Numerous speakers at medical meetings fail to disclose financial conflicts, despite explicit requirements for them to do so.
“Disclosures by physicians are largely self-reported, but there is reason to suspect that this may change in the near future,” Dr. Kanu Okike of Brigham and Women's Hospital and Massachusetts General Hospital and colleagues wrote. “Legislation requiring all drug and device manufacturers to publicly disclose payments to physicians is currently pending in the U.S. Congress and has been met with widespread support.”
They analyzed payments made to physicians in 2007 by five makers of total hip and knee prostheses that together account for nearly 95% of the market. Payment listings were found on each company's Web site and included a range of direct and indirect expenditures (N. Engl. J. Med. 2009;361:1466-74).
The authors compared the payments with conflict-of-interest disclosures made by physicians who either presented at or served as board or committee members at the 2008 annual meeting of the American Academy of Orthopaedic Surgeons (AAOS).
A total of 1,347 payments were made to 1,162 physicians during 2007. Overall, 166 physicians received payments from multiple companies, and 282 payments exceeded $100,000. About a quarter of the payments (344) were made to presenters or board or committee members at the AAOS meeting.
In 70% of the 299 cases that could be evaluated for topic relatedness, the payment was directly related to the topic of the meeting presentation. Overall disclosure rate for the payments was 71%, including 79% for directly related payments, 50% for indirectly related payments, and 49% for unrelated payments.
The researchers also surveyed 91 physicians who did not disclose payments; 36 physicians responded to the survey. Reasons for nondisclosure included the payment being unrelated to the presentation topic (39%) and misunderstanding the disclosure requirements (14%). In addition, 11% of respondents said the payment had been disclosed but was inaccurately printed in the program.
The authors noted that the 43 nondisclosed payments relating directly to the presentations totaled $4.3 million.
A limitation of the study included assessing payment relatedness by comparing the presentation topic with the specialty of the companies in question, which “could have underestimated the number of unrelated payments and, consequently, the overall rate of disclosure,” they wrote.
As for their own disclosures, the authors noted that coauthors Dr. Mininder Kocher, Dr. Charles Mehlman, and Dr. Mohit Bhandari have received grants from or consulted for several medical device firms, including several of those mentioned in the study. No other conflicts of interest were reported.