Orthopedic Surgeons: What We've Got Here Is Failure to Disclose

The recent publication of commercial payments to physicians allows anyone to compare these data with information disclosed by the very same physicians. And that's just what a few orthopedic surgeons systematically did. Their analysis of their colleagues' disclosures, or lack thereof, is available in the latest issue of the NEJM.

The authors compared online reports of payments in 2007 from the 5 major prosthetic-joint companies (Biomet, DePuy, Smith and Nephew, Stryker, and Zimmer)* with payments voluntarily disclosed by physician participants at the annual meeting of the American Academy of Orthopedic Surgeons (AAOS).

Their findings:

• About one quarter of the commercial payments in 2007 (344/1347) were made to physicians who were AAOS meeting presenters, committee members, or board members in 2008.
• 146 (42%) of these payments exceeded $100,000 (each); 135 (39%) ranged from $10,000 to $100,000; and 63 (18%) were less than $10,000. (From Figure 2, it appears that close to 40 payments exceeded $1 million each.)
• In most cases, payments were made directly to physicians (78% of payments) and were directly related to the presentation topic (70% of payments).
• The overall disclosure rate was 71% (245/344 payments)—meaning that nearly 30% of payments to orthopedic surgeons were not voluntarily disclosed, despite the fact that the meeting's disclosure instructions were broad.**
• Compliance with disclosure was somewhat higher for direct payments (79%) and was substantially lower for indirect payments (50%). (An indirect payment is made through another company or organization—for instance, a medical-education communications company, or MECC.)
• The total amount of undisclosed direct payments (n = 43) exceeded $4 million; the total amount of undisclosed indirect payments (n = 16) exceeded $7 million.
• Payments were more likely to be disclosed if they exceeded $10,000, were given to an individual physician, or included in-kind support.
• Reasons for nondisclosure (from those few nondisclosing, surveyed physicians who responded) included 1) the payment was unrelated to the presentation topic; 2) the disclosure requirements were misunderstood; or 3) the disclosure was incorrectly printed.

* The companies' publication of physician payments in 2007 was required as part of a DoJ settlement.

** The meeting participant was directed to make a disclosure "if he or she has received something of value from a commercial company or institution, which relates directly or indirectly to the subject of their presentation."