The Physician Payment Sunshine Act: testing the value of transparency

Evaluating Funding for Authors Achieving High Citations vs. Online Popularity

INTRODUCTION

The Altmetric score is a validated tool that measures online attention of scientific studies. A relationship between government/industry funding for authors and their study's citations have been previously demonstrated. It is not known whether funding is related to greater online attention. We hypothesize authors publishing studies achieving greater online attention (higher Altmetric scores) receive greater monetary support from industry while authors publishing studies achieving critical acclaim (more citations) receive greater monetary support from the National Institute of Health (NIH).

METHODS

Top spine surgery studies between 2010 and 2021 were selected based on Altmetric scores and citation number. The Open Payments Database was accessed to evaluate industry financial relationships while the NIH Research Portfolio Online Reporting Tool was accessed to evaluate NIH funding. Payments were compared between groups and analyzed with the Student t-test, analysis of variance, and chi square analysis. Alpha <0.05.

RESULTS

There were 60 and 51 authors with payment data in the top 50 Altmetric and top 50 citation studies, respectively, with eight authors having studies in both groups. Total industry payments between groups were not markedly different. The eight authors with studies in both groups received markedly more industry payments for consulting, travel/lodging, and faculty/speaking fees. Authors with articles in both groups (50%) were significantly more likely to receive NIH support, compared with authors of the top Altmetric articles (5%; P < 0.001) and top citation articles (12%; P < 0.001). Authors receiving NIH support received significantly less industry payments compared with authors not receiving NIH support ($148,544 versus $2,159,526; P < 0.001).

DISCUSSION

These findings reject our hypothesis: no notable differences for industry payments and NIH funding between authors for top Altmetric and citation studies. Authors receiving funding from industry versus the NIH are generally two distinct groups, but there is a small group supported by both. These studies achieve both critical acclaim (citations) and online popularity (Altmetric scores).

DATA AVAILABILITY

Data can be available on reasonable request.

The corporate capture of the nutrition profession in the USA: the case of the Academy of Nutrition and Dietetics

OBJECTIVE

The involvement of unhealthy commodity corporations in health policy and research has been identified as an important commercial determinant contributing to the rise of non-communicable diseases. In the USA, health professional associations have been subject to corporate influence. This study explores the interactions between corporations and the Academy of Nutrition and Dietetics (AND), and their implications for the profession in the USA and globally.

DESIGN

We conducted an inductive analysis of documents (2014-2020) obtained through freedom of information requests, to assess key AND actors' dealings with food, pharmaceutical and agribusiness corporations. We also triangulated this information with publicly available data.

SETTING

The USA.

PARTICIPANTS

Not applicable.

RESULTS

The AND, AND Foundation (ANDF) and its key leaders have ongoing interactions with corporations. These include AND's leaders holding key positions in multinational food, pharmaceutical or agribusiness corporations, and AND accepting corporate financial contributions. We found the AND has invested funds in corporations such as Nestlé, PepsiCo and pharmaceutical companies, has discussed internal policies to fit industry needs and has had public positions favouring corporations.

CONCLUSION

The documents reveal a symbiotic relationship between the AND, its Foundation and corporations. Corporations assist the AND and ANDF with financial contributions. AND acts as a pro-industry voice in some policy venues, and with public positions that clash with AND's mission to improve health globally.

Impact of the Affordable Care Act's Physician Payments Sunshine Act on branded statin prescribing

OBJECTIVE

To evaluate the impact of the Affordable Care Act's Physician Payments Sunshine Act (PPSA), which mandates disclosure of industry payments to physicians, on physician prescribing of branded statins.

DATA SOURCES

Administrative claims data from 2011 to 2015 from three large national commercial insurers were provided by the Health Care Cost Institute.

STUDY DESIGN

We adopted a difference-in-differences and event study design, leveraging the control group of physicians in two states, MA and VT, which implemented state laws on disclosure of industry payments prior to the national PPSA. To further address potential confounding caused by differences in prescribing patterns across states, our analytical sample includes physicians practicing in border counties between the treatment (NH, NY, and RI) and control (MA and VT) states.

DATA COLLECTION

We restricted our sample to physicians who had at least 50 new-fill prescription claims for statins during the five-year study period, with at least one new-fill prescription claim each year.

PRINCIPAL FINDINGS

We found that the PPSA led to a 7% (p < 0.001) reduction in monthly new prescriptions of brand-name statin over the study period, with little change in generic prescribing. The reduction in branded prescriptions was concentrated among physicians with the highest tercile of drug spending pre-PPSA, with a decrease of 15% (p < 0.001) in new branded statin prescriptions. The decline was most prominent after mandated reporting of industry payments began before the payment data was published.

CONCLUSIONS

The PPSA may have achieved its intended effect of reducing branded prescriptions at least in the short run, particularly among physicians most likely to have engaged in excessive or low-value prescribing of branded drugs.

CMS Open Payments Database Analysis of Industry Payments for Foot and Ankle Surgery Research

With decreasing federal funding, the role of industry in supporting medical investigations continues to grow. To increase transparency between physicians and industry, the Centers for Medicare and Medicaid Services introduced the Open Payments Program, providing a searchable database of physician payments from entities including medical device companies. This study describes industry research payments and trends among foot and ankle surgeons. Research Payment Data among foot and ankle surgeons from the Open Payments Database was reviewed from 2013 through 2020. Payment year, value, type, and physician name were collected, and descriptive statistics were presented. Linear regression assessed trends in the number and value of payments. Analysis of variance and subsequent post hoc testing assessed differences in mean payment value. A p value of ≤.05 was considered statistically significant. Overall, 10,872 payments totaling $69,595,393.10 among 446 foot and ankle surgeons were analyzed. No statistically significant increase in number of physicians, payments, or mean payment value per physician was observed from 2013 through 2020. However, the average value of payments in 2019 and 2020 was greater than 2015 and 2017 (p ≤ .05). The top 50 physicians according to cumulative payment value received $54,696,623.10 with 9427 (86.7%) cash and cash-equivalent payments representing the most common payment type overall. Industry continues to provide financial support to foot and ankle surgery research. Results of this investigation spur future studies to examine the relationship between payments and positive results reported by lead investigators in published research.

Awareness and Perceptions among Members of a Japanese Cancer Patient Advocacy Group Concerning the Financial Relationships between the Pharmaceutical Industry and Physicians

Objectives: Awareness and perceptions of financial conflicts of interest (FCOI) between pharmaceutical companies (Pharma) and healthcare domains remain unclear in Japanese cancer patient communities. This study aimed to assess awareness (RQ1), the influence of FCOI on physician trustworthiness (RQ2), and their perception (RQ3) among the Japanese cancer patient advocacy group members. Methods: A cross-sectional study using a self-administered survey was conducted with a Japanese cancer patient advocacy group between January and February 2019. The main outcome measures included awareness and perceptions of physician–Pharma interactions, their impact on physician trustworthiness, and attitudes towards FCOI among medical and other professions. Furthermore, we performed thematic analyses on the comments which responders provided in the surveys. Results: Among the 524 contacted members, 96 (18.3%) completed the questionnaire, including 69 (77.5%) cancer patients. In RQ1, most of the respondents were aware of physician–Pharma interactions, although the extent differed based on the nature of the interaction. Furthermore, the respondents mainly considered these interactions influential on clinical practice (RQ2) and agreed to the need for further regulation of physician–Pharma interactions (QR3). In qualitative analyses (n = 56), we identified the 4 following themes: perception towards the FCOI (Theme 1), concerns about the respondent’s treatment (Theme 2), reason of physician–Pharma interactions (Theme 3), and possible solutions from the patient perspective (Theme 4). Conclusions: Most respondents were generally aware of physician–Pharma-associated FCOI and perceived them negatively. Additionally, participants appeared supportive of further FCOI regulation to protect patient-centred care. Abbreviations: FCOI—financial conflicts of interest; United States—US; Pharma—pharmaceutical companies; RQ—research question.

Industry Payments Among Appropriate Use Criteria Voting Panels: An Open Payments Analysis

BACKGROUND

Although multiple studies have consistently demonstrated that orthopaedic surgeons receive greater transfers of value than other specialties, the industry payments of providers who are involved in the formation of practice guidelines have not been thoroughly explored. Therefore, the purpose of our analysis was to evaluate the industry payments of the authors of the Appropriate Use Criteria (AUC) from the American Academy of Orthopaedic Surgeons (AAOS).

METHODS

The publicly available AAOS web portal (OrthoGuidelines.org) was queried for all AUCs that had been released between January 1, 2013, and December 31, 2019, regarding the management of musculoskeletal pathologies. A cross-sectional analysis of the Centers for Medicare & Medicaid Services (CMS) Open Payments database was conducted to determine the number and total value of industry payments to AUC voting committee members during the year of voting for the AUC. Industry payments for each orthopaedic surgeon voting member were compared with payments received by orthopaedic surgeons nationwide who received any payment within the same year. The proportion of orthopaedic surgeon voting members who received any industry payment was compared with the proportion of orthopaedic surgeons nationwide who received payments.

RESULTS

Our analysis included a total of 18 different AUCs with 216 voting members, 157 of whom were orthopaedic surgeons. Of the orthopaedic surgeon voting members, 105 (67%) received industry payments, a rate roughly comparable with the national average among orthopaedic surgeons (74%). For 7 of 18 AUCs (39%), the median payment per orthopaedic surgeon voting member was above the median among orthopaedic surgeons receiving payments nationwide that year. Qualitatively, orthopaedic surgeon voting members were more likely to receive payments in the form of royalties, licenses, or speaking fees than orthopaedic surgeons nationwide.

CONCLUSIONS

AUC voting members receive payments at frequencies and magnitudes that are roughly comparable with orthopaedic surgeons nationwide. Whether voting panel members receiving payments at these rates is ideal or is in the best interest of patients is a policy decision for the AAOS and society at large. Our study confirms that payments are common and, thus, continued vigilance is justified.

Ten years later: a review of the US 2009 institute of medicine report on conflicts of interest and solutions for further reform

Conflicts of interest (COIs) in healthcare are increasingly discussed in the literature, yet these relationships continue to influence healthcare. Research has consistently shown that financial COIs shape prescribing practices, medical education and guideline recommendations. In 2009, the Institute of Medicine (IOM, now the National Academy of Medicine) published Conflicts of Interest in Medical Research, Practice, and Education-one of the most comprehensive reviews of empirical research on COIs in medicine. Ten years after publication of theIOM's report, we review the current state of COIs within medicine. We also provide specific recommendations for enhancing scientific integrity in medical research, practice, education and editorial practices.

OUP accepted manuscript

Background

Propensity score matching (PSM), a statistical technique that estimates a treatment effect by accounting for predictor covariates, has been used to evaluate biologics for inflammatory bowel disease (IBD). Financial conflicts of interest are prevalent in the marketing of biologic medications. It is unclear whether this burden of conflicts is present among authors of PSM studies comparing IBD biologics and biosimilars.

Objective

This study was aimed to determine the prevalence of financial conflicts of interest among authors of PSM studies evaluating IBD biologics and biosimilars.

Methods

We conducted a systematic search for PSM studies comparing biologics and biosimilars in IBD treatment. We identified 21 eligible studies. Two independent authors extracted self-declared conflicts from the disclosures section. Each participating author was searched on the Centers for Medicare & Medicaid Services Open Payments to identify payment amounts and undisclosed conflicts. Primary outcome was the prevalence of author conflicts. Secondary analyses assessed for an association between conflict prevalence and reporting of positive outcomes.

Results

Among 283 authors, conflicts were present among 41.0% (116 of 283). Twenty-three per cent (27 of 116) of author conflicts involved undisclosed payments. Studies with positive outcomes were significantly more likely to include conflicted authors than neutral studies (relative risk = 2.34, 95% confidence interval: 1.71 to 3.21, P < 0.001).

Conclusions

Overall, we found a high burden of undisclosed conflicts among authors of PSM studies comparing IBD biologics and biosimilars. Given the importance of PSM studies as a means for biologic comparison and the potential for undue industry influence from these payments, authors should ensure greater transparency with reporting of industry relationships.

Industry Payments to Adult Reconstruction-Trained Orthopedic Surgeons: An Analysis of the Open Payments Database From 2014 to 2019

BACKGROUND

In recent time, there has been an increased push toward transparency in industry funding toward physicians. The Physician Payments Sunshine Act called for the creation of the Open Payments Database managed by the Centers for Medicare & Medicaid Services. To our knowledge, there have been no studies evaluating the trends in payments among adult reconstruction fellowship-trained orthopedic surgeons. The purpose of this study is to investigate trends in all payments to adult reconstruction-trained orthopedic surgeons from 2014 to 2019. Secondary outcomes included evaluating trends in yearly subpayment categories, regional variations, as well as characterizing the top 5 industry companies.

METHODS

A review of the Centers for Medicare & Medicaid Services Open Payments Database was performed to identify all payments to adult reconstruction-trained orthopedic surgeons. A total of 94,265 payments were made to 4911 surgeons accounting for a total of $258,865,231.20 during the study period. Our primary outcome was to assess the trend in median payment per year to individual surgeons. Secondary outcomes included evaluating payment trends with respect to subtype, location as defined by United States Census regions, as well as specifics concerning the top 5 companies.

RESULTS

Over the study period, there was a nonsignificant increasing trend in median payment per surgeon (r = 0.49, P = .096). However, there was also a significantly increasing trend in the number of payments per year (r = 0.83, P = .014), as well as the number of surgeons receiving payments (r = 0.88, P = .019). With respect to subcategory payments, there were significantly increasing trends in the median payment per surgeon for education (1054%, r = 0.942, P < .001) and entertainment/food and beverage expenses (20.2%, r = 0.49, P = .020), as well as a significantly decreasing trend for median honoraria payments per surgeon (20.2%, r = -0.04, P = .005). No significant regional trends were identified. Of the top 5 companies, one demonstrated a significantly decreasing trend in median payment per surgeon (21.6%, r = -0.109, P < .001), whereas the others remained unchanged.

CONCLUSION

In this study, we found a nonsignificant increasing trend in payments to adult reconstruction-trained surgeons as well as an increasing number of surgeons receiving payments. There were increasing trends in median payment per surgeon for education and entertainment expenses, but a decreasing trend for honoraria payments. No significant regional trends were identified. The majority of the top 5 companies had nonsignificant trends in their payments. Further studies are needed to characterize the disclosure of payments and the impact of industry payments on clinical outcomes.

LEVEL OF EVIDENCE

IV.

The Influence of the Sunshine Act on Industry Payments to United States Orthopaedic Sports Medicine Surgeons

PURPOSE

The purpose of the present study is to investigate trends in overall payments to orthopaedic sports medicine surgeons reported by the Open Payments Database (OPD) over the 6 full years of available data (2014-2019).

METHODS

A retrospective review of industry payments to United States sports medicine trained orthopaedic surgeons from 2014 to 2019 was performed using the Centers for Medicare and Medicaid Services OPD. Total payments and subtype payments were analyzed for yearly trends. Regional analysis was also performed. The primary outcome was the overall trend in total median payments (defined as the median total payments per surgeon per year), which was assessed via the Jonckheere-Terpstra test. Descriptive statistics include medians with interquartile ranges. P values < .05 were considered statistically significant.

RESULTS

From 2014 to 2019, there were a total of 1,941,772 payments to 12,816 sports medicine orthopaedic surgeons. The median payments to surgeons demonstrated a significant upward trend (P < .001). The total number of payments (r = 0.002; P = .99) did not significantly correlate with changing year. The top 5 compensated surgeons received 45.8% of all industry contributions with a median total payment of $9,210,974.06 (interquartile range: 25,029,951.46). The majority of industry contributions in the top 5 earners were attributed to royalties and licenses (98.7%). Across the study period, 89.4% of the total orthopaedic sports medicine surgeons received a yearly total payment less than $10,000, which made up 8.3% of the total industry payment sum. Those receiving a yearly total payment greater than $500,000 accounted for 0.3% of surgeons but received 53.4% of the sum payments. We found a yearly increasing trend in payments in all regions including the Midwest, South, Northeast, and West (P < .001, P < .001, P < .001, and P = .006).

CONCLUSION

Despite the transparency of reporting mandated by the Sunshine Act, orthopaedic sports medicine surgeons have continued to maintain industry relationships with a notable disparity in distribution.

CLINICAL SIGNIFICANCE

Our analysis suggests continued relationships among sports medicine surgeons and industry. Future research is needed to determine how this impacts medical practice in the United States.

Review of Industry Payments to General Orthopaedic Surgeons Reported by the Open Payments Database: 2014 to 2019

Introduction:

The Physician Payments Sunshine Act was placed into law in 2010 in an effort to create transparency between physicians and industry. Along with many other specialties, orthopaedic surgeons have long worked intimately with medical industry companies. This study aimed to evaluate trends in industry payments to general orthopaedic surgeons from 2014 to 2019.

Methods:

A retrospective review of the Center of Medicare and Medicaid Services' Open Payments Database was done to identify all industry payments to all general orthopaedic surgeons (ie, not subspecialty affiliated) from 2014 to 2019. The researchers analyzed total payments and subtype payments for yearly trends, and a regional analysis was done. The primary outcome was the overall trend in total median payments, which was assessed through the Jonckheere-Terpstra test. Descriptive statistics include medians with interquartile ranges. P < 0.05 was considered statistically significant.

Results:

Between 2014 and 2019, a total of 1,330,543 payments totaling $1.79 billion dollars was paid to 108,041 general orthopaedic surgeons. During this time, the number of surgeons receiving payments increased with a significant uptrend in median payments per surgeon (P < 0.001; Table 1). The top 25% percentile of general orthopaedic surgeons received >95% of payments, whereas the bottom 25% received <0.1%. The general payment types all saw significant increases (P < 0.001) between 2014 and 2019, with the exception of “Ownership or Investment Interests” (P = 0.657) and “Royalty or License” (P = 0.517). Significant regional uptrends in median industry payments were also seen in the Midwest, Northeast, South, and West (P < 0.001). Four of the top five orthopaedic industry companies made payment increases between 2014 and 2019.

Conclusion:

Industry payments to general orthopaedic surgeons between 2014 and 2019 have increased with a considerable disparity in payments among the top-paid orthopaedic surgeons.

Pharmaceutical industry self-regulation and non-transparency: country and company level analysis of payments to healthcare professionals in seven European countries

The European pharmaceutical industry uses the alleged efficacy of self-regulation to question the need for transparency laws similar to the US Physician Payment Sunshine Act. We conducted a comparative analysis of 20 large companies' payment disclosures in seven European countries in 2017-2019. The data was extracted as part of eurosfordocs.eu, a novel transparency project that scrapes and integrates publicly available databases and disclosures. Our analysis of EUR 735 million showed marked differences in country payment patterns. For example, payment totals per registered doctor were substantially larger in Spain and lowest in Sweden. There were significant country and company differences in individualized data completeness. Only 19% of totals were reported with recipient names in Germany, compared to Ireland (59%), the United Kingdom (60%), Italy (67%), Switzerland (73%), Sweden (79%) and Spain (100%), with little or no improvement over time. Payment data in Spain was particularly difficult to extract. Thus, in no country did self-regulation generate comprehensive individualized data allowing for building an accurate picture of financial relationships between the industry and healthcare professionals. We conclude that the cultures and policies of countries and companies create structural problems of data inaccessibility and incompleteness within the self-regulatory framework. Therefore, this study supports calls for a Europe-wide "Sunshine Act" to achieve real transparency of drug company payments.

Orthopaedic Foot and Ankle Surgeon Industry Compensation Reported by the Open Payments Database

Background. The current study aims to characterize and explore trends in Open Payments Database (OPD) payments reported to orthopaedic foot and ankle (F&A) surgeons. OPD payments are classified as General, Ownership, or Research. Methods. General, Ownership, and Research payments to orthopaedic F&A surgeons were characterized by total payment sum and number of transactions. The total payment was compared by category. Payments per surgeon were also assessed. Median payments for all orthopaedic F&A surgeons and the top 5% compensated were calculated and compared across the years. Medians were compared through Mann-Whitney U tests. Results. Over the period, industry paid over $39 million through 29,442 transactions to 802 orthopaedic F&A surgeons. The majority of this payment was General (64%), followed by Ownership (34%) and Research (2%). The median annual payments per orthopaedic F&A surgeon were compared to the 2014 median ($616): 2015 ($505; P = .191), 2016 ($868; P = .088), and 2017 ($336; P = .084). Over these years, the annual number of compensated orthopaedic F&A surgeons increased from 490 to 556. Averaged over 4 years, 91% of the total orthopaedic F&A payment was made to the top 5% of orthopaedic F&A surgeons. The median payment for this group increased from $177 000 (2014) to $192 000 (2017; P = .012). Conclusion. Though median payments to the top 5% of orthopaedic F&A surgeons increased, there was no overall change in median payment over four years for all compensated orthopaedic F&A surgeons. These findings shed insight into the orthopaedic F&A surgeon-industry relationship.Levels of Evidence: III, Retrospective Study.

Perceptions of the provision of drug information, pharmaceutical detailing and engagement with non-personal promotion at a large physicians network: a mixed-methods study

OBJECTIVE

Non-personal promotion (NPP) such as digital, print-based marketing, direct promotional visits and free drug samples are means of pharmaceutical marketing. This study described practices of drug information, pharmaceutical detailing and engagement with NPP at an integrated network of providers.

DESIGN

This was a sequential explanatory mixed-methods study. A survey was followed by semistructured interviews. The questionnaire elicited preferred sources of drug information, management of drug information and perceptions on drug samples, coupons and pharmaceutical representative visits. Interviews were audio-recorded and transcribed. Data were analysed using descriptive statistics (quantitative) and content analysis (qualitative).

SETTING

Face-to-face or telephonic interviews were conducted at a large physicians network in Northern Kentucky.

PARTICIPANTS

Eighty-two medical assistants, primary care, specialty providers and other office staff who completed the survey and 16 interviewees.

RESULTS

Most respondents were women (79.3%), office managers (26.8%) and individuals employed for 15 years or longer within the organisation (30.5%). Most participants (85.3%) indicated that pharmaceutical representative visits are the most common source of drug information. Paper-based material was the most frequent form in which information was received in physician offices (62.2%). Medical assistants were usually responsible for handling drug information (46.3%) on arrival in the office, compared with 15.3% of physicians. Drug representative detailing and lunches (62.2%) were the desired method of drug information communication followed by electronic mail or e-journals (11%). Interviewees generated three themes that described pharmaceutical representative visits and interactions with prescriber and non-prescriber personnel in the offices.

CONCLUSIONS

We found significant involvement of non-prescriber personnel in drug information management at primary and specialty care offices. Participants perceived that pharmaceutical representatives have an important role in keeping the offices informed and supplied with relevant drug information, coupons and samples. Findings highlight the importance of engaging prescriber and non-prescriber personnel to guarantee relevant information reaches providers.

Industry Payments to Orthopedic Spine Surgeons Reported by the Open Payments Database: 2014-2017

STUDY DESIGN

This was a retrospective study of publicly available data.

OBJECTIVE

The objective of this study was to characterize and assess trends in Open Payments Database (OPD) industry payments reported to orthopedic spine surgeons from 2014 to 2017.

SUMMARY OF BACKGROUND DATA

There have been a lack of studies characterizing OPD industry payments to orthopedic spine surgeons over the 4 full years of data available.

MATERIALS AND METHODS

General industry payments made to orthopedic spine surgeons from 2014 to 2017 were characterized by year with analysis of: number of compensated surgeons, median payment per surgeon, top strata of compensated surgeons, and subtype (ie, food/beverage). Research and Ownership Payments were characterized by median payment per surgeon. Mann-Whitney U tests were used to compare payments.

RESULTS

For General Payments, the number of compensated orthopedic spine surgeons increased from 1539 in 2014 to 1673 in 2017. Later year median General Payments per surgeon were compared with the 2014 median ($1051): 2015 ($1070: P=0.375), 2016 ($1263: P=0.012), and 2017 ($978: P=0.561). In 2014, the top 10% of compensated orthopedic spine surgeons received 89% of the total General compensation to orthopedic spine surgeons, top 5% received 79%, and the top 1% received 55%. The median General Payment for these 3 top strata remained similar over the 4 years evaluated (P>0.05). For subtype analyses, the median aggregate General Payment for "education" increased (P=0.002) across the years. Finally, it was determined that the median payment per surgeon for Research and Ownership Payment categories remained stable across the time period (P>0.05).

CONCLUSIONS

Many expected industry payments to surgeons to decrease under public scrutiny of the OPD, but the present study showed no net change in median payment (General, Research, and Ownership) over the years studied. In the age of greater transparency, these findings shed insight into the orthopedic spine surgeon-industry relationship.

LEVEL OF EVIDENCE

Level III.

Characteristics of Reported Industry Payments to Neurosurgeons: A 5-Year Open Payments Database Study

OBJECTIVE

The aim of this study was to characterize the payments made by medical industry to neurosurgeons from 2014 to 2018.

METHODS

A retrospective study was performed from January 1, 2014 to December 31, 2018 of the Open Payments Database. Collected data included the total number of industry payments, the aggregate value of industry payments, and the mean value of each industry payment made to neurosurgeons per year over the 5-year period.

RESULTS

A total of 105,150 unique surgeons, with 13,668 (12.99%) unique neurosurgeons, were identified to have received an industry payment during 2014-2018. Neurosurgeons were the second highest industry-paid surgical specialty, with a total 421,151 industry payments made to neurosurgeons, totaling $477,451,070. The mean average paid amount per surgeon was $34,932 (±$936,942). The largest proportion of payments were related to food and beverage (75.5%), followed by travel and lodging (14.9%), consulting fees (3.5%), nonconsulting service fees (2.1%), and royalties or licensing (1.9%), totaling 90.4% of all industry payments to neurologic surgeons. Summed across the 5-year period, the largest paid source types were royalties and licensing (64.0%; $305,517,489), consulting fees (11.8%; $56,445,950), nonconsulting service fees (7.3%; $34,629,109), current or prospective investments (6.8%, $32,307,959), and travel and lodging (4.8%, $22,982,165).

CONCLUSIONS

Our study shows that over the most recent 5-year period (2014-2018) of the Centers for Medicare and Medicaid Services Open Payments Database, there was a decreasing trend of the total number of payments, but an increasing trend of the total amount paid to neurosurgeons.

Evaluating Financial Conflicts of Interest Among Contributors to Clinical Practice Guidelines of the American College of Obstetricians and Gynecologists

Context

Patient care is an essential part of the practice of obstetrics and gynecology, and patient care is directed by clinical practice guidelines. To increase the validity of these guidelines, we must make sure that there is no outside influence by financial conflicts of interest.

Objective

To investigate the existence of and reporting patterns regarding payments received by contributors to guidelines from the American College of Obstetricians and Gynecologists (ACOG), ACOG executive committee members, and companies making these payments and to examine the compliance of those receiving payments to ACOG's conflict of interest policies.

Methods

The Center for Medicare and Medicaid's Open Payments database was used to search practice bulletin committee members and practice bulletin collaborators from 2014-2016, as well as current executive committee board members. Open Payments was also used to evaluate companies that provided payments, and amounts were totaled. The main outcome measure was the monetary values of payments received and the compliance with disclosure statements enforced by ACOG. Manufacturer payments to physicians in the database were analyzed descriptively.

Results

General and research payments were calculated among 65 physicians in the Open Payments database: 44 physician members of both the obstetrics and the gynecology practice bulletin committees, 4 2016 ACOG executive board physician members, and 17 contributing physician authors. Research payments accounted for greater than 78% of all payments. Consulting, travel and lodging, and speaking fees totaled greater than $90,000 and contributed to more than 90% of the total amount of general payments. Food and beverage payments contributed to 10% of all general payments. Three covered members were noncompliant with the financial conflicts of interest guidelines, receiving industry payments exceeding $5000.

Conclusion

A small number of companies provide the majority of contributions; however, there is no evidence to suggest bias toward manufactures within ACOG practice bulletins. Future investigations into pharmaceutical manufacturer payments, specifically for consulting fees, may be warranted. (Clinical Trial Registry UMIN-CTR, UMIN000029165)

All Disclosure is Good Disclosure: Patient Awareness of the Sunshine Act and Perceptions of Surgeon-Industry Relationships

STUDY DESIGN

This was a prospective study.

OBJECTIVE

To determine patient awareness of surgeon-industry relationships, how these relationships affect patient perceptions of surgeons, and which relationships cause the greatest concern to patients.

SUMMARY OF BACKGROUND DATA

The prevalence of orthopedic surgeon-industry relationships led to the establishment of a national database of physician-industry interaction [Open Payments Database (OPD)] as part of the Physician Payments Sunshine Act (PPSA).

MATERIALS AND METHODS

A 10-item questionnaire was administered to patients before their first evaluation. Two questions asked about awareness of the surgeon's industry relationships and of the OPD. One question evaluated the importance of surgeon-industry relationships of patients when choosing a provider. Six questions assessed patient perception of specific types of surgeon-industry relationships. Lastly, each patient ranked specific types of surgeon-industry relationships (1-most concerning to 6-least/not concerning). The distribution of patient-perceptions was compared using a Friedman 2-way analysis of variance by Ranks test. Distributions across awareness were compared using a Kruskal-Wallis test.

RESULTS

A total of 205 patients completed the survey. A majority of patients were unaware of their surgeons' relationships with industry and the existence of the OPD. However, most patients considered surgeon-industry relationships an important, very important or most important part of choosing their physician. There were significant differences in how industry relationships affected patient perceptions. Research funding had the most positive impact on perception. Financial ownership was reported to be the most concerning relationship followed by royalty payments and consulting.

CONCLUSIONS

Our results suggest that despite a lack of awareness, most patients consider surgeon-industry relationships an important factor in choosing their doctor. Patients generally report a more positive view of surgeons that have active relationships with industry. These results emphasize the value of disclosure for surgeons; it provides transparency and improves their standing amongst a majority of their patients.

Industry Payments to Pediatric Orthopaedic Surgeons Reported by the Open Payments Database: 2014 to 2017

BACKGROUND

The Open Payments Database (OPD), mandated by the Sunshine Act, is a national registry of physician-industry transactions. Payments are reported as either General, Research, or Ownership payments. The current study aims to investigate trends in OPD General payments reported to pediatric orthopaedic surgeons from 2014 to 2017.

METHODS

General industry payments made to pediatric orthopaedic surgeons (as identified by OPD) were characterized by median payment, payment subtype, and census region. As fewer Research and Ownership payments were made, only payment totals for these categories were determined. General payment data were analyzed for trends using the nonparametric Mann-Whitney U test.

RESULTS

For General payments, there was an increase in the number of compensated pediatric orthopaedists from 2014 to 2017 (324 vs. 429). Of those compensated, there was no significant change in median payment per compensated surgeon ($201 vs. $197; P=0.82). However, a large percentage of total General payment dollars in pediatric orthopaedics were made to the top 5% of compensated pediatric orthopaedists each year (average 71% of total General industry compensation). For this top 5% group, median General payment per compensated surgeon increased from 2014 ($14,624) to 2017 ($32,752) (P=0.006). A significant increase in median subtype aggregate payment per surgeon was observed in the education (P<0.001) and royalty/license (P=0.031) subtypes; a significant decrease was observed for travel/lodging payments (P=0.01). Midwest pediatric orthopaedists received the highest median payment across all years studied. Few payments for research and ownership were made to pediatric orthopaedists. Four-year aggregate payment totals were $18,151 and $3,223,554 for Research and Ownership payments, respectively.

CONCLUSIONS

Many expected payments to surgeons to decrease when put under the public scrutiny of the OPD. Not only was this decrease not observed for General payments to pediatric orthopaedic surgeons during the 2014 to 2017 period, but also the median General payment to the top 5% increased. These findings are important to note in the current era of increased transparency.

LEVEL OF EVIDENCE

Level III.

Conflicts of Interest in Inflammatory Bowel Disease Articles on UpToDate

Background

Financial conflicts of interest (FCOIs) are widespread in inflammatory bowel disease (IBD) and may be particularly important in point-of-care (POC) resources, such as UpToDate, that are used to aid clinical decision making. In this study, we determined the prevalence of industry payments from companies making biologic medications for IBD to contributors of UpToDate articles on IBD.

Methods

This cross-sectional analysis included UpToDate articles that mention the use of biologic medications for IBD. We collected the names of the contributors (authors and editors) and their disclosures on UpToDate. We then searched for their names on the Center for Medicare and Medicaid Open Payments database and compared the payment information from 2013 to 2018 with UpToDate's disclosures. We presented data per episode, which describes one instance of participation by one person in one article, regardless of whether that person contributed to multiple articles.

Results

We identified 23 articles on the treatment of Crohn's disease and ulcerative colitis that mentioned the use of biologic medications, with 86 total episodes. Sixty-two (72%) episodes involved FCOIs. The median payment associated with each episode was $$55 (interquartile range = $44 to $145,241). Contributors did not fully disclose FCOIs in 41 (48%) episodes. Deputy editors, who are required to be free of FCOIs, in general did not have substantial episodes involving FCOI.

Conclusions

We found that UpToDate articles on inflammatory bowel disease involve substantial FCOI, many of which are not disclosed. The presence of these FCOIs may hamper trust in the objectivity of treatment recommendations.

Association of Biologic Prescribing for Inflammatory Bowel Disease With Industry Payments to Physicians

This economic evaluation examines whether pharmaceutical industry payments to gastroenterologists are associated with how often they prescribe the pharmaceuticals’ drugs for inflammatory bowel disease.

Evaluation of Industry Relationships Among Authors of Otolaryngology Clinical Practice Guidelines

Importance

Financial relationships between physicians and industry have influence on patient care. Therefore, organizations producing clinical practice guidelines (CPGs) must have policies limiting financial conflicts during guideline development.

Objectives

To evaluate payments received by physician authors of otolaryngology CPGs, compare disclosure statements for accuracy, and investigate the extent to which the American Academy of Otolaryngology-Head and Neck Surgery complied with standards for guideline development from the Institute of Medicine (IOM).

Design, Setting, and Participants

This cross-sectional analysis retrieved CPGs from the American Academy of Otolaryngology-Head and Neck Surgery Foundation that were published or revised from January 1, 2013, through December 31, 2015, by 49 authors. Data were retrieved from December 1 through 31, 2016. Industry payments received by authors were extracted using the Centers for Medicare & Medicaid Services Open Payments database. The values and types of these payments were then evaluated and used to determine whether self-reported disclosure statements were accurate and whether guidelines adhered to applicable IOM standards.

Main Outcomes and Measures

The monetary amounts and types of payments received by physicians who author otolaryngology guidelines and the accuracy of disclosure statements.

Results

Of the 49 physicians in this sample, 39 (80%) received an industry payment. Twenty-one authors (43%) accepted more than $1000; 12 (24%), more than $10 000; 7 (14%), more than $50 000; and 2 (4%), more than $100 000. Mean (SD) financial payments amounted to $18 431 ($53 459) per physician. Total reimbursement for all authors was $995 282. Disclosure statements disagreed with the Open Payments database for 3 authors, amounting to approximately $20 000 among them. Of the 3 IOM standards assessed, only 1 was consistently enforced.

Conclusions and Relevance

Some CPG authors failed to fully disclose all financial conflicts of interest, and most guideline development panels and chairpersons had conflicts. In addition, adherence to IOM standards for guideline development was lacking. This study is relevant to CPG panels authoring recommendations, physicians implementing CPGs to guide patient care, and the organizations establishing policies for guideline development.

Industry Consulting Payments to Orthopedic Surgeons Are Associated With Increased Publications

In accordance with the Physician Payment Sunshine Act, all industry payments to physicians in the United States have become publicly available. Previous research has indicated that orthopedic surgeons receive the greatest amount of industry compensation compared with other surgical subspecialists. However, the relationship between this compensation and research productivity is less clear. This study sought to investigate the relationship between consulting fees paid to orthopedic surgeons and academic productivity. Using the Centers for Medicare & Medicaid Services Open Payments Database, this study identified 2555 orthopedic surgeons who received at least one industry consulting fee in 2015. Physicians who received total consulting fees of at least $20,000 (US) were stratified into the high payment group. The number of publications and the h-index for each physician were used as metrics of scholarly impact. Mean publication number and h-index for the high payment group were compared with all other physicians in the sample using an independent-samples t test. A total of 2555 orthopedic surgeons received consulting payments totaling $62,323,143 in 2015. The mean consulting payment was $24,393 (SD, $45,465). The publication number was greater for the high payment group (mean, 61.6; SD, 135.6) compared with all other physicians in the sample (mean, 36.1; SD, 95.6). Additionally, the mean h-index for the high payment group was 13.7 (SD, 14.3) compared with 10.0 (SD, 11.6) for all other orthopedic surgeons. These findings indicate that the orthopedic surgeons who receive more in industry consulting fees are also those who contribute most substantially to the body of orthopedic literature. [Orthopedics. 2019; 42(3):137-142.].

Industry payments to physician journal editors

Background

Open Payments is a United States federal program mandating reporting of medical industry payments to physicians, increasing transparency of physician conflicts of interest (COI). Study objectives were to assess industry payments to physician-editors, and to compare their financial COI rate to all physicians within the specialty.

Methods and findings

We performed a retrospective analysis of prospectively collected data, reviewing Open Payments from August 1, 2013 to December 31, 2016. We reviewed general payments (“… not made in connection with a research agreement”) and research funding to “top tier” physician-editors of highly-cited medical journals. We compared payments to physician-editors and physicians-by-specialty. In 35 journals, 333 (74.5%) of 447 “top tier” US-based editors met inclusion criteria. Of these, 212 (63.7%) received industry-associated payments in the study period. In an average year, 141 (42.3%) of physician-editors received any direct payments to themselves including general payments and research payments, 66 (19.8%) received direct payments >$5,000 (National Institutes of Health threshold for a Significant Financial Interest) and 51 (15.3%) received >$10,000. Mean annual general payments to physician-editors was $55,157 (median 3,512, standard deviation 561,885, range 10–10,981,153). Median general payments to physician-editors were mostly higher compared to all physicians within their specialty. Mean annual direct research payment to the physician-editor was $14,558 (median 4,000, range 15–174,440). Mean annual indirect research funding to the physician-editor’s institution (highly valued by academic leaders such as departmental chairs and deans) was $175,282 (median 49,107, range 0.18–5,000,000). The main study limitation was difficulty identifying physician-editors primarily responsible for making manuscript decisions.

Conclusions

A substantial minority of physician-editors receive payments from industry within any given year, sometimes quite large. Most editors received payment of some kind during the four-year study period. Given the extent of editors’ influences on the medical literature, more robust and accessible editor financial COI declarations are recommended.

The Physician Payment Sunshine Act: Evaluating Industrial Payments in Radiology

RATIONALE AND OBJECTIVES

The characterization of payments made to physicians by pharmaceutical companies, device manufacturers, and group purchasing organizations is crucial for assessing potential conflicts of interest and their impact on practice patterns. This study examines the compensation received by general radiologists (GR) in the United States, as well as radiologists in the following five subspecialties: body imaging, neuroradiology, pediatric radiology, nuclear radiology and radiological physics, and vascular and interventional radiology.

MATERIALS AND METHODS

Data were extracted from the Open Payments database for radiology subspecialists in the United States who received installments in calendar year 2015 from pharmaceutical and device manufacturing companies.

RESULTS

In 2015, a total of $43,685,052 was paid in 65,507 payments (mean $667/payment; median $32/payment) to radiologists, including 9826 GR, 362 body imaging radiologists, 479 neuroradiologists, 127 pediatric radiologists, 175 physicians in nuclear radiology and radiological physics, and 1584 vascular and interventional radiologists. Payments were unequally distributed across these six major subspecialties of radiology (p < 0.01), with GR receiving the largest number of total payments (44,695), and neuroradiologists receiving significantly higher median payments than any other subspecialty ($80 vs $32 for all radiologists; p < 0.01). Medtronic Neurovascular was the single largest payer to all radiologists combined.

CONCLUSION

Commercial entities make substantial payments to radiologists, with a significant variation in payments made to the different radiology subspecialties. While the largest number of total payments was made to GGR, the highest median payments were made to neuroradiologists, and significant dispersion in these payments was seen across different geographic regions. The impact of these payments on practice patterns remains to be elucidated.

Industry Payments in Cardiology: A Cross-sectional Analysis of Open Payments Data

Background

The goal of Open Payments and the Physician Payments Sunshine Act is to foster transparency and accountability to help stakeholders better understand financial ties between physicians and teaching hospitals and the pharmaceutical and medical device industries.

Objective

To evaluate the nature of industry relationships among cardiologists using the Open Payments database.

Methods

The authors used the Centers for Medicare & Medicaid Services Open Payments data for calendar year 2015 to evaluate the financial relationship between cardiologists and medical industries (manufacturers of medications, devices, biologics, and medical supplies). The database used in this specific investigation included general payments reported for 2015. Payments were broken down by totals, type, company, and range.

Results

In the 2015 calendar year, 81,977 payments were made to 12,078 cardiologists, amounting to $13,906,167.43. The minimum payment made to a cardiologist was $1.16 and the maximum, $2,805,825. The most frequent category was $11 to $50, with 53,722 payments made (65.5%), followed by less than $10, with 12,307 payments made (15.0%).

Conclusion

Payments to cardiologists were highly variable. Additional studies regarding the effects of these payments may be warranted.

Prevalence of Financial Conflicts of Interest Among Authors of Clinical Guidelines Related to High-Revenue Medications

This study examines the presence and extent of undeclared financial conflicts of interest among authors of clinical practice guidelines related to high-revenue medications.

Financial Conflicts of Interest Among Authors of Endocrine Society Clinical Practice Guidelines

CONTEXT

There has been a proliferation of clinical practice guidelines in endocrinology and a coincident increased interest in transparency regarding relationships between physicians and industry.

EVIDENCE ACQUISITION

We collected self-reported disclosures and Open Payments data for 169 authors of 26 clinical practice guidelines published between 2010 and 2017 by the Endocrine Society. Conflicts of interest in which pharmaceutical and device companies manufactured drugs or products pertinent to an author's specific clinical practice guideline(s) were deemed relevant. Open Payments data were grouped into research and nonresearch (consultancies, honoraria, travel, food) categories.

EVIDENCE SYNTHESIS

We compared the policies of the Endocrine Society regarding seven conflict of interest recommendations issued by the National Academy of Medicine in 2011.

CONCLUSION

Relevant nonresearch financial conflicts of interest were self-reported by 42% of authors of clinical practice guidelines. Open Payments were recorded for 74% (84 of 113) of US authors between 2013 and 2016. Payments to 84 US authors totaled $5.5 million for nonresearch activities and $30.9 million for research. The nonresearch payments were divided into consulting (46%), honoraria (26%), travel (25%), and food (3%). The Endocrine Society partially follows the National Academy of Medicine recommendations to limit conflicts of interest. Readers should be aware of how clinical practice guidelines are developed and the policies of the organizations and journals that publish them. Professional societies and journal editors should strive to ensure that their policies and practices promote objective and unbiased clinical practice guidelines.

Mining Open Payments Data: Analysis of Industry Payments to Thoracic Surgeons From 2014-2016

Background

The financial relationship between physicians and industries has become a hotly debated issue globally. The Physician Payments Sunshine Act of the US Affordable Care Act (2010) promoted transparency of the transactions between industries and physicians by making remuneration data publicly accessible in the Open Payments Program database. Meanwhile, according to the World Health Organization, the majority of all noncommunicable disease deaths were caused by cardiovascular disease.

Objective

This study aimed to investigate the distribution of non-research and non-ownership payments made to thoracic surgeons, to explore the regularity of financial relationships between industries and thoracic surgeons.

Methods

Annual statistical data were obtained from the Open Payments Program general payment dataset from 2014-2016. We characterized the distribution of annual payments with single payment transactions greater than US $10,000, quantified the major expense categories (eg, Compensation, Consulting Fees, Travel and Lodging), and identified the 30 highest-paying industries. Moreover, we drew out the financial relations between industries to thoracic surgeons using chord diagram visualization.

Results

The three highest categories with single payments greater than US $10,000 were Royalty or License, Compensation, and Consulting Fees. Payments related to Royalty or License transferred from only 5.38% of industries to 0.75% of surgeons with the highest median (US $13,753, $11,992, and $10,614 respectively) in 3-year period. In contrast, payments related to Food and Beverage transferred from 93.50% of industries to 98.48% of surgeons with the lowest median (US $28, $27, and $27). The top 30 highest-paying industries made up approximately 90% of the total payments (US $21,036,972, $23,304,996, and $28,116,336). Furthermore, just under 9% of surgeons received approximately 80% of the total payments in each of the 3 years. Specifically, the 100 highest cumulative payments, accounting for 52.69% of the total, transferred from 27 (6.05%) pharmaceutical industries to 86 (1.89%) thoracic surgeons from 2014-2016; 7 surgeons received payments greater than US $1,000,000; 12 surgeons received payments greater than US $400,000. The majority (90%) of these surgeons received tremendous value from only one industry.

Conclusions

There exists a great discrepancy in the distribution of payments by categories. Royalty or License Fees, Compensation, and Consulting Fees are the primary transferring channels of single large payments. The massive transfer from industries to surgeons has a strong “apical dominance” and excludability. Further research should focus on discovering the fundamental driving factors for the strong concentration of certain medical devices and how these payments will affect the industry itself.

Time trends in the reporting of conflicts of interest, funding and affiliation with industry in intensive care research: a systematic review

PURPOSE

Conflict of interest (COI) may compromise, or have the appearance of compromising, a researcher's judgment or integrity in conducting or reporting research. We sought to assess time trends of COI and funding statement reporting in the critical care literature.

METHODS

PubMed was searched by using Medical Subject Headings and the appropriate corresponding keywords: "INTENSIVE CARE UNIT" or "ICU" as a major topic. Four years in a 15-year time period (2001-2016) were arbitrarily chosen and one study month was randomly selected for each study period. Studies published during the selected months were included in the analysis.

RESULTS

Three hundred and seventy-four studies were evaluated, including five reviews (1.3%) and ten randomized clinical trials (RCTs) (2.7%). COI statements were available in 65% of the studies and 8% had declared COI. COI statement rate, declared COI and funding statements increased over time, while the number of authors affiliated with industry and the discordance between the lack of COI statement and affiliation with industry decreased. Declared COI were more frequent in 2011-2016 as compared to 2001-2010 (OR 4.06; 95% CI 1.15-25.79) and in the higher quartile of a journal's impact factor (OR of 16.73; 95% CI 3.28-306.20). Surprisingly, focus of the study, country of the first author and/or endorsement of the study by a trial group were not associated with COI statements.

CONCLUSION

Our study suggests COI reporting to have been unintuitive to most investigators and unreliable before ICMJE statements, and that strong incentives are needed to implement adequate reporting of COI.

The Receipt of Industry Payments is Associated With Prescribing Promoted Alpha-blockers and Overactive Bladder Medications

OBJECTIVE

To determine the impact of physicians' financial relationships with the pharmaceutical industry on prescribing marketed alpha-blockers and overactive bladder (OAB) medications. We also aim to examine if the number or total value of transactions is influential.

MATERIALS AND METHODS

We linked the Open Payments Program database of industry payments to prescribers with Medicare Part D prescription data. We used binomial logistic regression to identify the association between receipt of industry payment and prescribing of marketed alpha-blockers (silodosin) and OAB medications (fesoterodine, solifenacin, and mirabegron). We also evaluated the impact of increasing total value and number of payments on prescribing of marketed drugs.

RESULTS

The receipt of industry payment was associated with increased odds of prescribing the marketed drug for all included drugs: silodosin (odds ratio [OR] 34.1), fesoterodine (OR 5.9), solifenacin (OR 2.7), and mirabegron (OR 6.8) (all P <.001). We also found that increasing value of total payment and increasing frequency of payments were both independently associated with increased odds of prescribing with a dose-response effect.

CONCLUSION

There is a consistent association between receipt of industry payment and prescribing marketed alpha-blockers and OAB medications. Both the total value and number of transactions were associated with prescribing.

Accuracy Between AJSM Author-Reported Disclosures and the Centers for Medicare and Medicaid Services Open Payments Database

BACKGROUND

Inaccurate disclosures of physician and industry relationships in scientific reporting may create an asymmetry of information by hiding potential biases. The accuracy of conflict of interest disclosure in sports medicine research is unknown.

PURPOSE

To compare author financial disclosures in published articles in 2016 in the American Journal of Sports Medicine ( AJSM) with the Centers for Medicare and Medicaid Services' Open Payments Database (OPD) to determine the percentage of payments values and percentage of eligible authors with discrepancies.

STUDY DESIGN

Cross-sectional study; no level of evidence (nonclinical).

METHODS

All articles published in 2016 in AJSM were screened to identify eligible authors. On the basis of OPD reporting, physician authors affiliated with a US institution were included. Stated disclosures in AJSM publications for these authors were identified and compared with industry-reported payments on OPD.

RESULTS

A total of 434 authors were included in this study. Mean and median total payments per author per year were $76,941 and $1692, respectively. The most commonly received payment was for food and beverage (81.3% of authors), followed by travel and lodging (45.4%) and consulting (31.8%). Authors with higher total payments were less likely to be discrepant in their reporting-notably, authors earning >$500,000 had 16.1% of payment values with discrepancy, as opposed to 85.3% for those earning <$10,000 ( P < .001). First authors had a lower percentage of payment values with discrepancy (13.8%) versus middle authors (31.9%, P = .001). Finally, men had a lower percentage of payment values with discrepancy (418 authors, 22.3% of payment values with discrepancy) as compared with women (16 authors, 95.3%; P < .001). Regarding industry payments specifically requested on the AJSM disclosure form for authors (royalties, consulting, research payments, and ownership and investments), only 25.3% of authors had a discrepancy in these payment categories in aggregate.

CONCLUSION

Discrepancies exist between disclosures reported by authors publishing in AJSM and what is reported in the OPD. Authors receiving lower total payments, middle authors, and women are more likely to have disclosure discrepancies. Additionally, industry research funding support and ownership interest are most likely to go unreported. However, this study did not assess whether authors with industry payments preferentially published studies pertaining to products from companies from which they received funding. As national registries such as the OPD are increasingly utilized, physicians may benefit from referencing such databases before submitting conflict of interest disclosures.

An Analysis of the Open Payment Database in Neurotology

Since the introduction of the Sunshine Act in 2010 and Open Payments Database (OPD) in 2013, a significant amount of data has been collected on physicians and the payments received through ties with pharmaceutical and medical device companies. To date, a study within the field of otology and neurotology using data from the 2015 OPD has not been conducted. As such, we assessed the validity and accuracy of OPD information for otologists and neurotologists (O&Ns). Of the 126 physicians listed as O&Ns in the OPD, 25 were actually general otolaryngologists, and 1 was a cardiologist. In addition, 88 O&Ns were misclassified by the OPD as general otolaryngologists. A total of 1156 payments, summing $1,966,204, were made to O&Ns as a whole, with 646, 507, and 3 payments classified as general, research, and ownership/investment interests, respectively. Analysis of OPD data for O&Ns demonstrates a significant financial relationship between O&N physicians and industry, as well as noteworthy inaccuracies in the OPD that likely affect other subspecialties.

An Evaluation of Industry Relationships Among Contributors to AAOS Clinical Practice Guidelines and Appropriate Use Criteria

BACKGROUND

A long-standing relationship between orthopaedic surgeons and industry has made financial conflicts of interest a concerning issue. Research supports that financial conflicts of interest can influence both medical research and clinical practice. Financial conflicts of interest may also influence clinical practice guideline recommendations and their corresponding appropriate use criteria. Because of the influential nature of these guidelines, it is imperative that care be taken to minimize bias during guideline development.

METHODS

We retrieved clinical practice guidelines and their corresponding appropriate use criteria from the American Academy of Orthopaedic Surgery that were published or revised between 2013 and 2016. We extracted industry payments received by physicians using the Centers for Medicare & Medicaid Services Open Payments database. We then evaluated the value and types of these payments. We also used these data to determine whether disclosure statements were accurate and whether guideline development was in adherence with the Institute of Medicine's (IOM's) standards.

RESULTS

Of the 106 physicians that were evaluated, 85 (80%) received at least 1 industry payment, 56 (53%) accepted >$1,000, and 35 (33%) accepted >$10,000. Financial payments amounted to a mean of $93,512 per physician. Total reimbursement for the 85 clinical practice guideline and appropriate use criteria contributors was $9,912,309. We found that disclosure statements disagreed with the Open Payments data and that the IOM standards were not completely enforced.

CONCLUSIONS

Clinical practice guideline and appropriate use criteria contributors received substantial payments from industry, many disclosure statements were inaccurate, and the IOM standards were not completely met.

CLINICAL RELEVANCE

Clinical practice guidelines and appropriate use criteria are critical for practicing evidence-based medicine. If financial conflicts of interest are present during their development, it is possible that patient care may be compromised.

Evaluating Industry Payments Among Dermatology Clinical Practice Guidelines Authors

Importance

It is well documented that financial conflicts of interest influence medical research and clinical practice. Prior to the Open Payments provisions of the Affordable Care Act, financial ties became apparent only through self-disclosure. The nature of financial interests has not been studied among physicians who develop dermatology clinical practice guidelines.

Objective

To evaluate payments received by physicians who author dermatology clinical practice guidelines, compare disclosure statements for accuracy, determine whether pharmaceutical companies from which the authors received payments manufactured products related to the guidelines, and examine the extent to which the American Academy of Dermatology enforced their Administrative Regulations for guideline development.

Design, Setting, and Participants

Three American Academy of Dermatology guidelines published from 2013 to 2016 were retrieved. Double data extraction was used to record financial payments received by 49 guideline authors using the Open Payments database. Payments received by the authors from the date of the initial literature search to the date of publication were used to evaluate disclosure statement accuracy, detail the companies providing payments, and evaluate Administrative Regulations enforcement. This study is applicable to clinical practice guideline panels drafting recommendations, physicians using clinical practice guidelines to inform patient care, and those establishing policies for guideline development.

Main Outcomes and Measures

Our main outcomes are the monetary values and types of payments received by physicians who author dermatology guidelines and the accuracy of disclosure statements. Data were collected from the Open Payments database and analyzed descriptively.

Results

Of the 49 authors evaluated, 40 received at least 1 reported industry payment, 31 accepted more than $1000, 25 accepted more than $10 000, and 18 accepted more than $50 000. Financial payments amounted to a mean of $157 177 per author. The total reimbursement among the 49 authors from 2013 to 2015 was $7 701 681. Of the 40 authors receiving payments, 22 did not accurately disclose industry relationships. Authors received payments from companies with products directly related to the guideline topic. Violations to the Administrative Regulations were found.

Conclusions and Relevance

Dermatology clinical practice guideline authors received sizable industry payments and did not completely disclose these payments. The American Academy of Dermatology policies may benefit from stricter enforcement or the adoption of new standards.

Evaluation of Industrial Compensation to Cardiologists in 2015

The categorization and characterization of pharmaceutical and device manufacturers or group purchasing organization payments to clinicians is an important step toward assessing conflicts of interest and the potential impact of these payments on practice patterns. Payments have not previously been compared among the subspecialties of cardiology. This is a retrospective analysis of the Open Payments database, including all installments and payments made to doctors in the calendar year 2015 by pharmaceutical and device manufacturers or group purchasing organization. Total payments to individual physicians were then aggregated based on specialty, geographic region, and payment type. The Gini Index was further employed to calculate within each specialty to measure income disparity. In 2015, a total of $166,089,335 was paid in 943,744 payments (average $175.00 per payment) to cardiologists, including 23,372 general cardiologists, 7,530 interventional cardiologists, and 2,293 cardiac electro-physiologists. Payments were mal-distributed across the 3 subspecialties of cardiology (p <0.01), with general cardiology receiving the largest number (73.5%) and total payments (62.6%) and cardiac electrophysiologists receiving significantly higher median payments ($1,662 vs $361 for all cardiologists; p <0.01). The Medtronic Company was the largest single payer for all 3 subspecialties. In conclusion, pharmaceutical and device manufacturers or group purchasing organizations continue to make substantial payments to cardiac practitioners with a significant variation in payments made to different cardiology subspecialists. The largest number and total payments are to general cardiologists, whereas the highest median payments are made to cardiac electrophysiologists. The impact of these payments on practice patterns remains to be examined.

Deciphering the Sunshine Act: Transparency Regulation and Financial Conflicts in Health Care

The Physician Payments Sunshine Act ("Sunshine Act"), enacted to address financial conflicts in health care, is the first comprehensive federal legislation mandating public reporting of payments between drug companies, device manufacturers, and medicine. This article analyzes the Sunshine Act's uneven record, exploring how the law serves as an intriguing example of the uncertain case for transparency regulation in health care. The Sunshine Act's bumpy rollout demonstrates that commanding transparency through legislation can be arduous because of considerable implementation challenges. Capturing all the relevant information about financial relationships and reporting it with sufficient contextual and comparative data has proven disappointingly difficult. In addition, the law suffers from uncertainty and poor design as to the intended audience. Indeed, there is strong reason to believe that it will not significantly impact decision-making of primary recipients like patients. Yet the Sunshine Act nonetheless retains important and perhaps underappreciated value. From the almost four years of information generated, we have learned that industry-medicine financial ties vary significantly by physician specialty, and somewhat by physician gender. In many medical fields the distribution of top dollar payments tends to be heavily skewed to a few recipients, all of which have important implications for optimal management of financial conflicts and for health policy more generally. Accordingly, the Sunshine Act's greatest potential is not guiding decisions of individual patients or physicians, but its downstream effects. This Article traces how secondary audiences, such as regulators, watchdogs, and counsel are already starting to make productive use of Sunshine Act information. Public reporting has, for example, made more feasible linking industry payment information with Medicare reimbursement data. As a result, policymakers can more closely examine correlations between industry spending directed at individual physicians and their prescribing and referral decisions. Moreover, savvy counsel are recognizing that Sunshine Act information provides explosive evidence in private civil litigation and this Article explores the first wave of cases.

The Effects of Public Disclosure of Industry Payments to Physicians on Patient Trust: A Randomized Experiment

BACKGROUND

Financial ties between physicians and the pharmaceutical and medical device industry are common, but little is known about how patient trust is affected by these ties.

OBJECTIVE

The purpose of this study was to evaluate how viewing online public disclosure of industry payments affects patients' trust ratings for physicians, the medical profession, and the pharmaceutical and medical device industry.

DESIGN

This was a randomized experimental evaluation.

PARTICIPANTS

There were 278 English-speaking participants over age 18 who had seen a healthcare provider in the previous 12 months who took part in the study.

INTERVENTIONS

Participants searched for physicians on an online disclosure database, viewed payments from industry to the physicians, and assigned trust ratings. Participants were randomized to view physicians who received no payment ($0), low payment ($250-300), or high payment (>$13,000) from industry, or to a control arm in which they did not view the disclosure website. They also were asked to search for and then rate trust in their own physician.

MAIN MEASURES

Primary outcomes were trust in individual physician, medical profession, and industry. These scales measure trust as a composite of honesty, fidelity, competence, and global trust.

KEY RESULTS

Compared to physicians who received no payments, physicians who received payments over $13,000 received lower ratings for honesty [mean (SD): 3.36 (0.86) vs. 2.75 (0.95), p < 0.001] and fidelity [3.19 (0.65) vs. 2.89 (0.68), p = 0.01]. Among the 7.9% of participants who found their own physician on the website, ratings for honesty and fidelity decreased as the industry payment to the physician increased (honesty: Spearman's ρ = -0.52, p = 0.02; fidelity: Spearman's ρ = -0.55, p = 0.01). Viewing the disclosure website did not affect trust ratings for the medical profession or industry.

CONCLUSIONS

Disclosure of industry payments to physicians affected perceptions of individual physician honesty and fidelity, but not perceptions of competence. Disclosure did not affect trust ratings for the medical profession or the pharmaceutical and medical device industry. ClinicalTrials.gov identifier: NCT02179632 ( https://clinicaltrials.gov/ct2/show/NCT02179632 ).

Payments by US pharmaceutical and medical device manufacturers to US medical journal editors: retrospective observational study

Objective To estimate financial payments from industry to US journal editors.Design Retrospective observational study.Setting 52 influential (high impact factor for their specialty) US medical journals from 26 specialties and US Open Payments database, 2014.Participants 713 editors at the associate level and above identified from each journal's online masthead.Main outcome measures All general payments (eg, personal income) and research related payments from pharmaceutical and medical device manufacturers to eligible physicians in 2014. Percentages of editors receiving payments and the magnitude of such payments were compared across journals and by specialty. Journal websites were also reviewed to determine if conflict of interest policies for editors were readily accessible.Results Of 713 eligible editors, 361 (50.6%) received some (>$0) general payments in 2014, and 139 (19.5%) received research payments. The median general payment was $11 (£8; €9) (interquartile range $0-2923) and the median research payment was $0 ($0-0). The mean general payment was $28 136 (SD $415 045), and the mean research payment was $37 963 (SD $175 239). The highest median general payments were received by journal editors from endocrinology ($7207, $0-85 816), cardiology ($2664, $0-12 912), gastroenterology ($696, $0-20 002), rheumatology ($515, $0-14 280), and urology ($480, $90-669). For high impact general medicine journals, median payments were $0 ($0-14). A review of the 52 journal websites revealed that editor conflict of interest policies were readily accessible (ie, within five minutes) for 17/52 (32.7%) of journals.Conclusions Industry payments to journal editors are common and often large, particularly for certain subspecialties. Journals should consider the potential impact of such payments on public trust in published research.

Factors Associated With Financial Relationships Between Spine Surgeons and Industry: An Analysis of the Open Payments Database

STUDY DESIGN

A retrospective review of Centers for Medicare and Medicaid Services Database.

OBJECTIVE

Utilizing Open Payments data, we aimed to determine the prevalence of industry payments to orthopedic and neurospine surgeons, report the magnitude of those relationships, and help outline the surgeon demographic factors associated with industry relationships.

SUMMARY OF BACKGROUND DATA

Previous Open Payments data revealed that orthopedic surgeons receive the highest value of industry payments. No study has investigated the financial relationship between spine surgeons and industry using the most recent release of Open Payments data.

METHODS

A database of 5898 spine surgeons in the United States was derived from the Open Payments website. Demographic data were collected, including the type of residency training, years of experience, practice setting, type of medical degree, place of training, gender, and region of practice. Multivariate generalized linear mixed models were utilized to determine the relationship between demographics and industry payments.

RESULTS

A total of 5898 spine surgeons met inclusion criteria. About 91.6% of surgeons reported at least one financial relationship with industry. The median total value of payments was $994.07. Surgeons receiving over $1,000,000 from industry during the reporting period represented 6.6% of the database and accounted for 83.5% of the total value exchanged. Orthopedic training (P < 0.001), academic practice setting (P < 0.0001), male gender (P < 0.0001), and West or South region of practice (P < 0.0001) were associated with industry payments. Linear regression analysis revealed a strong inverse relationship between years of experience and number of payments from industry (r = -0.967, P < 0.0001).

CONCLUSION

Financial relationships between spine surgeons and industry are highly prevalent. Surgeon demographics have a significant association with industry-surgeon financial relationships. Our reported value of payments did not include ownership or research payments and thus likely underestimates the magnitude of these financial relationships.

LEVEL OF EVIDENCE

3.

Public Awareness of and Contact With Physicians Who Receive Industry Payments: A National Survey

BACKGROUND

The Physician Payments Sunshine Act, part of the Affordable Care Act, requires pharmaceutical and medical device firms to report payments they make to physicians and, through its Open Payments program, makes this information publicly available.

OBJECTIVE

To establish estimates of the exposure of the American patient population to physicians who accept industry payments, to compare these population-based estimates to physician-based estimates of industry contact, and to investigate Americans' awareness of industry payments.

DESIGN

Cross-sectional survey conducted in late September and early October 2014, with data linkage of respondents' physicians to Open Payments data.

PARTICIPANTS

A total of 3542 adults drawn from a large, nationally representative household panel.

MAIN MEASURES

Respondents' contact with physicians reported in Open Payments to have received industry payments; respondents' awareness that physicians receive payments from industry and that payment information is publicly available; respondents' knowledge of whether their own physician received industry payments.

KEY RESULTS

Among the 1987 respondents who could be matched to a specific physician, 65% saw a physician who had received an industry payment during the previous 12 months. This population-based estimate of exposure to industry contact is much higher than physician-based estimates from the same period, which indicate that 41% of physicians received an industry payment. Across the six most frequently visited specialties, patient contact with physicians who had received an industry payment ranged from 60 to 85%; the percentage of physicians with industry contact in these specialties was much lower (35-56%). Only 12% of survey respondents knew that payment information was publicly available, and only 5% knew whether their own doctor had received payments.

CONCLUSIONS

Patients' contact with physicians who receive industry payments is more prevalent than physician-based measures of industry contact would suggest. Very few Americans know whether their own doctor has received industry payments or are aware that payment information is publicly available.

Bringing Transparency to Medicine: Exploring Physicians' Views and Experiences of the Sunshine Act

The Physician Payments Sunshine Act (PPSA) requires health care product manufacturers to report to the federal government payments more than $10 to physicians. Bringing unprecedented transparency to medicine, PPSA holds great potential for enabling medical stakeholders to manage conflicts of interest (COI) and build patient trust-crucial responsibilities of medical professionalism. The authors conducted six focus groups with 42 physicians in Chicago, IL, San Francisco, CA, and Washington, DC, to explore attitudes and experiences around PPSA. Participants valued the concept of transparency but were wary of the law's design and consequences. They downplayed PPSA's potential and felt it undermined public trust. Showing broad unawareness of COI, they dismissed the notion of industry influence and welcomed company "perks." Misapprehensions may leave physicians unprepared to advance the opportunities PPSA holds for professionalism. The authors offer recommendations for government and medicine to improve physicians' and other stakeholders' understandings and use of the data.