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Tzortziou Brown V, McCartney M, Talaga P, Huxtable R, Papanikitas A, David-Barrett E. Policies on doctors' declaration of interests in medical organisations: a thematic analysis. J R Soc Med 2023; 116:295-306. [PMID: 37288549 PMCID: PMC10549255 DOI: 10.1177/01410768231181248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 04/25/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVES There has been growing concern about doctors' conflicts of interests (COIs) but it is unclear what processes and tools exist to enable the consistent declaration and management of such interests. This study mapped existing policies across a variety of organisations and settings to better understand the degree of variation and identify opportunities for improvement. DESIGN Thematic analysis. SETTING We studied the COI policies of 31 UK and international organisations which set or influence professional standards or engage doctors in healthcare commissioning and provision settings. PARTICIPANTS 31 UK and international organisations. MAIN OUTCOME MEASURES Organisational policy similarities and differences. RESULTS Most policies (29/31) referred to the need for individuals to apply judgement when deciding whether an interest is a conflict, with just over half (18/31) advocating a low threshold. Policies differed on the perception of frequency of COI, the timings of declarations, the type of interests that needed to be declared, and how COI and policy breaches should be managed. Just 14/31 policies stated a duty to report concerns in relation to COI. Only 18/31 policies advised COI would be published, while three stated that any disclosures would remain confidential. CONCLUSIONS The analysis of organisational policies revealed wide variation in what interests should be declared, when and how. This variation suggests that the current system may not be adequate to maintain a high level of professional integrity in all settings and that there is a need for better standardisation that reduces the risk of errors while addressing the needs of doctors, organisations and the public.
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Affiliation(s)
| | | | - Patrycja Talaga
- Wolfson Institute of Population Health, Queen Mary University of London, London, E1 4NS, UK
| | - Richard Huxtable
- Centre for Ethics in Medicine, Population Health Sciences, Bristol Medical School, Bristol, BS8 2PS, UK
| | - Andrew Papanikitas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
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Sutherland M, Sen-Crowe B, Shir A, McKenney M, Elkbuli A. Disclosure of Conflicts of Interest Among Speakers, Moderators, Presenters, and Discussants at National Trauma Meetings. Am Surg 2023; 89:362-371. [PMID: 34111975 DOI: 10.1177/00031348211025750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Official conference participants (OCPs) consisting of speakers, moderators, discussants, and presenters) with conflicts of interest (COI) could negatively influence the audience's ability to fairly evaluate information if their COI is not properly disclosed. We aim to examine the patterns of COI disclosures by OCPs and the nature and extent of financial compensation at 3 annual trauma conferences. METHODS A retrospective cohort analysis of COI disclosures of OCPs, in the EAST, WTA, and AAST Annual Meetings from 2016 to 2019. The Open Payments Database (OPD) was used to describe the nature and extent of financial compensation. Descriptive statistics and independent sample t-tests were performed with significance defined as P < .05. RESULTS Eastern Association for the Surgery of Trauma: conflicts of interest ranged from 3.8 to 6.0% of OCPs. Moderators, discussants, and presenters comprised decreasing proportions disclosing COIs, whereas speakers comprised an increasing proportion. Western Trauma Association: conflicts of interest ranged from 1.3 to 6.8% of OCPs. Moderators comprised an increasing proportion whereas speakers comprised a decreasing proportion. American Association for the Surgery of Trauma: conflicts of interest ranged from 3.6 to 5.4% of OCPs. Speakers, moderators, and presenters comprised progressively decreasing proportions, whereas discussants comprised an increasing proportion. Participants who did not disclose a COI comprised the majority of payment recipients in the OPD. CONCLUSION Official conference participants who disclosed a COI varied between EAST, WTA, and AAST Annual Meetings from 2016 to 2019. Implementation of standardized COI disclosure policies with explicitly communicated definitions/categories can maximize the participants' understanding of the disclosure process, translate into improved COI reporting, and preserve an evidence-based environment that is free from commercial influence for physicians to teach and learn.
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Affiliation(s)
- Mason Sutherland
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Brendon Sen-Crowe
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Adam Shir
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA.,Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA
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Ha G, Gray R, Clappier M, Tanna N, Kasabian AK. Conflict of Interest at Microsurgery Conferences: Disclosure of Its Extent and Nature. J Reconstr Microsurg 2021; 38:390-394. [PMID: 34500478 DOI: 10.1055/s-0041-1735260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Industry relationships and conflicts of interest can impact research funding, topics, and outcomes. Little research regarding the role of biomedical companies at microsurgery conferences is available. This study evaluates the role of industry at conferences by comparing payments received by speakers at the American Society for Reconstructive Microsurgeons (ASRM) meeting with those received by speakers at the American Society of Aesthetic Plastic Surgeons (ASAPS) meeting, the American Society of Plastic Surgeons (ASPS) meeting, and an average plastic surgeon. It also compares payments made by different companies. METHODS General payments received by speakers at the 2017 ASAPS, ASPS, and ASRM conferences were collected from the Open Payments Database. Mean payments received at each conference were calculated and the Mann-Whitney U test evaluated differences between conference speakers and the average plastic surgeon. The total amount of payments from each company was collected through the Open Payments Database, and Z-tests identified which companies paid significantly more than others. RESULTS The mean (and median) general payments made to conference speakers at ASAPS (n = 75), ASPS (n = 247), and ASRM (n = 121) were $75,577 ($861), $27,562 ($1,021), and $16,725 ($652), respectively. These payments were significantly greater (p < 0.001 for all) than those of the average plastic surgeon ($4,441 and $327), but not significantly different from each other. Allergan contributed significantly more than other companies to speakers at ASPS and ASAPS, while LifeCell Corporation, Zimmer Biomet Holdings, and Axogen contributed significantly more to speakers at ASRM. CONCLUSION Payments to physicians at ASRM were significantly higher than those of an average plastic surgeon but not significantly different from those of speakers at ASAPS and ASPS. Certain companies paid significantly more than their peers at each conference. Given these findings, speakers should strive to make clear the nature and extent of their conflicts of interest when presenting at conferences.
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Affiliation(s)
- Grace Ha
- Division of Plastic & Reconstructive Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Rachel Gray
- Division of Plastic & Reconstructive Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Mona Clappier
- Division of Plastic & Reconstructive Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Neil Tanna
- Division of Plastic & Reconstructive Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Armen K Kasabian
- Division of Plastic & Reconstructive Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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Tisherman RT, Couch BK, Reddy RP, Tisherman SA, Shaw JD. Conflict of interest disclosure in orthopaedic and general surgical trauma literature. Injury 2021; 52:2148-2153. [PMID: 33812702 DOI: 10.1016/j.injury.2021.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 02/27/2021] [Accepted: 03/03/2021] [Indexed: 02/02/2023]
Abstract
SIGNIFICANCE Financial relationships between industry and physicians are a key aspect for the advancement of surgical practice and training, but these relationships also result in a conflict of interest with respect to research. Financial payments to physicians are public within the United States in the Open Payments Database, but the rate of accurate financial disclosure of payments has not previously been studied in trauma surgery publications. OBJECTIVE To determine the rate of accurate financial disclosure in major surgical trauma journals compared with the Open Payments Database. MATERIALS AND METHODS The names of all authors publishing in The Journal of Orthopaedic Trauma, Injury, and The Journal of Trauma and Acute Care Surgery between 2015 and 2018 were obtained from MEDLINE. Non-physicians, physicians outside of the United States, physicians without payments in the Open Payments Database, and physicians with payments types of only "Food and Drink" were excluded. Financial disclosure statements were obtained from the journal websites and manually compared against Open Payments Database entries the year prior to submission and during the year of submission up until 3 months prior to publication for each individual physician. Main outcomes were accuracy of disclosure published with each article, total amount of payments received (disclosure or undisclosed), surgical subspecialty of the reporting physician. Statistical comparisons were made using Chi-square testing with significance defined as p<0.05. RESULTS Between 2015 and 2018, 5070 articles were published involving 28,948 authors. 2945 authors met inclusion criteria. 490 authors accurately disclosed their financial relationships with industry (16.6%). The median value of undisclosed payments was $22,140 [IQR $6465, $77,221] which was significantly less than the medial value of disclosed payment of $66,433 [IQR $24,624, $161,886], p<0.001 Orthopaedic surgeons disclosed at a higher rate (26.3%, 479/1818) than general surgeons (4.8%, 47/971), p<0.001. CONCLUSIONS Physician-industry relationships are key for advancing surgical practice and providing training to physicians. These relationships are not inherently unethical, but there is consistently high inaccuracy of financial disclosure across multiple trauma surgery journals which may indicate the need for further education on financial disclosures during surgical training or active obtainment of publicly available financial disclosures by journals.
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Affiliation(s)
- Robert T Tisherman
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 1010, Pittsburgh, PA 15213, United States
| | - Brandon K Couch
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 1010, Pittsburgh, PA 15213, United States
| | - Rajiv P Reddy
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 1010, Pittsburgh, PA 15213, United States
| | - Samuel A Tisherman
- Department of Surgery, University of Maryland School of Medicine, United States
| | - Jeremy D Shaw
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 1010, Pittsburgh, PA 15213, United States.
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Tian T, Shah AY, Darling J, Zaepfel C, Chatterjee A, Iafrati M, Salehi P. Assessment of Self-Reported Financial Conflicts of Interest in Vascular Surgery Studies. J Vasc Surg 2021; 74:2047-2053. [PMID: 34171423 DOI: 10.1016/j.jvs.2021.05.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 05/11/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION With increased collaboration between surgeons and industry, there has been a push towards improving transparency of conflicts of interest (COI). This study aims to determine the accuracy of reporting of COIs among studies in major vascular surgery journals. METHODS A literature search identified all comparative studies published from January 2018 - December 2018 from three major United States vascular surgery journals (Journal of Vascular Surgery, Vascular and Endovascular Surgery, and Annals of Vascular Surgery). Industry payments were collected using the Centers for Medicare & Medicaid Services (CMS) Open Payments database. COI discrepancies were identified by comparing author declaration statements with payments found for the year of publication and year prior. RESULTS A total of 239 studies (1642 authors) were identified. Two hundred twenty-one studies (92%) and 669 authors (63%) received undisclosed payments when utilizing a cut-off payment amount of $250. In 2018, 10,778 payments (totaling $22,174,578) were made by 145 companies. Food and beverage payments were the most commonly reported transaction (42%), but accounted for only 3% of total reported monetary values. Authors who accurately disclosed payments received significantly higher median general payments compared to authors who did not accurately disclose payments ($56,581 [IQR: $2441 - $100,551] vs $2,361 [IQR: $525 - $9,699], p < .001). When stratifying by dollar-amount discrepancy, the proportions of authors receiving undisclosed payments decreased with increasing payment thresholds. Multivariate analysis demonstrated that first and senior authors were both significantly more likely to have undisclosed payments (OR 2.0, 95% CI 1.1-3.6 and OR 2.9, 95% CI 1.6-5.2, respectively). CONCLUSIONS There is a significant discordance between self-reported COI in vascular surgery studies compared to payments received in the CMS Open Payments database. This study highlights the need for increased efforts to both improve definitions of what constitutes a relevant COI and encourage a standardized reporting process for vascular surgery studies.
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Affiliation(s)
- Tina Tian
- Department of Surgery, Tufts Medical Center; Boston, MA
| | - Anand Y Shah
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center; Boston, MA
| | | | - Charlie Zaepfel
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center; Boston, MA
| | - Abhishek Chatterjee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center; Boston, MA
| | - Mark Iafrati
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center; Boston, MA
| | - Payam Salehi
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center; Boston, MA.
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Lois AW, Ehlers AP, Minneman J, Oh JS, Khandelwal S, Wright AS. Disclosure at #SAGES2018: An analysis of physician–industry relationships of invited speakers at the 2018 SAGES national meeting. Surg Endosc 2019; 34:2644-2650. [DOI: 10.1007/s00464-019-07037-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 07/24/2019] [Indexed: 11/28/2022]
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Hughes JD, Shin JJ, Albers M, Musahl V, Fu FH. A Closer Look at the Relationship Between Industry and Orthopaedic Sports Medicine Surgeons. Orthop J Sports Med 2019; 7:2325967118823175. [PMID: 30733974 PMCID: PMC6344948 DOI: 10.1177/2325967118823175] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: A recent study demonstrated that discrepancies exist between disclosures reported by authors publishing in The American Journal of Sports Medicine and disclosures listed in the Physician Payments Sunshine Act–initiated Open Payments database, managed by the Centers for Medicare & Medicaid Services (CMS). However, no study to date has explored the relationship between the biopharmaceutical and device industry (industry) and the membership base of the American Orthopaedic Society for Sports Medicine (AOSSM). Purpose: To critically examine the relationship between orthopaedic sports medicine surgeons and industry. Study Design: Cross-sectional study. Methods: The publicly available CMS Open Payments database website was accessed to search for sports medicine orthopaedic surgeons in the United States who were members of the AOSSM. Financial data, specifically general, research, and ownership payments for 2015, were recorded for each surgeon. The American Academy of Orthopaedic Surgeons (AAOS) disclosures of each surgeon were then obtained. Descriptive statistics and simple proportions were calculated to summarize the collected data, including years in practice and amount of payment. Median values for general payments were compared to provide a more accurate reflection of payments transferred to a “typical” sports medicine surgeon. Results: A total of $58,113,561 in general payments, $3,996,051 in research payments, $72,481,814 in money invested, and $144,552,383 in interest earned from money invested were identified as being paid to 2274 surgeons (all amounts in US$). The distribution of total general payments received was skewed: 10% of surgeons received 95.4% ($55,463,183) of the total general payments. A total of 1433 surgeons had completed, up-to-date AAOS disclosures. Although 44% (635 surgeons) self-reported no financial conflict to the AAOS, the Open Payments database indicated some level of industry support to these surgeons. Unreported general payments totaled $1,393,212, or a median of $561 per surgeon (interquartile range, $10-$200,048). Conclusion: Although orthopaedic sports medicine surgeons received substantial payments from industry, most of the total general payments were given to a small proportion of people. The regional distribution of these payments did not differ significantly. Summary reports of data are largely skewed by outliers and should be interpreted with caution. However, a large percentage of these surgeons failed to reveal industry support of any kind in their AAOS disclosures, including meals and educational funding, demonstrating the importance of transparency and accuracy when completing financial disclosures.
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Affiliation(s)
| | - Jason J Shin
- UPMC Rooney Sports Complex, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Marcio Albers
- UPMC Rooney Sports Complex, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- UPMC Rooney Sports Complex, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Freddie H Fu
- UPMC Rooney Sports Complex, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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