Evidence & Methods
Financial conflicts of interest can bias presented and published research. Thus, accurate disclosure is vital so that the audience (ie, listeners at a conference, readers of journal articles) can consider this information when analyzing the results.
The authors found that about half of the time there were significant discrepancies in the reporting of conflicts when comparing NASS disclosures from the annual meeting with published reports from two device manufacturers.
The information is important given recent concerns about conflicts of interest and reported research results in spine surgery literature. That said, there may be valid reasons for discrepancies, such as timing of disclosure and undefined dollar amounts depending on when consulting or royalty payments are received. Beyond this, there is limited literature to suggest that the amount of money received holds a linear relationship with potential bias. Clearly, however, given the increased and justified scrutiny of sponsored authors, aiming for accuracy in reporting is an important goal.
Although these payments to physicians by medical industries affect all areas of medicine, the field of orthopedic surgery and spine surgery are of special relevance given their well-established physician-industry relationships [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15]. The concerns about physician relationships with industry include potential financial conflicts of interest that may impact research, medical decision-making, and patient care. Consequently, financial relationships and interactions between orthopedic surgeons and medical device manufacturing companies are drawing greater attention [16], [17]. To increase transparency, disclosure of physician relationships with industry has become standard practice in medical journals and academic society meetings [11]. However, the definition of what constitutes appropriate disclosure continues to evolve [18].
Although few question the importance of increased financial transparency in the medical arena, the implementation of such disclosure reporting is complex and fraught with potential errors and inconsistencies. This has been highlighted in recent studies demonstrating that significant variability exists in the reporting of financial conflicts of interest by individual surgeons presenting in the same year at different spine surgery society meetings [10] and sports medicine society meetings [9]. In fact, in a separate study, Jegede et al. identified that surgeons had a difficult time simply deciphering what financial information was being asked for disclosure when reviewing instructions from journal or society meetings [8]. Other studies have also found inconsistencies between company payments and physician disclosures but these were done in the time before the passing of the PPSA and stricter disclosure guidelines [7], [11].
The purpose of the current study was to evaluate the accuracy of physician's self-reported, conflict-of-interest disclosures with the posted payments to these same physicians on the web sites of spine implant manufacturers in the period preceding the implementation of the PPSA. To this end, we analyzed payments to physicians that were made in 2010 by two large spine implant manufacturers, Medtronic and Depuy Spine Inc., and compared these with the monetary conflict-of-interest disclosures made by physicians who were participants at the 2011 annual meeting of the North American Spine Society (NASS). This conference and companies were chosen as the periods for disclosure reporting and posted payments were overlapping and should have been comparable.
