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Healthy Skepticism Library item: 16610

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

 

Publication type: news

Winstein KJ
Orthopedists Fail to Disclose Payments
The Wall Street Journal 2009 Oct 8
http://online.wsj.com/article/SB10001424052748704252004574459423318094700.html


Full text:

Orthopedists failed to disclose over 20% of the payments they receive from makers of hip and knee replacements when presenting research related to the companies’ products, a new study found. The finding, publishedthis weekin the New England Journal of Medicine, comes amid growing legislative efforts to require medical companies to disclose payments made to physicians, and researchers to alert the public to potential conflicts of interest that may color how doctors treat them.

Such laws have been enacted in Massachusetts and Vermont, and a federal effort, the Physician Payment Sunshine Act, is pending a vote in the U.S. Senate as part of a health-care reform bill. The Advanced Medical Technology Association, which represents device makers, says it supports the legislation.

“Disclosure is key, but self-disclosure by physicians may not be so accurate,” said Mininder Kocher, a Harvard Medical School orthopedic surgeon who participated in the research.

In the study, researchers measured the accuracy of disclosures by orthopedic surgeons who presented research at the March 2008 annual meeting of the American Academy of Orthopaedic Surgeons, by comparing the doctors’ disclosures against a similar list published by five makers of hip and knee implants.

In 2007, the companies agreed to disclose their payments to surgeons-including royalties for help in developing new implants, and consulting fees-as part of a Justice Department investigation in which prosecutors accused the companies of violating anti-kickback laws by paying physicians to use their products. The companies are Zimmer Holdings Inc. and Biomet Inc. of Warsaw, Ind.; Stryker Corp. of Kalamazoo, Mich.; Smith & Nephew PLC of London; and the DePuy Orthopaedics unit of Johnson & Johnson, New Brunswick, N.J.

The researchers found that among 344 payments disclosed by the companies in their agreement with the government, only 245 were disclosed by the recipients, meaning 29% of payments weren’t properly disclosed by researchers. Looking only at payments “directly related” to the topic of a doctor’s presentation, the study found that 165 of 208 such payments were properly disclosed, meaning one in five were concealed from conference-goers. In total, more than $4 million in directly related payments weren’t disclosed.

“We were a little surprised at how high the nondisclosure rate was,” said Dr. Kocher, who attended the meeting. “Some of that might have been intentional and perhaps people shouldn’t be trusted, but I think the big part is it’s very confusing how self-disclosure happens now in scientific meetings and in journals.”

Joseph Zuckerman, a New York University doctor who serves as the orthopedist society’s president, said the group had significantly tightened its conflict-disclosure policies since the 2008 meeting. “In 2007 or 2008, it was a different deal than it is now,” he said. “When the Department of Justice came out with their [settlements], it got everybody’s attention,” he said.

“We have made conflict of interest front and center,” said Dr. Zuckerman, who said he earned about $132,000 last year from Exactech Inc., in royalties for a shoulder-replacement system he helped design. He said that such relationships between doctors and manufacturers “have benefited millions of patients.”

 

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...to influence multinational corporations effectively, the efforts of governments will have to be complemented by others, notably the many voluntary organisations that have shown they can effectively represent society’s public-health interests…
A small group known as Healthy Skepticism; formerly the Medical Lobby for Appropriate Marketing) has consistently and insistently drawn the attention of producers to promotional malpractice, calling for (and often securing) correction. These organisations [Healthy Skepticism, Médecins Sans Frontières and Health Action International] are small, but they are capable; they bear malice towards no one, and they are inscrutably honest. If industry is indeed persuaded to face up to its social responsibilities in the coming years it may well be because of these associations and others like them.
- Dukes MN. Accountability of the pharmaceutical industry. Lancet. 2002 Nov 23; 360(9346)1682-4.