Medicine’s open secret: conflicted interests?

The financial conflicts of interests of doctors who earned $1 million or more from orthopedic device makers in 2007 were regularly omitted from disclosures in published medical journal articles, according to a study published online in the Archives of Internal Medicine.

Researchers from Columbia University compared disclosures on studies by 41 doctors who earned $1 million or more from five orthopedic device makers. The payments were for  speaking fees, research grants, royalty payments or other compensation. The device makers were required to post the data online as part of a settlement of kick-back allegations with the federal government.

The study reported that only 44 published articles — fewer than half  of the 95 reviewed for the study —  "disclosed a financial relationship between the author and the orthopedic device maker." Only 7 of the articles gave information about the amount of money involved.

And of the 27 doctors who published more than one study in the year after collecting $1 million or more, only four consistently disclosed their ties to the firm.

Another 14 of the authors — 52 percent of those who published more than one article in 2008 — sometimes mentioned the company's name and sometimes did not. Nine "never mentioned the company payments."

A 2009 New England Journal of Medicine study found that while nearly 80 percent of doctors who presented papers at a major orthopedic surgeons meeting in 2008 disclosed a financial tie to the device makers when there was a direct link in the article, less than 50 percent disclosed when the connection was "indirect."

"Although accurate disclosure of industry relationships is vital to the integrity of professional meeting, full disclosures in medical journal articles is of even greater concern," the Columbia University researchers wrote. "These articles constitute a permanent scientific record that is used by practicing physicians, guideline committees, purchasers, and patients to evaluate treatment options."

The study's authors added that medical journals needed to ensure better disclosure and noted that independent verification of authors financial disclosures is now  possible with greater online disclosure of such payments by drug and device makers.

Moreover, in 2013, the Affordable Care Act — the health bill passed in the spring — requires that gifts and payments worth more than $10 be reported to a searchable online database.

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