A study released on September 13 reveals that consultants who received payments of $1 million or more from orthopedic manufacturers, including DePuy, Stryker, Biomet, and Smith & Nephew, failed to disclose the financial relationship when publishing articles about the orthopedic industry in medical journals.
The study, completed by Columbia University professor David J. Rothman and two Columbia researchers and published online at The Archives of Internal Medicine, examines orthopedic surgeon researchers who received at least $1 million dollars from and acted as consultants for the major orthopedic manufacturers named above in 2007. In 2008, those researchers went on to publish articles in medical journals that related to the companies. According to the report, those articles included studies, reviews and analyses intended to influence patient care.
The new findings raise questions about the lack of transparency in publications about drug and medical device companies, which are primarily read by medical professionals who are not aware that a conflict of interest exists. This could have a significant influence on the way patients are treated. Rothman explained that, “Patients have a real stake in transparency. You want to make sure that the surgeon is choosing the device that is best for you and that your doctor is not getting biased information. The system is broken if you can’t follow million-dollar payments to physicians by companies, and that’s the situation.”
It remains uncertain whether the doctors or the medical journals where the studies were published failed to disclose the payments. What is known is that in 2007, the five orthopedic companies paid a total of around $250 million to consultants: DePuy Orthopaedics paid $63 million; Stryker, $45 million; Biomet, $27 million; and Smith and Nephew paid $24 million.
According to the study, nearly half of the total, or $114 million, was paid to 41 doctors. 32 of those doctors authored pieces about specific devices, such as hip or knee implants made by the companies, that appeared in orthopedic journals in 2008. Rothman and his colleagues used a sample of 95 doctor-authored articles and found that more than half of them failed to mention financial ties to an orthopedic company. Although 44 of the published articles reported the industry payments, only seven mentioned the specific amount paid, and even then only stated it was more than $10,000. The largest payout was nearly $9 million.
In the future, payments from drug, device, and medical supply companies to doctors are required to be listed in a public database, as mandated by the Patient Protection and Affordable Care Act. This should help reduce what Dr. Marcia Angell, formerly of The New England Journal of Medicine called, “…one more indication of the widespread corruption of the medical profession by industrial money.”