Physician Payments for Journal Articles Scrutinized

While it has become standard practice in recent years for journal authors to disclose relationships with industry, the requirements have varied—leaving authors to determine the relevance of a financial relationship to a submitted article. As a result, disclosures have been inconsistent—even when the information could have been verified independently by the journals, researchers say in the latest Archives of Internal Medicine.

When researchers compared physician payment information from five orthopedic device companies with disclosure of company payments in journal articles in their study, they were able to find nondisclosed payments to 41 orthopedic surgeon researchers that ranged from just over $1 million to a high of $8.8 million. Of those authors, 32 published 151 articles between Jan. 1, 2008, and Jan. 15, 2009.

While almost all of the articles written by the surgeons were directly related to a device made by the company, none of the journal articles revealed how substantial those payments were that were made to the authors.

Whether the surgeons didn't disclose these details or whether the journals didn't publish the information is not known, says David Rothman, MD, president of the Institute on Medicine as a Profession (IMAP) at Columbia University, which conducted the Archives study. "We weren't pointing a finger at either surgeons or editors because we didn't know where [the nondisclosure] was."

However, the point of the study was to identify "the extraordinary lapse in the system" of revealing this data, says Rothman, who is also a professor and director of the Center for the Study of Society and Medicine at Columbia. The researchers obtained their data by reviewing 2007 physician payment data from five orthopedic device company sites to "evaluate the transparency provided by the current system."

While the new healthcare reform law will require all drug and device makers to report payments to physicians in a searchable public database by 2013, Rothman says it will not necessarily solve the problem unless journal editors use the information and physicians make full disclosures.

Using a top-down approach—by getting leading medical education institutions and the leading professional medical societies to really start emphasizing and using the data in and around conflict of interest—is one way "that this would be cost-effectively done" in the future, Rothman says.

Also, the emphasis on avoiding conflict-of-interest can start in the early years. "When I lecture medical students here at Columbia and talk about this subject, I tell them...[to] understand that from the very beginning, every dollar that [they] take—from a device or drug company—will be public information. It's a very different orientation," he says.

In a separate study on conflict-of-interest that appears this week in the Journal of the American Medical Association (JAMA), researchers found that some resident physicians rationalized that they were comfortable accepting gifts—because they had made sacrifices and they were "worthy of that treatment."

No physicians took any gifts in this study, said co-author, Sunita Sah, who is a former practicing physician who once consulted for pharmaceutical companies on sales and marketing to physician.

However, in their survey of 301 resident physicians, they found that "reminding physicians of sacrifices made in obtaining their education" resulted in gifts being evaluated as more acceptable: 21.7% in the control group vs. 47.5% in the group who "reminded" were more accepting of receiving gifts.

Financial self-interest may not "fully explain physicians’ acceptance of gifts," said the researchers from Carnegie-Mellon University in Pittsburgh. Rather, well-intentioned physicians may use rationalizations—subjective perceptions of hardships to accept "potentially biasing gifts."

Making conflict-of-interest disclosures is important to consumers, Rothman says, as evidenced by a recent Consumer Reports survey that found that nearly half of the patients questioned thought that gifts from pharmaceutical companies influenced their physicians' choices of medications.

But it's important as well to healthcare leaders. "What is certain is that colleagues need to know—whether you're making appointments to formulary committees, to lecture assignments, to medical students, or training residents or [making] decisions on publications," he says.

"It's a little bit of a pain in the neck" now to go to separate company sites to verify information, he says. While having an aggregated and more searchable site is still a few years off, Rothman advises: "Sure, trust your colleagues—but verify."