A study in the New England Journal of Medicine today found that doctors, left to their own devices, do not always report potential conflicts of interest up to half the time.
The study led by Dr. Mininder Kocher of Children's Hospital Boston examined the issue of doctors disclosing conflicts by looking at the voluntary disclosures made by presenters at a 2008 conference of orthopaedic surgeons, comparing them with the records of payments made online.
Before the March 2008 annual meeting of the Academy of American Orthopedic Surgeons, physicians who were making presentations or serving on committees for the meeting were asked to list payments they received that could indicate potential conflicts of interest. About seven out of 10 physicians disclosed financial relationships that the device manufacturers had already made public, the authors concluded.
"The thrust has been voluntary disclosure from the physicians," Kocher said in an interview (with the Boston Globe). "Our study would suggest that that may not be so accurate and is difficult to validate."
The disclosure rate was higher for payments directly related to the topic the doctor was addressing at the meeting and lower for indirectly related topics. A talk about knee replacement results would be directly related to a physician's royalty payments for knee implants while a discussion of physical therapy regimens would not, Kocher said.
When contacted by Kocher's team about missing disclosures, the most common reason given was that the doctors felt the payments they received had nothing to do with the subject of their talks. The rate of non-disclosure ranged from 21 per cent to 50 per cent.
The doctors made presentations at the meeting or served as committee members, roles that required them to disclose the company payments. The five companies, which account for 95% of the market for hip and knee replacement prostheses, were forced to list the payments as part of a settlement of an investigation by the U.S. Justice Department.
About 30% of the time the doctors did not disclose their financial ties to the device firms, the study found. For payments that were directly related to their presentation, the non-disclosure rate was 21%. For payments that were deemed unrelated, the rate was 50%.
The doctors were required to disclose both related and non-related payments, although the system involved self-reporting.
The undisclosed payments totaled just over $12 million (US), and averaged about $151,000, Kocher said.
Te revelation comes as Republican Iowa Senator Charles Grassley pushes forward his proposal for a sunshine act in the US that would make the relationship between researchers and corporation more transparent.