Friday, October 9, 2009

Disclosures Reported by The New England Journal of Medicine

On October 8th, the New England Journal of Medicine published an abstract entitled; "Accuracy of Conflict-of-Interest Disclosures Reported by Physicians" based on a survey taken at the AAOS Meeting in San Francisco.

As Americans' become more aware of "payments made to physicians," a by product of the DOJ's settlement with Stryker, DePuy, Smith and Nephew, Biomet, and Zimmer, the authors of this special article believed that this provided them with an opportunity to assess the accuracy of physicians' conflict-of-interest disclosures. The authors posed an excellent analysis as to their concerns. These included that the investigator/physician may have a financial conflict of interest in their observations, potentially suppressing negative results so that a company can commercially benefit from a biased study design, and they questioned the ethical behavior of the investigators.

The most notable finding of this abstract was the high rate of non-disclosure. During 2007, the fact remains that 1347 payments were made to 1162 physicians, in which 166 physicians received multiple payments from multiple companies. 147 physicians received payment form at least two companies, 18 physicians received payment from at least 3 companies, and 1 physicians received payment from at least 4 companies. The overall disclosure rate was 79.3%, while the non-disclosure rate was 20.7%. 282 physicians received payment that exceeded $100,000, and 47 physicians received compensation in excess of $1 million.

TSB wonders what these figures would look like if NASS did an analysis of all the surgeons that are on the payroll of various spine companies? We had the opportunity to review 2007 and 2008 NASS programs for the last few years, only to determine that we could have a field day. TSB realizes that some of our readers are compelled to question our intentions. But let's face facts, even if you have a great product, how do you sell in a market when everyone is on the take (a nice commentator on the ethical behavior of surgeons and distributors). Recently, one of our readers told us of attempting to sell a product to a group of surgeons', only to find out that the surgeons' had invested into a competitor's company. What if the product is not as good? Is the patient getting the best product? Possibly? And, then the bigger question must be posed; "Is the surgeon the gatekeeper and advocate for his patient, or, is he or she a slave to their master, the company or distributor that pays them?"

The unethical actions of a few, will come back to haunt the industry, it's inevitable. TSB wants to know what our readers believe?


  1. The disclosures at NASS last year appeared to show an interesting trend: either disclose all 25+ companies from which one has received anything from a sandwich to x million in royalties, or disclose nothing. The thought behind this is probably something like this: "if people see how many companies think I'm worth paying for, I must be really good, and they will realize that by having so many pay masters I can be be completely honest and scientific." If only it worked that way. That said, the non-disclosure rate at NASS must be higher than 20.7%. And why are the Zimmers and DePuys and Strykers disclosing their consultants for hips and knees, and not for spine? Hmmm.... MM, you write about the unethical actions of a few. I hope that you are right, but live in fear.

  2. Cerevertebral: unless I misunderstood what you wrote, I NEVER LIVE IN FEAR, considering that I have never done anything unethical in the business. It would be nice competing on an even playing field. It's like steroid use, just because a lot of people are doing it, doesn't me that it is good for you or your health! I think you get the analogy. Thanks for your commentary

  3. MM you misunderstood; I don't live in fear because of my actions, but because I think the 'few' in reality may turn out to be 'many'. Let's wait and see.