli Lilly & Co. and post their payments.
But disclosure by itself doesn't solve the conflict of interest problem, Kassirer said.
"The kinds of relationship that orthopedists have made with industry in terms of developing new products and enhancing old ones is good for medicine and it's good for people and it's good for my knee that got replaced three years ago," he said. "So I don't begrudge any of them for getting money to do that kind of work. What I do begrudge them is getting on speakers bureaus for these companies and hawking their products."
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Elizabeth Cooney is a former
health reporter for the Worcester Telegram & Gazette, where she also was a
business reporter and an editor. Earlier in her career, she edited medical
books and journals at Little, Brown, and worked for Boston magazine.Boston Globe Health and Science staff:
- Gideon Gil, Health and Science Editor
- Ishani Ganguli, Short White Coat blogger
