Surgeons Fail to Disclose Corporate Payments


Orthopedic surgeons who received payments from device makers often failed to follow disclosure policies required by their chief professional society, researchers said.

Nearly 30 percent payments to surgeons serving as board and committee members of the American Academy of Orthopedic Surgeons (AAOS), and to presenters at its 2008 annual meeting, went unreported, according to Dr. Kanu Okike, of Harvard University.

The AAOS written policy requires disclosure of all payments -- including non-cash remuneration such as travel, gifts, entertainment, and meals -- from companies selling products related directly or indirectly to presentation topics.

Yet, some 20 percent of payments directly related to presentation topics at the 2008 meeting went undisclosed, as did half of indirectly related and unrelated payments, Okike and colleagues found.

The researchers suggested that, in light of their findings, the current disclosure system based on physician self-reporting may soon be replaced by mandatory reporting by companies making such payments.

"Legislation requiring all drug and device manufacturers to publicly disclose payments to physicians is currently pending in the U.S. Congress and has been met with widespread support," Okike and colleagues wrote.

"On the basis of the results of our study, one might expect the adoption of such policies to allow the identification of conflicts of interest that were previously undisclosed."

Following the Money

The researchers compared disclosure statements printed in the AAOS 2008 meeting program with payment records in 2007 released by five manufacturers of knee and hip prostheses.

The manufacturers -- Biomet, DePuy, Smith and Nephew, Stryker, and Zimmer -- made the payment records public as part of a settlement with the Department of Justice, which was investigating an alleged payola scheme involving financial inducements to surgeons.

Okike and colleagues identified 344 payments in these records that were made to AAOS board or committee members or to researchers presenting at the group's 2008 meeting.

Of these, 245 (71.2 percent) were disclosed in the final meeting program.

The study authors did not say how many AAOS meeting participants received payments, but they did find that 91 failed to report payments.

Okike and colleagues sent them questionnaires about the reasons for the nondisclosure, which were completed by 40 percent.

Just under 40 percent of respondents said the payment was unrelated to their presentation topic. Misunderstanding of the disclosure requirement was cited by 14 percent, and 11 percent said they had reported the payment but it was mistakenly omitted from the meeting program.

Larger payments were more likely to be disclosed by physicians, Okike and colleagues found. About 90 percent of those exceeding $100,000 were disclosed, compared with just 43 percent of payments less than $10,000.

Payments made to individual physicians rather than an organization to which the physician belonged were also more likely to be reported: disclosure rate 78 percent versus 46 percent.

Board and committee members and presenters at symposia or instructional courses were more likely to disclose payments than physicians who did not have such roles.

Payments directly related to the presentation topic, according to criteria adopted by Okike and colleagues, were also more likely to be reported than those indirectly related or unrelated.

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