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Dubin JA, Hameed D, Baksh N, Bains SS, Mont MA, Nace J, Delanois RE, Golladay G. Impact of Reporting Bias, Conflict of Interest, and Funding Sources on Quality of Orthopaedic Research. J Arthroplasty 2024; 39:1348-1352. [PMID: 37972663 DOI: 10.1016/j.arth.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Influence of factors like reporting outcomes, conflicts of interest, and funding sources on study outcomes, particularly positive outcomes in orthopedics, remains underexplored. As transparency of partnerships in orthopaedic surgery through conflicts of interest statements has increased over the years, there has been a lack of focus on the value of these partnerships in influencing study outcomes. We aimed to investigate the associations between reporting outcomes, conflicts of interest, and sources of funding on study outcomes. METHODS We reviewed articles published in 1 year in The Journal of Bone and Joint Surgery, The American Journal of Sports Medicine, and The Journal of Arthroplasty. The abstracts were examined for appropriate inclusion, while the authors' names, academic degrees, funding disclosures, and departmental and institutional affiliations were redacted. There were a total of 1,351 publications reviewed from January 1, 2021 to December 31, 2021. RESULTS A significant association was found between positive outcomes and reported conflicts of interest (75% versus 25%, P < .001). Likewise, conflicts of interest showed significant association with industry-sponsored studies (88% versus 12%, P < .001) and evidence level > II (72% versus 28%, P < .001). Industry-sponsored research accounted for the highest percentage of studies involving a conflict of interest (88%) and level I studies (12%). CONCLUSIONS Conflicts of interest are significantly associated with positive outcomes in orthopaedics. Sponsored studies were more inclined to have conflicts of interest and accounted for the majority of level I studies.
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Affiliation(s)
- Jeremy A Dubin
- Rubin Institute for Advanced Orthopedics Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Daniel Hameed
- Rubin Institute for Advanced Orthopedics Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Nayeem Baksh
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), Brooklyn, New York
| | - Sandeep S Bains
- Rubin Institute for Advanced Orthopedics Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics Sinai Hospital of Baltimore, Baltimore, Maryland
| | - James Nace
- Rubin Institute for Advanced Orthopedics Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Gregory Golladay
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), Brooklyn, New York; Department of Orthopaedic Surgery, Virginia Commonwealth University Health, Richmond, Virginia
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Melo DL, Islam T, Nasser K, Bédard ELR, Turner SR. Conflict of interest disclosure by US cardiothoracic surgeons. World J Surg 2024; 48:723-728. [PMID: 38323663 DOI: 10.1002/wjs.12094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/06/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Surgeon-industry collaboration is a key driver of advancement in surgical technology and practice. Disclosures of financial relationships between investigators and industries are important to ensure transparent and critical evaluation of literature. METHODS All American cardiothoracic (CT) surgeons who published in three major CT surgery journals in 2019 were identified. Whether these surgeons disclosed any conflicts of interest was recorded and compared to actual payments received within 5 years of publication as reported by the Centers for Medicare and Medicaid Services data. RESULTS In the study period, there were 1079 unique manuscripts involving 885 American CT surgeons as authors, which combined for 2719 author instances. Of these, 96.2% of authors (851 of 885) received payments from companies. The authors who received payments produced 2651 author instances (97.4%). Financial disclosure was reported in only 11.4% (301 of 2651) of these instances. In total, 851 surgeons received more than $187 million over 5 years, with the highest-paid surgeon receiving an average of over $5.9 million per year. The largest individual payments were from "Associated Research Funding," with over $115 million being paid to 277 surgeons over 5 years. The top paying company issued over $96.5 million to American CT surgeons over 5 years. CONCLUSIONS Nearly all the reviewed publications in three top CT surgery journals were by surgeons who received payments from companies, but very few of these payments were recorded as potential conflicts of interest. A more consistent and robust policy of COI disclosure is needed to reduce perceptions of bias.
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Affiliation(s)
- Dyanna L Melo
- Division of Thoracic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Taufiq Islam
- Division of Thoracic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Khadija Nasser
- Division of Thoracic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Eric L R Bédard
- Division of Thoracic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Simon R Turner
- Division of Thoracic Surgery, University of Alberta, Edmonton, Alberta, Canada
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Khunte M, Zhong A, Wu X, Payabvash S, Gandhi D, Forman HP, Malhotra A. Distribution and Disparities of Industry Payments to Radiologists (2016-2020). Acad Radiol 2023; 30:3056-3063. [PMID: 37210267 DOI: 10.1016/j.acra.2023.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND The frequency, magnitude, and distribution of industry payments to radiologists are not well understood. RATIONALE AND OBJECTIVES The aim of this study was to analyze the distribution of industry payments to physicians working in diagnostic radiology, interventional radiology, and radiation oncology, study the categories of payments and determine their correlation. MATERIALS AND METHODS The Open Payments Database from the Centers for Medicare & Medicaid Services was accessed and analyzed for the period from January 1, 2016 to December 31, 2020. Payments were grouped into six categories: consulting fees, education, gifts, research, speaker fees, and royalties/ownership. The total amount and types of industry payments going to the top 5% group were determined overall and for each category of payment. RESULTS From 2016 to 2020, a total of 513 020 payments, amounting to $370 782 608, were made to 28 739 radiologists suggesting that approximately 70% of the 41 000 radiologists in the US received at least one industry payment during the 5-year period. The median payment value was $27 (IQR: $15-$120) and the median number of payments per physician over the 5-year period was 4 (IQR: 1-13). Gifts were the most frequent payment type made (76.4%), but accounted for only 4.8% of payment value. The median total value of payments earned by members of the top 5% group over the 5-year period was $58 878 (IQR: $29 686-$162 425) ($11 776 per year) compared to $172 (IQR: $49-877) ($34 per year) in the bottom 95% group. Members of the top 5% group received a median of 67 (IQR: 26-147) individual payments (13 payments per year) while members of the bottom 95% group received a median of 3 (IQR: 1-11) (0.6 payments per year). CONCLUSION Between 2016 and 2020, industry payments to radiologists were highly concentrated both in terms of number/frequency and value of payments.
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Affiliation(s)
- Mihir Khunte
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT 06520-8042 (M.K., S.P., H.P.F., A.M.)
| | - Anthony Zhong
- Harvard Medical School, Boston, Massachusetts (A.Z.)
| | - Xiao Wu
- Department of Radiology, University of California at San Francisco, San Francisco, California (X.W.)
| | - Seyedmehdi Payabvash
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT 06520-8042 (M.K., S.P., H.P.F., A.M.)
| | - Dheeraj Gandhi
- Department of Radiology, Neurology and Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland (D.G.)
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT 06520-8042 (M.K., S.P., H.P.F., A.M.)
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT 06520-8042 (M.K., S.P., H.P.F., A.M.).
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Ware JW, Venere K, Miller SA, Freeman H, Scalzitti DA, Hoogeboom T. A Systematic Appraisal of Conflicts of Interest and Researcher Allegiance in Clinical Studies of Dry Needling for Musculoskeletal Pain Disorders. Phys Ther 2023; 103:pzad023. [PMID: 37384639 DOI: 10.1093/ptj/pzad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 10/03/2022] [Accepted: 12/23/2022] [Indexed: 07/01/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the frequency and methods of conflicts of interest (COI) reporting in published dry needling (DN) studies and to determine the frequency of researcher allegiance (RA). METHODS A pragmatic systematic search was undertaken to identify DN studies that were included in systematic reviews. Information regarding COI and RA were extracted from the full text of the published DN reports, and study authors were sent a survey inquiring about the presence of RA. A secondary analysis also was undertaken based on study quality/risk of bias scores that were extracted from the corresponding systematic reviews and study funding extracted from each DN study. RESULTS Sixteen systematic reviews were identified, containing 60 studies of DN for musculoskeletal pain disorders, 58 of which were randomized controlled trials. Of the DN studies, 53% had a COI statement. None of these studies disclosed a COI. Nineteen (32%) authors of DN studies responded to the survey. According to the RA survey, 100% of DN studies included at least 1 RA criterion. According to the data extraction, 1 RA criterion was met in 45% of the DN studies. The magnitude of RA per study was 7 times higher according to the surveys than in the published reports. CONCLUSION These results suggest that COI and RA might be underreported in studies of DN. In addition, authors of DN studies might be unaware of the potential influence of RA on study results and conclusions. IMPACT Improved reporting of COI/RA might improve credibility of results and help identify the various factors involved in complex interventions provided by physical therapists. Doing so could help optimize treatments for musculoskeletal pain disorders provided by physical therapists.
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Affiliation(s)
- John W Ware
- Infirmary Therapy Services, Mobile, Alabama, USA
| | - Kenny Venere
- Department of Rehabilitation Medicine, New York University Langone Medical Center, New York, New York, USA
| | - Stephanie A Miller
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, Indiana, USA
| | - Heather Freeman
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, Indiana, USA
| | - David A Scalzitti
- Department of Health, Human Function, & Rehabilitation Sciences, George Washington University, Washington, DC, USA
| | - Thomas Hoogeboom
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
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Alawi SA, Grigorescu O, Bota O, Dragu A. [The Impact of Industrial Sponsorship on Research Findings in Randomised Clinical Trials in Plastic and Aesthetic Surgery: a Cross- Section Analysis of the Past 12 Years]. HANDCHIR MIKROCHIR P 2023; 55:132-139. [PMID: 36758580 DOI: 10.1055/a-1996-1894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Industry funding of research studies can cause the results in the field of plastic, reconstructive and aesthetic surgery to be biased towards the sponsors. This paper aims to review randomised clinical trials (RCTs) published by leading international journals in plastic, reconstructive and aesthetic surgery with respect to characteristics and possible industry-friendly conclusions in favour of those funding the study. MATERIAL AND METHODS Characteristic data and funding of RCTs published by leading international plastic surgery journals from January 2010 to January 2022 were evaluated. The studies were categorised based on their thematic focus and the results in light of the existing funding. RESULTS A total of 381 RCTs were included in the analysis, 68.5% of which were from a university (n=261). The larger proportion of studies did not disclose any information about the research funding. While 26% (n=98) of the studies analysed were funded by companies, 9.7% (n=37) were funded by universities/the government (p<0.05, 95% confidence interval). The overall focus of private clinics was aesthetics (n=32). Generally, the topic aesthetics (n=153) was funded by industry in 28 of 100 cases (28% industry/private sponsors compared with 9% university/government). Regarding reconstruction/burns/hand surgery, 9.2% of studies were funded by companies/private sponsors. Funding for research by university-based institutions was industry-sponsored in 25% (n=64) of cases. Regarding industry-sponsored studies, 73% (n=71) of the results were product-friendly in their conclusion (p<0.05, 95% confidence interval) and placed their thematic focus on therapeutic drug/product application (n=50, 75%). CONCLUSION In terms of funding, industry and private sponsors take a leading role both in reconstruction and aesthetics. Nonetheless, the majority of the evaluated studies were not financed by the private sector. In cases where the research was funded by private companies, the results were significantly in favour of the product. Aesthetics as a focus is currently more frequently funded by industry than reconstruction, burn, and hand surgery.
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Affiliation(s)
- Seyed Arash Alawi
- UniversitätsCentrum für Orthopädie, Unfall- & Plastische Chirurgie Abteilung für Plastische und Handchirurgie Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Oana Grigorescu
- UniversitätsCentrum für Orthopädie, Unfall- & Plastische Chirurgie Abteilung für Plastische und Handchirurgie Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Olimpiu Bota
- UniversitätsCentrum für Orthopädie, Unfall- & Plastische Chirurgie Abteilung für Plastische und Handchirurgie Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Adrian Dragu
- UniversitätsCentrum für Orthopädie, Unfall- & Plastische Chirurgie Abteilung für Plastische und Handchirurgie Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Germany
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Muraille E, Naccache P, Pillot J. The Tragedy of Liberal Democratic Governance in the Face of Global Threats. Front Public Health 2022; 10:902724. [PMID: 35875018 PMCID: PMC9304815 DOI: 10.3389/fpubh.2022.902724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
In hindsight, the early response of liberal governments to the SARS-CoV-2 pandemic was chaotic and generally inefficient. Though one might be tempted to attribute these failures to the incompetence of certain political decision-makers, we propose another explanation. Global threats require a coordinated international response, which is only possible if the threat is perceived in the same way by all, and if government priorities are similar. The effectiveness of the response also relies on massive adhesion of citizens to the measures imposed, which in turn requires trust in government. Our hypothesis is that certain fundamental features of liberalism complicate such global and collective responses: neutrality of the state and primacy of the individual over collective society. Liberalism considers that institutions and public policy must not be designed to favor any specific conception of the common good. That which is best for all is usually determined by a "competition of opinions," which frequently leads to scientific expertise being considered as only one opinion among many. Liberalism also imposes strict respect for individual freedoms and private interests and tends to reject any form of collectivism or dictate imposed by the common good. In order to solve these structural problems and improve society's management of global threats, we make several proposals, such as the introduction of a minimal and consensual definition of the common good and the promotion of a health policy guided by One Health-like concepts. Overall, our analysis suggests that because political ideologies provide their own definitions of the common good and the place of scientific knowledge in the governance process and can thus affect the response to global threats, they should be urgently taken into consideration by public health experts.
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Affiliation(s)
- Eric Muraille
- Laboratoire de Parasitologie, ULB Center for Research in Immunology (U-CRI), Université Libre de Bruxelles, Gosselies, Belgium
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Discussion: Assessment of Gender Disparities and Geographic Variations in Payments from Industry among Plastic Surgeons in the United States. Plast Reconstr Surg 2022; 149:1485-1486. [PMID: 35613296 DOI: 10.1097/prs.0000000000009120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ha G, Gray R, Clappier M, Tanna N, Kasabian AK. Conflict of Interest at Microsurgery Conferences: Disclosure of Its Extent and Nature. J Reconstr Microsurg 2021; 38:390-394. [PMID: 34500478 DOI: 10.1055/s-0041-1735260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Industry relationships and conflicts of interest can impact research funding, topics, and outcomes. Little research regarding the role of biomedical companies at microsurgery conferences is available. This study evaluates the role of industry at conferences by comparing payments received by speakers at the American Society for Reconstructive Microsurgeons (ASRM) meeting with those received by speakers at the American Society of Aesthetic Plastic Surgeons (ASAPS) meeting, the American Society of Plastic Surgeons (ASPS) meeting, and an average plastic surgeon. It also compares payments made by different companies. METHODS General payments received by speakers at the 2017 ASAPS, ASPS, and ASRM conferences were collected from the Open Payments Database. Mean payments received at each conference were calculated and the Mann-Whitney U test evaluated differences between conference speakers and the average plastic surgeon. The total amount of payments from each company was collected through the Open Payments Database, and Z-tests identified which companies paid significantly more than others. RESULTS The mean (and median) general payments made to conference speakers at ASAPS (n = 75), ASPS (n = 247), and ASRM (n = 121) were $75,577 ($861), $27,562 ($1,021), and $16,725 ($652), respectively. These payments were significantly greater (p < 0.001 for all) than those of the average plastic surgeon ($4,441 and $327), but not significantly different from each other. Allergan contributed significantly more than other companies to speakers at ASPS and ASAPS, while LifeCell Corporation, Zimmer Biomet Holdings, and Axogen contributed significantly more to speakers at ASRM. CONCLUSION Payments to physicians at ASRM were significantly higher than those of an average plastic surgeon but not significantly different from those of speakers at ASAPS and ASPS. Certain companies paid significantly more than their peers at each conference. Given these findings, speakers should strive to make clear the nature and extent of their conflicts of interest when presenting at conferences.
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Affiliation(s)
- Grace Ha
- Division of Plastic & Reconstructive Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Rachel Gray
- Division of Plastic & Reconstructive Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Mona Clappier
- Division of Plastic & Reconstructive Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Neil Tanna
- Division of Plastic & Reconstructive Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Armen K Kasabian
- Division of Plastic & Reconstructive Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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Ashkarran AA, Swann J, Hollis L, Mahmoudi M. The File Drawer Problem in Nanomedicine. Trends Biotechnol 2021; 39:425-427. [PMID: 33568314 DOI: 10.1016/j.tibtech.2021.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
The role of the 'file drawer' problem in nanomedicine, which partly drives the current limited clinical success of therapeutic nanoparticles, has been poorly investigated. We propose an integrated functioning of all stakeholders as the only effective way to address the file drawer problem in an efficient and timely manner.
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Affiliation(s)
- Ali Akbar Ashkarran
- Department of Radiology and Precision Health Program, Michigan State University, East Lansing, MI, USA
| | - Jennifer Swann
- Department of Biological Sciences, Lehigh University, Bethlehem, PA, USA
| | - Leah Hollis
- Department of Advanced Studies, Leadership and Policy, Morgan State University, Baltimore, MD, USA
| | - Morteza Mahmoudi
- Department of Radiology and Precision Health Program, Michigan State University, East Lansing, MI, USA.
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Elsamadicy AA, Freedman IG, Koo AB, Reeves BC, Havlik J, David WB, Hong CS, Kolb L, Laurans M, Matouk CC, DiLuna M. Characteristics of Reported Industry Payments to Neurosurgeons: A 5-Year Open Payments Database Study. World Neurosurg 2020; 145:e90-e99. [PMID: 33011357 DOI: 10.1016/j.wneu.2020.09.137] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to characterize the payments made by medical industry to neurosurgeons from 2014 to 2018. METHODS A retrospective study was performed from January 1, 2014 to December 31, 2018 of the Open Payments Database. Collected data included the total number of industry payments, the aggregate value of industry payments, and the mean value of each industry payment made to neurosurgeons per year over the 5-year period. RESULTS A total of 105,150 unique surgeons, with 13,668 (12.99%) unique neurosurgeons, were identified to have received an industry payment during 2014-2018. Neurosurgeons were the second highest industry-paid surgical specialty, with a total 421,151 industry payments made to neurosurgeons, totaling $477,451,070. The mean average paid amount per surgeon was $34,932 (±$936,942). The largest proportion of payments were related to food and beverage (75.5%), followed by travel and lodging (14.9%), consulting fees (3.5%), nonconsulting service fees (2.1%), and royalties or licensing (1.9%), totaling 90.4% of all industry payments to neurologic surgeons. Summed across the 5-year period, the largest paid source types were royalties and licensing (64.0%; $305,517,489), consulting fees (11.8%; $56,445,950), nonconsulting service fees (7.3%; $34,629,109), current or prospective investments (6.8%, $32,307,959), and travel and lodging (4.8%, $22,982,165). CONCLUSIONS Our study shows that over the most recent 5-year period (2014-2018) of the Centers for Medicare and Medicaid Services Open Payments Database, there was a decreasing trend of the total number of payments, but an increasing trend of the total amount paid to neurosurgeons.
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Affiliation(s)
- Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut.
| | - Isaac G Freedman
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Andrew B Koo
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Benjamin C Reeves
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - John Havlik
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Wyatt B David
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Christopher S Hong
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Luis Kolb
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Maxwell Laurans
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Charles C Matouk
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Michael DiLuna
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
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Nalleballe K, Veerapaneni KD, Harada Y, Veerapaneni P, Arulprakash N, Lopez-Castellanos JR, Sheng S, Rowen J, Dandu V, Onteddu S, Siddamreddy S. Trends of Industry Payments in Neurology Subspecialties. Cureus 2020; 12:e9492. [PMID: 32879816 PMCID: PMC7458713 DOI: 10.7759/cureus.9492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/23/2020] [Indexed: 11/25/2022] Open
Abstract
Background Open Payments is a national disclosure program to promote transparency by the public disclosure of financial relationships between the pharmaceutical and medical device industries and physicians. Objective To explore payments from the industry to physicians in various neurology subspecialties. Methods Open Payments Program (OPP) data (https://openpaymentsdata.cms.gov) on industry-to-physician payments for the years 2014-2018 were extracted for general neurology, neuromuscular, neurophysiology, and vascular neurology. The data were then analyzed to explore trends in payments for various subspecialties and to identify the possible factors underlying these trends. Results Overall, industry-to-physician payments for neurology subspecialties increased by 16% from 2014 to 2018. The introduction of newer drugs in a subspecialty was likely the driving factor for higher industry payments. Nearly half of the total industry-to-physician payments were for the subspecialty of multiple sclerosis (MS)/Neuroimmunology; this coincided with Aubagio and Copaxone being the top two medications associated with the highest industry payments in 2014, Aubagio, and Lemtrada in 2018. A significant increase in spending percentages for headache, neuromuscular disorders, and movement disorders was observed while a relative decrease in the payments for MS/neuroimmunology and epilepsy was identified; these trends coincide with the introduction of new drugs such as Aimovig, Neuplazid, Nusinersen, and Austedo for headache, neuromuscular and movement disorders. Conclusions From 2014 to 2018, the total industry-to-physician payments for neurology subspecialties increased while the distribution of industry-to-physician payments for various neurology subspecialties showed notable changes. The introduction of newer medications in a subspecialty coincided with higher industry payments. Identification of these trends and potential motives of the industry spending is critical to address any potential physician bias in prescribing medications.
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Affiliation(s)
- Krishna Nalleballe
- Neurology/Stroke, University of Arkansas for Medical Sciences (UAMS), Little Rock, USA
| | | | - Yohei Harada
- Neurology, University of Arkansas for Medical Sciences (UAMS), Little Rock, USA
| | | | | | | | - Sen Sheng
- Neurology, University of Arkansas for Medical Sciences (UAMS), Little Rock, USA
| | - Julia Rowen
- Pharmacy, University of Arkansas for Medical Sciences (UAMS), Little Rock, USA
| | - Vasuki Dandu
- Neurology, Baptist Health Medical Center, Little Rock, USA
| | - Sanjeeva Onteddu
- Neurology/Stroke, University of Arkansas for Medical Sciences (UAMS), Little Rock, USA
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All Disclosure is Good Disclosure: Patient Awareness of the Sunshine Act and Perceptions of Surgeon-Industry Relationships. Clin Spine Surg 2020; 33:E96-E100. [PMID: 31693520 DOI: 10.1097/bsd.0000000000000915] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a prospective study. OBJECTIVE To determine patient awareness of surgeon-industry relationships, how these relationships affect patient perceptions of surgeons, and which relationships cause the greatest concern to patients. SUMMARY OF BACKGROUND DATA The prevalence of orthopedic surgeon-industry relationships led to the establishment of a national database of physician-industry interaction [Open Payments Database (OPD)] as part of the Physician Payments Sunshine Act (PPSA). MATERIALS AND METHODS A 10-item questionnaire was administered to patients before their first evaluation. Two questions asked about awareness of the surgeon's industry relationships and of the OPD. One question evaluated the importance of surgeon-industry relationships of patients when choosing a provider. Six questions assessed patient perception of specific types of surgeon-industry relationships. Lastly, each patient ranked specific types of surgeon-industry relationships (1-most concerning to 6-least/not concerning). The distribution of patient-perceptions was compared using a Friedman 2-way analysis of variance by Ranks test. Distributions across awareness were compared using a Kruskal-Wallis test. RESULTS A total of 205 patients completed the survey. A majority of patients were unaware of their surgeons' relationships with industry and the existence of the OPD. However, most patients considered surgeon-industry relationships an important, very important or most important part of choosing their physician. There were significant differences in how industry relationships affected patient perceptions. Research funding had the most positive impact on perception. Financial ownership was reported to be the most concerning relationship followed by royalty payments and consulting. CONCLUSIONS Our results suggest that despite a lack of awareness, most patients consider surgeon-industry relationships an important factor in choosing their doctor. Patients generally report a more positive view of surgeons that have active relationships with industry. These results emphasize the value of disclosure for surgeons; it provides transparency and improves their standing amongst a majority of their patients.
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Abstract
Background and Purpose—
Industry payments to physicians raise concerns regarding conflicts of interest that could impact patient care. We explored nonresearch and nonownership payments from industry to vascular neurologists to identify trends in compensation.
Methods—
Using Centers for Medicare and Medicaid Services and American Board of Psychiatry and Neurology data, we explored financial relationships between industry and US vascular neurologists from 2013 to 2018. We analyzed payment characteristics, including payment categories, payment distribution among physicians, regional trends, and biomedical manufacturers. Furthermore, we analyzed the top 1% (by compensation) of vascular neurologists with detailed payment categories, their position, and their contribution to stroke guidelines.
Results—
The number of board certified vascular neurologist increased from 1169 in 2013 to 1746 in 2018. The total payments to vascular neurologist increased from $99 749 in 2013 to $1 032 302 in 2018. During the study period, 16% to 17% of vascular neurologists received industry payments. Total payments from industry and mean physician payments increased yearly over this period, with consulting fee (31.1%) and compensation for services other than consulting (30.7%) being the highest paid categories. The top 10 manufacturers made the majority of the payments, and the top 10 products changed from drug or biological products to devices. Physicians from south region of the United States received the highest total payment (38.72%), which steadily increased. Payments to top 1% vascular neurologists increased from 64% to 79% over the period as payments became less evenly distributed. Among the top 1%, 42% specialized in neuro intervention, 11% contributed to American Heart Association/American Stroke Association guidelines, and around 75% were key leaders in the field.
Conclusions—
A small proportion of US vascular neurologists consistently received the majority of industry payments, the value of which grew over the study period. Only 11% of the top 1% receiving industry payments have authored American Heart Association/American Stroke Association guidelines, but ≈75% seem to be key leaders in the field. Whether this influences clinical practice and behavior requires further investigation.
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Ray GS, Lechtig A, Rozental TD, Bernstein DN, Merchan N, Johnson AH. Gender Disparities in Financial Relationships Between Industry and Orthopaedic Surgeons. J Bone Joint Surg Am 2020; 102:e12. [PMID: 31834109 DOI: 10.2106/jbjs.19.00669] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recent studies in a number of surgical subspecialties have demonstrated that financial relationships with industry differ between men and women. This study aimed to determine if gender disparities exist in industry relationships with orthopaedic surgeons. METHODS This retrospective study utilized publicly available data from the Centers for Medicare & Medicaid Services (CMS) at OpenPayments.cms.gov. Data were extracted for payments made to orthopaedic surgeons from industry for royalties, licensing, or consulting fees from 2016 to 2017. A physician's profile was used to determine name, gender, practice location, and subspecialty. Years of experience were recorded from publicly available websites. Total number of payments and amounts were compared among men and women, subspecialties, and locations. Multivariable linear regression models were used to determine predictors of total payments and number of payments. RESULTS Royalties and consulting fees were paid to 3,418 individual physicians (11% of 29,996 physicians in the American Academy of Orthopaedic Surgeons [AAOS] census) and accounted for 88% of total payments. The majority of the total payment amount (99.6%) was made to men, while only 0.4% went to women. Male gender was a predictor of total number of payments (β = 5.17, p < 0.001), as were years of experience (β = 0.15 [95% confidence interval (CI): 0.10 to 0.20], p < 0.001), Mountain region (β = 2.77 [95% CI: 0.37 to 5.17], p = 0.02), and adult reconstructive subspecialty (β = 4.07 [95% CI: 1.89 to 6.25], p < 0.001). Years of experience (β = 0.046 [95% CI: 0.039 to 0.052], p < 0.001), male gender (β = 1.09 [95% CI: 0.67 to 1.51], p < 0.001), Mountain region (β = 0.35 [95% CI: 0.020 to 0.68], p = 0.04), and adult reconstructive subspecialty (β = 0.33 [95% CI: 0.030 to 0.63], p = 0.03) were associated with higher payments. CONCLUSIONS Male gender, years of experience, Mountain region, and adult reconstructive subspecialty are independent predictors of a higher number of industry payments and payment amount. These disparities in industry payments may contribute to continued inequities in scholarship, academic rank, and leadership opportunities.
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Affiliation(s)
- G S Ray
- Tufts University School of Medicine, Boston, Massachusetts
| | - A Lechtig
- Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - T D Rozental
- Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - D N Bernstein
- Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - N Merchan
- Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - A H Johnson
- Foot & Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
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DiRisio AC, Muskens IS, Cote DJ, Babu M, Gormley WB, Smith TR, Moojen WA, Broekman ML. Oversight and Ethical Regulation of Conflicts of Interest in Neurosurgery in the United States. Neurosurgery 2019; 84:305-312. [PMID: 29850841 DOI: 10.1093/neuros/nyy227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 05/02/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Developmental incentives are fundamental to surgical progress, yet financial and professional incentives inherently create conflicts of interest (COI). Understanding how to manage COI held by neurosurgeons, industry, hospitals, and journal editors, without thwarting progress and innovation is critical. OBJECTIVE To present an overview of COI associated with innovation in neurosurgery, and review ways to manage these in an ethically sound manner. METHODS A review of the literature was performed to assess conflicts of interest that affect neurosurgical innovation, and review ways to manage COI of various parties while adhering to ethical standards. RESULTS COI are inherent to collaboration and innovation, and are therefore an unavoidable component of neurosurgery. The lack of a clear distinction between clinical practice and innovation, ability to use devices off-label, and unstandardized disclosure requirements create inconsistencies in the way that conflicts of interest are handled. Additionally, lack of requirements to compare innovation to the standard of care and inherent bias that affects study design and interpretation can have profound effects on the medical literature. Conflicts of interest can have both direct and downstream effects on neurosurgical practice, and it is possible to manage them while improving the quality of research and innovation. CONCLUSION Conflicts of interest are inherent to surgical innovation, and can be handled in an ethically sound manner. Neurosurgeons, device companies, hospitals, and medical journals can take steps to proactively confront bias and ensure patient autonomy and safety. These steps can preserve public trust and ultimately improve evidence-based neurosurgical practice.
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Affiliation(s)
- Aislyn C DiRisio
- Computational Neurosciences Out-comes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ivo S Muskens
- Computational Neurosciences Out-comes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands
| | - David J Cote
- Computational Neurosciences Out-comes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maya Babu
- Department of Neuro-surgery, Mayo Clinic, Rochester, Minnesota
| | - William B Gormley
- Computational Neurosciences Out-comes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Timothy R Smith
- Computational Neurosciences Out-comes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wouter A Moojen
- Department of Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands.,Department of Neuro-surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Marike L Broekman
- Computational Neurosciences Out-comes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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Nesello PFT, Baroni AC, Selistre LDS. Level of Evidence and Industry Sponsorship Associated with Favorable Outcomes in Publications on Platelet-Rich-Plasma Therapy in Musculoskeletal Disorders. Rev Bras Ortop 2019; 55:263-268. [PMID: 32616969 PMCID: PMC7316539 DOI: 10.1055/s-0039-1700834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/16/2018] [Indexed: 10/25/2022] Open
Abstract
Platelet-rich plasma is derived from centrifuging whole blood. There is increasing interest in the sports medicine and athlete community about providing endogenous growth factors directly to the injury site, using autologous blood products such as platelet-rich plasma. The aim of the present study is to evaluate the association between research financing, conflict of interests, level of evidence and author affiliation with the interpretation of results in articles published on platelet-rich plasma therapy in musculoskeletal ailments. A review of the current literature was performed. The outcome was classified as favorable or unfavorable. The declaration of conflict of interests and the type of funding was extracted from each article. The financing was classified as industry-sponsored; not industry-sponsored; or unidentifiable. The level of evidence was categorized from I to IV. Higher positive outcomes were observed in 134 studies with industry sponsorship compared with not industry-sponsored studies (odds ratio [OR]: 0.26; 95% confidence interval [95%CI]: 0.08-0.85; p < 0.05). Compared with level of evidence I, levels II and IV increase the probability of positive outcomes by 12.42 times ( p < 0.01) and 10.97 times ( p < 0.01) respectively. Proportionally, industry-sponsored studies are more likely to present positive results, as well as articles with a lower quality of evidence.
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Affiliation(s)
- Pietro Felice Tomazini Nesello
- Instituto de Medicina do Esporte e Ciências Aplicadas ao Movimento Humano, Universidade de Caxias do Sul, Caxias do Sul, RS, Brasil
| | - Allan Cassio Baroni
- Instituto de Medicina do Esporte e Ciências Aplicadas ao Movimento Humano, Universidade de Caxias do Sul, Caxias do Sul, RS, Brasil
| | - Luciano da Silva Selistre
- Departamento de Bioestatística, Hospital Geral, Universidade de Caxias do Sul, Caxias do Sul, RS, Brasil
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The Impact of Corporate Payments on Robotic Surgery Research: A Systematic Review. Ann Surg 2019; 269:389-396. [PMID: 30067545 DOI: 10.1097/sla.0000000000003000] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To quantify the influence of financial conflict of interest (COI) payments on the reporting of clinical results for robotic surgery. DATA SOURCES AND STUDY SELECTION A systematic search (Ovid MEDLINE databases) was conducted (May 2017) to identify randomized controlled trials (RCTs) and observational studies comparing the efficacy of the da Vinci robot on clinical outcomes. Financial COI data for authors (per study) were determined using open payments database. MAIN OUTCOMES AND MEASURES Primary outcomes assessed were receipt of financial COI payments and overall conclusion reported between robotic versus comparative approach. Quality/risk of bias was assessed using Newcastle-Ottawa Scale (NOS)/Cochrane risk of bias tool. Disclosure discrepancies were also analyzed. DATA EXTRACTION AND SYNTHESIS Study characteristics, surgical subspecialty, methodological assessment, reporting of disclosure statements, and study findings dual abstracted. The association of the amount of financial support received as a predictor of reporting positive findings associated robotic surgery was assessed at various cut-offs of dollar amount received by receiver operating curve (ROC). RESULTS Thirty-three studies were included, 9 RCTs and 24 observational studies. There was a median, 111 patients (range 10 to 6420) across studies. A little more than half (17/33) had a conclusion statement reporting positive results in support of robotic surgery, with 48% (16/33) reporting results not in favor [equivocal: 12/33 (36%), negative: 4/33 (12%)]. Nearly all (91%) studies had authors who received financial COI payments, with a median of $3364.46 per study (range $9 to $1,775,378.03). ROC curve demonstrated that studies receiving greater than $9557.31 (cutpoint) were more likely to report positive robotic surgery results (sensitivity: 0.65, specificity: 0.81, area under the curve: 0.73). Studies with financial COI payment greater than this amount were more likely to report beneficial outcomes with robotic surgery [(78.57% vs 31.58%, P = 0.013) with an odds ratio of 2.07 (confidence interval: 0.47-3.67; P = 0.011)]. Overall, studies were high quality/low risk of bias [median NOS: 8 (range 5 to 9)]; Cochrane risk: "low risk" (9/9, 100%)]. CONCLUSION AND RELEVANCE Financial COI sponsorship appears to be associated with a higher likelihood of studies reporting a benefit of robotic surgery. Our findings suggest a dollar amount where financial payments influence reported clinical results, a concept that challenges the current guidelines, which do not account for the amount of COI funding received.
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The Influence of Conflicts of Interest on Outcomes in the Lumbar Disc Arthroplasty Literature: A Systematic Review. Spine (Phila Pa 1976) 2019; 44:1162-1169. [PMID: 31374001 DOI: 10.1097/brs.0000000000003015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A systematic review. OBJECTIVE The aim of this study was to determine the association between study outcomes and the presence of a conflict of interest (COI) in the lumbar disc arthroplasty (LDA) literature. SUMMARY OF BACKGROUND DATA Previous studies have evaluated the efficacy of LDA as a surgical alternative to arthrodesis. As investigators may have financial relationships with LDA device companies, it is important to consider the role of COI on study outcomes. METHODS A systematic review was performed to identify articles reporting clinical outcomes of LDA. Any financial COIs disclosed were recorded and confirmed through Open Payments and ProPublica databases. Study outcomes were graded as favorable, unfavorable, or equivocal. Pearson Chi-squared analysis was used to determine an association between COI and study outcomes. Favorable outcomes were tested for an association with study characteristics using Poisson regression with robust error variance. RESULTS Fifty-seven articles were included, 30 had a financial COI, while 27 did not. Ninety percent of the conflicted studies disclosed their COI in the article. Studies with United States authors were more likely to be conflicted (P = 0.019). A majority of studies reported favorable outcomes for LDA (n = 39). Conflicted studies were more likely to report favorable outcomes than nonconflicted studies (P = 0.020). Articles with COIs related to consultant fees (P = 0.003), research funding (P = 0.002), and stock ownership (P < 0.001) were more likely to report favorable outcomes. CONCLUSION This study highlights the importance for authors to accurately report conflicting relationships with industry. As such, orthopedic surgeons should critically evaluate study outcomes with regard to potential conflicts before recommending LDA as a surgical option to their patients. LEVEL OF EVIDENCE 3.
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Ahlawat A, Narayanaswami P. Financial relationships between neurologists and industry. Neurology 2019; 92:1006-1013. [DOI: 10.1212/wnl.0000000000007640] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/04/2019] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo analyze research and nonresearch payments from the pharmaceutical and device industry to neurologists in 2015 using the Centers for Medicare and Medicaid Services (CMS) Open Payments Database.MethodsIn this retrospective database analysis, we computed the percentage of neurologists in the United States receiving payments, the median/mean payments per neurologist, payment categories, regional trends, and sponsors. We computed the number of practicing neurologists from the Association of American Medical Colleges State Physician Workforce Data Book, 2015.ResultsIn 2015, approximately 96% of US neurologists received nonresearch payments totaling $93,920,993. The median payment per physician was $407. The highest proportion of neurologists (24%) received between $1,000 and $10,000. Food and beverage was the most frequent category (83% of the total number of payments). The highest amount was paid for serving as faculty/speaker for noncontinuing medical education activities (49%). The top sponsor of nonresearch payments was Teva Pharmaceuticals ($16,461,055; 17.5%). A total of 412 neurologists received $2,921,611 in research payments (median $1,132). Multiple sclerosis specialists received the largest proportion ($285,537; 9.7%). Daiichi Sankyo paid the largest amount in research payments ($826,029; 28%).ConclusionsThe Open Payments program was established to foster transparent disclosure of physician compensations from industry, in response to legislative and public concerns of the effect of conflicts of interest on practice, education, and research. The effects of this program remain unclear and studies of changes in prescribing practices, costs, and other outcomes are necessary. CMS should ensure that incorrect information can be rectified quickly and easily.
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Groff H, Azboy I, Parvizi J. Differences in Reported Outcomes in Industry-Funded vs Nonfunded Studies Assessing Thromboprophylaxis After Total Joint Arthroplasty. J Arthroplasty 2018; 33:3398-3401. [PMID: 30017220 DOI: 10.1016/j.arth.2018.06.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 06/14/2018] [Accepted: 06/19/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There are numerous studies discussing thromboprophylaxis after total joint arthroplasty (TJA), with varying conclusions. Patient inclusion criteria may be different for each study, which may lead to selection bias and misrepresentation of data. This study aimed to investigate if industry funding impacted patient demographics and overall reported outcomes of studies analyzing venous thromboembolism (VTE) prevention after TJA. METHODS Electronic searches were completed using Ovid, PubMed, and Embase databases. Studies were included if (1) they are published in the English language between 2000 and 2016; (2) they included patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA); and (3) they evaluated prevention and control of postoperative VTE with at least one of the following thromboprophylactic agents: aspirin, enoxaparin, dalteparin, dabigatran, apixaban, rivaroxaban, dabigatran, ximelagatran, fondaparinux, or coumadin. Data were extracted and analyzed via mixed-effect logistic regression. RESULTS Fifty-seven studies were included; 29 were industry funded, and 28, nonfunded. There were no significant differences between patient's age, body mass index, or revision exclusions between funded and nonfunded studies. Funded studies reported less pulmonary embolisms, fewer events of major bleeding, and significantly less 90-day mortality compared with nonfunded studies. CONCLUSION Industry-funded studies reported less pulmonary embolisms, major bleeding, and mortality compared with nonfunded studies. Detailed demographic data were missing from the literature, and we were unable to demonstrate the cause of different reported outcomes between industry-funded and nonfunded studies. Further investigations should be aimed toward understanding how funded studies report less adverse outcomes in analyzing VTE after TJA.
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Affiliation(s)
- Hannah Groff
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ibrahim Azboy
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Orthopaedics and Traumatology, Istanbul Medipol University School of Medicine, Istanbul, Turkey
| | - Javad Parvizi
- Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
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Zaorsky NG, Ahmed AA, Zhu J, Yoo SK, Fuller CD, Thomas CR, Choi M, Holliday EB. Industry Funding Is Correlated With Publication Productivity of US Academic Radiation Oncologists. J Am Coll Radiol 2018; 16:244-251. [PMID: 30219342 DOI: 10.1016/j.jacr.2018.07.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/11/2018] [Accepted: 07/20/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Industry payments to physicians are financial conflicts of interest and may influence research findings and medical decisions. We aim to (1) characterize industry payments within radiation oncology; and (2) explore the potential correlation between receiving disclosed industry payments and academic productivity. MATERIALS/METHODS CMS database was used to extract 2015 industry payments. For academic radiation oncologists, research productivity was characterized by h- and m-indices, as well as receipt of National Institutes of Health (NIH) funding, which is not an industry payment. Logistic regression models were used to determine whether publication metrics (m-index, h-index) and other study characteristics such as gender, PhD status, NIH institution funding status, were associated with the endpoints, research and general payments. Associations between the amount of payments (if any) and publication metrics were further studied using linear regression models. RESULTS A total of 22,543 individual payments totaling $25,532,482 to 2,995 radiation oncologists were included. Among the 1,189 academic radiation oncologists, 75% received less than $167; on the other hand, 10 (<1%) individuals received $6,425,728 (51%) of payments. On multiple logistic regression, research payments were significantly associated with the m-index, odds ratio 2.86 (95% confidence interval, 1.84-4.45, p-value <0.0001); as well as with the h-index, odds ratio 1.03 (95% confidence interval, 1.01-1.05, p-value <0.0001). The linear regression model shows that both m-index and h-index were significantly positively associated with the amount of general payments (p-values <0.0001). CONCLUSION There is an association between disclosed payment from the industry and increased individual research productivity metrics. Further research to find the cause behind this association is warranted.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania; Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
| | - Awad A Ahmed
- Department of Radiation Oncology, University of Miami, Miami, Florida
| | - Junjia Zhu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Stella K Yoo
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University Knight Cancer Institute, Portland, Oregon
| | - Mehee Choi
- Department of Radiation Oncology, Loyola University Chicago, Chicago, Illinois
| | - Emma B Holliday
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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The Accuracy of Conflict-of-Interest Disclosures Reported by Plastic Surgeons and Industry. Plast Reconstr Surg 2018; 141:1592-1599. [DOI: 10.1097/prs.0000000000004380] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ahlawat A, Narayanaswami P. Financial relationships between neurologists and industry: The 2015 Open Payments database. Neurology 2018; 90:1063-1070. [PMID: 29728521 DOI: 10.1212/wnl.0000000000005657] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/08/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To analyze research and nonresearch payments from the pharmaceutical and device industry to neurologists in 2015 using the Centers for Medicare and Medicaid Services (CMS) Open Payments database. METHODS In this retrospective database analysis, we computed the percentage of neurologists in the United States receiving payments, the median/mean payments per neurologist, payment categories, regional trends, and sponsors. We computed the number of practicing neurologists from the Association of American Medical Colleges State Physician Workforce data book, 2015. RESULTS In 2015, approximately 51% of US neurologists received nonresearch payments totaling $6,210,414. The median payment per physician was $81. Payments to the top 10% of compensated neurologists amounted to $5,278,852 (84.5%). Food and beverage was the most frequent category (86.5% of the total number of payments). The highest amount was paid for serving as faculty/speaker for noncontinuing medical education activities (58%). The top sponsor of nonresearch payments was Teva Pharmaceuticals ($1,162,900; 18.5%). A total of 412 neurologists received $2,921,611 in research payments (median $1,132). Multiple sclerosis specialists received the largest proportion ($285,537; 9.7%). Daiichi Sankyo paid the largest amount in research payments ($826,029; 28%). CONCLUSIONS The Open Payments program was established to foster transparent disclosure of physician compensation from industry, in response to legislative and public concerns over the effect of conflicts of interest on practice, education, and research. The effects of this program remain unclear and studies of changes in prescribing practices, costs, and other outcomes are necessary. CMS should ensure that incorrect information can be rectified quickly and easily.
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Affiliation(s)
- Aditi Ahlawat
- From the Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
| | - Pushpa Narayanaswami
- From the Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA.
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Disclosure of Financial Conflicts of Interest in Plastic and Reconstructive Surgery. Plast Reconstr Surg 2017; 140:635-639. [DOI: 10.1097/prs.0000000000003598] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wells EM. Evidence Regarding the Impact of Conflicts of Interest on Environmental and Occupational Health Research. Curr Environ Health Rep 2017; 4:109-118. [PMID: 28397095 DOI: 10.1007/s40572-017-0139-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW This review describes published literature providing evidence for financial conflicts of interest in environmental and occupational health research. Secondary goals were to describe evidence that (a) utilized quantitative methods to evaluate the association of conflicts with study outcomes, and (b) assessed undisclosed as well as disclosed conflicts of interest. RECENT FINDINGS Forty-three studies were identified which contained descriptions of the impact of financial conflicts of interest on research results; 11 of these conducted quantitative analyses to demonstrate these relationships. All 11 articles which quantified associations identified significant associations of the presence of financial conflicts of interest with study findings. In studies which measured undisclosed conflicts, these comprised a substantial proportion of all conflicts. Suggestions for improving understanding and interpretation of research results are presented.
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Affiliation(s)
- Ellen M Wells
- School of Health Sciences, Purdue University, 550 Stadium Mall Drive, West Lafayette, IN, 47907, USA.
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Abstract
BACKGROUND Clinical research affecting how doctors practice medicine is increasingly sponsored by companies that make drugs and medical devices. Previous systematic reviews have found that pharmaceutical-industry sponsored studies are more often favorable to the sponsor's product compared with studies with other sources of sponsorship. A similar association between sponsorship and outcomes have been found for device studies, but the body of evidence is not as strong as for sponsorship of drug studies. This review is an update of a previous Cochrane review and includes empirical studies on the association between sponsorship and research outcome. OBJECTIVES To investigate whether industry sponsored drug and device studies have more favorable outcomes and differ in risk of bias, compared with studies having other sources of sponsorship. SEARCH METHODS In this update we searched MEDLINE (2010 to February 2015), Embase (2010 to February 2015), the Cochrane Methodology Register (2015, Issue 2) and Web of Science (June 2015). In addition, we searched reference lists of included papers, previous systematic reviews and author files. SELECTION CRITERIA Cross-sectional studies, cohort studies, systematic reviews and meta-analyses that quantitatively compared primary research studies of drugs or medical devices sponsored by industry with studies with other sources of sponsorship. We had no language restrictions. DATA COLLECTION AND ANALYSIS Two assessors screened abstracts and identified and included relevant papers. Two assessors extracted data, and we contacted authors of included papers for additional unpublished data. Outcomes included favorable results, favorable conclusions, effect size, risk of bias and whether the conclusions agreed with the study results. Two assessors assessed risk of bias of included papers. We calculated pooled risk ratios (RR) for dichotomous data (with 95% confidence intervals (CIs)). MAIN RESULTS Twenty-seven new papers were included in this update and in total the review contains 75 included papers. Industry sponsored studies more often had favorable efficacy results, RR: 1.27 (95% CI: 1.17 to 1.37) (25 papers) (moderate quality evidence), similar harms results RR: 1.37 (95% CI: 0.64 to 2.93) (four papers) (very low quality evidence) and more often favorable conclusions RR: 1.34 (95% CI: 1.19 to 1.51) (29 papers) (low quality evidence) compared with non-industry sponsored studies. Nineteen papers reported on sponsorship and efficacy effect size, but could not be pooled due to differences in their reporting of data and the results were heterogeneous. We did not find a difference between drug and device studies in the association between sponsorship and conclusions (test for interaction, P = 0.98) (four papers). Comparing industry and non-industry sponsored studies, we did not find a difference in risk of bias from sequence generation, allocation concealment, follow-up and selective outcome reporting. However, industry sponsored studies more often had low risk of bias from blinding, RR: 1.25 (95% CI: 1.05 to 1.50) (13 papers), compared with non-industry sponsored studies. In industry sponsored studies, there was less agreement between the results and the conclusions than in non-industry sponsored studies, RR: 0.83 (95% CI: 0.70 to 0.98) (six papers). AUTHORS' CONCLUSIONS Sponsorship of drug and device studies by the manufacturing company leads to more favorable efficacy results and conclusions than sponsorship by other sources. Our analyses suggest the existence of an industry bias that cannot be explained by standard 'Risk of bias' assessments.
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Affiliation(s)
- Andreas Lundh
- Odense University Hospital and University of Southern DenmarkCenter for Evidence‐Based MedicineSdr. Boulevard 29, Entrance 50 (Videncentret)OdenseDenmark5000
| | - Joel Lexchin
- York UniversitySchool of Health Policy and Management121 Walmer RdTorontoONCanadaM5R 2X8
| | - Barbara Mintzes
- The University of SydneyCharles Perkins Centre and Faculty of PharmacyRoom 6W75, 6th FloorThe Hub, Charles Perkins Centre D17SydneyNSWAustralia2006
| | - Jeppe B Schroll
- Herlev HospitalDepartment of Obstetrics and GynaecologyHerlev Ringvej 75HerlevDenmark2730
| | - Lisa Bero
- Charles Perkins Centre and Faculty of Pharmacy, University of Sydney6th Floor (6W76)The University of SydneySydneyNew South Wales 2006Australia
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Probst P, Grummich K, Klaiber U, Knebel P, Ulrich A, Büchler MW, Diener MK. Conflicts of interest in randomised controlled surgical trials: systematic review and qualitative and quantitative analysis. Innov Surg Sci 2016; 1:33-39. [PMID: 31579716 PMCID: PMC6753986 DOI: 10.1515/iss-2016-0001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/01/2016] [Indexed: 01/13/2023] Open
Abstract
Conflicts of interest may lead to biased trial designs and unbalanced interpretation of study results. We aimed to evaluate the reporting of potential conflicts of interest in full publications of surgical randomised controlled trials (RCTs). A systematic literature search was performed in CENTRAL, MEDLINE and EMBASE (1985-2014) to find all surgical RCTs of medical devices and perioperative pharmacological or nutritional interventions. The information on conflicts of interest was evaluated both quantitatively and qualitatively, and the development of stated conflicts over time was studied. Of 7934 articles, 444 met the inclusion criteria. In 93 of 444 trials (20.9%), conflicts of interest were disclosed. In half of the cases, the information provided was insufficient to permit conclusions regarding possible influence on the trials. Information about conflicts of interest has increased continuously during the last decades (1985-1994: 0%, 1995-2004: 2.8% and 2005-2014: 33.0%; p<0.001). Among the 115 industry-funded trials, industry participation was considered as a potential conflict of interest in 24 cases (20.9%). Over the past three decades, only every 10th trial has provided appropriate information on conflicts of interest. However, transparency is crucial for the reliability of evidence-based medicine. There is an urgent need for the full disclosure of all conflicts of interest in surgical publishing and for transparency regarding cooperation between academia and industry.
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Affiliation(s)
- Pascal Probst
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
- The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Heidelberg, Germany
| | - Kathrin Grummich
- The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Heidelberg, Germany
| | - Ulla Klaiber
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
- The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Heidelberg, Germany
| | - Phillip Knebel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
- The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Heidelberg, Germany
| | - Alexis Ulrich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Markus W. Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Markus K. Diener
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
- The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Heidelberg, Germany
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Fadlallah R, Nas H, Naamani D, El-Jardali F, Hammoura I, Al-Khaled L, Brax H, Kahale L, Akl EA. Knowledge, Beliefs and Attitudes of Patients and the General Public towards the Interactions of Physicians with the Pharmaceutical and the Device Industry: A Systematic Review. PLoS One 2016; 11:e0160540. [PMID: 27556929 PMCID: PMC4996522 DOI: 10.1371/journal.pone.0160540] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 07/21/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To systematically review the evidence on the knowledge, beliefs, and attitudes of patients and the general public towards the interactions of physicians with the pharmaceutical and the device industry. METHODS We included quantitative and qualitative studies addressing any type of interactions between physicians and the industry. We searched MEDLINE and EMBASE in August 2015. Two reviewers independently completed data selection, data extraction and assessment of methodological features. We summarized the findings narratively stratified by type of interaction, outcome and country. RESULTS Of the 11,902 identified citations, 20 studies met the eligibility criteria. Many studies failed to meet safeguards for protecting from bias. In studies focusing on physicians and the pharmaceutical industry, the percentages of participants reporting awareness was higher for office-use gifts relative to personal gifts. Also, participants were more accepting of educational and office-use gifts compared to personal gifts. The findings were heterogeneous for the perceived effects of physician-industry interactions on prescribing behavior, quality and cost of care. Generally, participants supported physicians' disclosure of interactions through easy-to-read printed documents and verbally. In studies focusing on surgeons and device manufacturers, the majority of patients felt their care would improve or not be affected if surgeons interacted with the device industry. Also, they felt surgeons would make the best choices for their health, regardless of financial relationship with the industry. Participants generally supported regulation of surgeon-industry interactions, preferably through professional rather than governmental bodies. CONCLUSION The awareness of participants was low for physicians' receipt of personal gifts. Participants also reported greater acceptability and fewer perceived influence for office-use gifts compared to personal gifts. Overall, there appears to be lower awareness, less concern and more acceptance of surgeon-device industry interactions relative to physician-pharmaceutical industry interactions. We discuss the implications of the findings at the patient, provider, organizational, and systems level.
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Affiliation(s)
- Racha Fadlallah
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Center for Systematic Reviews of Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
| | - Hala Nas
- Faculty of Medicine, University of Damascus, Damascus, Syria
| | - Dana Naamani
- Department of Biology, Faculty of Art and Science, American University of Beirut, Beirut, Lebanon
| | - Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Center for Systematic Reviews of Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Ihsan Hammoura
- Department of Biology, Faculty of Art and Science, American University of Beirut, Beirut, Lebanon
| | - Lina Al-Khaled
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Hneine Brax
- Faculty of Medicine, Université Saint Joseph, Beirut, Lebanon
| | - Lara Kahale
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Elie A. Akl
- Center for Systematic Reviews of Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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Chao AH, Gangopadhyay N. Industry Financial Relationships in Plastic Surgery. Plast Reconstr Surg 2016; 138:341e-348e. [DOI: 10.1097/prs.0000000000002404] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Al-Adawi S, Ali BH, Al-Zakwani I. Research Misconduct: The Peril of Publish or Perish. Oman Med J 2016; 31:5-11. [PMID: 26816563 DOI: 10.5001/omj.2016.02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
There is a spurt of interest in research productivity in the Gulf Cooperation Council (GCC) to lay the foundation for national development. From a global perspective, increased research productivity could conceivably be accompanied by an exponential increase in research misconduct (RM). Inevitably, erroneous or falsified data will be expected to adversely affect public health by misleading policy makers and clinicians alike into embarking on health policy and allocation of resources that are byproducts of RM. This will contribute significantly to the emerging crisis of confidence of the public in the integrity of scientific research. For a long time, RM has been considered only as plagiarism or data fabrication and falsification. However, the concept of RM nowadays encompasses more and, in this review, we discuss its possible implications in emerging economies, such as those of the GCC countries. We suggest that GCC countries ought to consider implementing remedial and punitive policies to deal with RM.
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Affiliation(s)
- Samir Al-Adawi
- 1 Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
2 Department of Pharmacology and Clinical Pharmacology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Badreldin H Ali
- 1 Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
2 Department of Pharmacology and Clinical Pharmacology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Ibrahim Al-Zakwani
- 1 Department of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
2 Department of Pharmacology and Clinical Pharmacology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
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Orthopaedic Surgeons Receive the Most Industry Payments to Physicians but Large Disparities are Seen in Sunshine Act Data. Clin Orthop Relat Res 2015; 473:3297-306. [PMID: 26088767 PMCID: PMC4562921 DOI: 10.1007/s11999-015-4413-8] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 06/11/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Industry payments made to physicians by drug and device manufacturers or group purchasing organizations are now reported to the Centers for Medicare and Medicaid Services (CMS) as a part of the Physician Payments Sunshine Act. Initial reports from the program show that orthopaedic surgeons lead all physician specialties in total and average industry payments. However, before further discussion of these payments and their implications can take place, it remains to be seen whether these figures are a true reflection of the field of orthopaedic surgery in general, rather than the result of a few outlier physicians in the field. In addition, the nature and sources of these funds should be determined to better inform the national dialogue surrounding these payments. QUESTIONS/PURPOSES We asked: (1) How do industry payments to orthopaedic surgeons compare with payments to physicians and surgeons in other fields, in terms of median payments and the Gini index of disparity? (2) How much do payments to the highest-receiving orthopaedic surgeons contribute to total payments? (3) What kind of industry payments are orthopaedic surgeons receiving? (4) How much do the highest-paying manufacturers contribute to total payments to orthopaedic surgeons? MATERIALS AND METHODS We reviewed the most recent version of the CMS Sunshine Act Open Payments database released on December 19, 2014, containing data on payments made between August 1, 2013 and December 31, 2013. Data on total payments to individual physicians, physician specialty, the types of payments made, and the manufacturers making payments were reviewed. The Gini index of statistical dispersion was calculated for payments made to orthopaedic surgeons and compared with payments made to physicians and surgeons in all other medical specialties. A Gini index of 0 indicates complete equality of payments to everyone in the population, whereas an index of 1 indicates complete inequality, or all income going to one individual. RESULTS A total of 15,376 orthopaedic surgeons receiving payments during the 5-month period were identified, accounting for USD 109,846,482. The median payment to orthopaedic surgeons receiving payments was USD 121 (interquartile range, USD 34-619). The top 10% of orthopaedic surgeons receiving payments (1538 surgeons) received at least USD 4160 and accounted for 95% of total payments. Royalties and patent licenses accounted for 69% of all industry payments to orthopaedic surgeons. CONCLUSIONS Even as a relatively small specialty, orthopaedic surgeons received substantial payments from industry (more than USD 110 million) during the 5-month study period. Whether there is a true return of value from these payments remains to be seen; however, future ethical and policy discussions regarding industry payments to orthopaedic surgeons should take into account the large disparities in payments that are present and also the nature of the payments being made. It is possible that patients and policymakers may view industry payments to orthopaedic surgeons more positively in light of these new findings. LEVEL OF EVIDENCE Level III, Economic and Decision Analysis.
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Jairam V, Yu JB. Examination of Industry Payments to Radiation Oncologists in 2014 Using the Centers for Medicare and Medicaid Services Open Payments Database. Int J Radiat Oncol Biol Phys 2015; 94:19-26. [PMID: 26547386 DOI: 10.1016/j.ijrobp.2015.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/02/2015] [Accepted: 09/08/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To use the Centers for Medicare and Medicaid Services Open Payments database to characterize payments made to radiation oncologists and compare their payment profile with that of medical and surgical oncologists. METHODS AND MATERIALS The June 2015 release of the Open Payments database was accessed, containing all payments made to physicians in 2014. The general payments dataset was used for analysis. Data on payments made to medical, surgical, and radiation oncologists was obtained and compared. Within radiation oncology, data regarding payment category, sponsorship, and geographic distribution were identified. Basic statistics including mean, median, range, and sum were calculated by provider and by transaction. RESULTS Among the 3 oncologic specialties, radiation oncology had the smallest proportion (58%) of compensated physicians and the lowest mean ($1620) and median ($112) payment per provider. Surgical oncology had the highest proportion (84%) of compensated physicians, whereas medical oncology had the highest mean ($6371) and median ($448) payment per physician. Within radiation oncology, nonconsulting services accounted for the most money to physicians ($1,042,556), whereas the majority of the sponsors were medical device companies (52%). Radiation oncologists in the West accepted the most money ($2,041,603) of any US Census region. CONCLUSIONS Radiation oncologists in 2014 received a large number of payments from industry, although less than their medical or surgical counterparts. As the Open Payments database continues to be improved, it remains to be seen whether this information will be used by patients to inform choice of providers or by lawmakers to enact policy regulating physician-industry relationships.
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Affiliation(s)
| | - James B Yu
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
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Holdefer RN, McAuliffe J, Seubert CN, MacDonald DB, Shils JL, Edwards ME, Cohen BA, Sturm PF. Intraoperative neuromonitoring for the prevention of iatrogenic injury during cervical and thoracic spine surgery. Hippokratia 2015. [DOI: 10.1002/14651858.cd011835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Robert N Holdefer
- University of Washington School of Medicine; Department of Rehabilitation; Box 359740 Seattle WA USA 98104-2499
| | - John McAuliffe
- Cincinnati Children's Hospital Medical Center; Department of Anesthesiology; 3333 Burnet Avenue E3-238 Cincinnati Ohio USA 45229-3039
| | - Christoph N Seubert
- University of Florida College of Medicine; Director, Intraoperative Neurologic Monitoring Laboratory, Shands at UF; Gainesville FL USA
| | - David B MacDonald
- King Faisal Specialist Hospital & Research Center; Department of Neurosciences; MBC 76, PO Box 3354 Riyadh Saudi Arabia 11211
| | - Jay L Shils
- Rush University Medical Center; Department of Anesthesiology; 1750 W. Harrison (Suite 739 jelke) Chicago IL USA 60612
| | - Mary E Edwards
- University of Florida; University of Florida Health Science Center Libraries; 1600 SW Archer Road PO Box 100206 Gainesville Florida USA 32610-0206
| | - Bernard A Cohen
- Neurological Monitoring Associates, LLC; 333 West Brown Deer Road Suite 240 Milwaukee WI USA 53217
| | - Peter F Sturm
- Cincinnati Children's Hospital Medical Center; 3333 Burnet Avenue ML2017 Cincinnati OH USA 45229
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Thirty years of disclosure of conflict of interest in surgery journals. Surgery 2015; 157:627-33. [DOI: 10.1016/j.surg.2014.11.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 10/20/2014] [Accepted: 11/17/2014] [Indexed: 11/23/2022]
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Rathi VK, Samuel AM, Mehra S. Industry Ties in Otolaryngology. Otolaryngol Head Neck Surg 2015; 152:993-9. [DOI: 10.1177/0194599815573718] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/29/2015] [Indexed: 11/17/2022]
Abstract
Objective To characterize nonresearch payments made by industry to otolaryngologists in order to explore how the potential for conflicts of interests varies among otolaryngologists and compares between otolaryngologists and other surgical specialists. Study Design Retrospective cross-sectional database analysis. Setting Open Payments program database recently released by Centers for Medicare and Medicaid Services. Subjects Surgeons nationwide who were identified as receiving nonresearch payment from industry in accordance with the Physician Payment Sunshine Act. Methods The proportion of otolaryngologists receiving payment, the mean payment per otolaryngologist, and the standard deviation thereof were determined using the Open Payments database and compared to other surgical specialties. Otolaryngologists were further compared by specialization, census region, sponsor, and payment amount. Results Less than half of otolaryngologists (48.1%) were reported as receiving payments over the study period, the second smallest proportion among surgical specialties. Otolaryngologists received the lowest mean payment per compensated individual ($573) compared to other surgical specialties. Although otolaryngology had the smallest variance in payment among surgical specialties (SD, $2806), the distribution was skewed by top earners; the top 10% of earners accounted for 87% ($2,199,254) of all payment to otolaryngologists. Otolaryngologists in the West census region were less likely to receive payments (38.6%, P < .001). Conclusion Over the study period, otolaryngologists appeared to have more limited financial ties with industry compared to other surgeons, though variation exists within otolaryngology. Further refinement of the Open Payments database is needed to explore differences between otolaryngologists and leverage payment information as a tool for self-regulation.
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Affiliation(s)
- Vinay K. Rathi
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andre M. Samuel
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Saral Mehra
- Department of Surgery (Otolaryngology), Yale University School of Medicine, New Haven, Connecticut, USA
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Seshia SS, Makhinson M, Phillips DF, Young GB. Evidence-informed person-centered healthcare part I: do 'cognitive biases plus' at organizational levels influence quality of evidence? J Eval Clin Pract 2014; 20:734-47. [PMID: 25429739 DOI: 10.1111/jep.12280] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2014] [Indexed: 12/17/2022]
Abstract
INTRODUCTION There is increasing concern about the unreliability of much of health care evidence, especially in its application to individuals. HYPOTHESIS Cognitive biases, financial and non-financial conflicts of interest, and ethical violations (which, together with fallacies, we collectively refer to as 'cognitive biases plus') at the levels of individuals and organizations involved in health care undermine the evidence that informs person-centred care. METHODS This study used qualitative review of the pertinent literature from basic, medical and social sciences, ethics, philosophy, law etc. RESULTS Financial conflicts of interest (primarily industry related) have become systemic in several organizations that influence health care evidence. There is also plausible evidence for non-financial conflicts of interest, especially in academic organizations. Financial and non-financial conflicts of interest frequently result in self-serving bias. Self-serving bias can lead to self-deception and rationalization of actions that entrench self-serving behaviour, both potentially resulting in unethical acts. Individuals and organizations are also susceptible to other cognitive biases. Qualitative evidence suggests that 'cognitive biases plus' can erode the quality of evidence. CONCLUSIONS 'Cognitive biases plus' are hard wired, primarily at the unconscious level, and the resulting behaviours are not easily corrected. Social behavioural researchers advocate multi-pronged measures in similar situations: (i) abolish incentives that spawn self-serving bias; (ii) enforce severe deterrents for breaches of conduct; (iii) value integrity; (iv) strengthen self-awareness; and (v) design curricula especially at the trainee level to promote awareness of consequences to society. Virtuous professionals and organizations are essential to fulfil the vision for high-quality individualized health care globally.
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Affiliation(s)
- Shashi S Seshia
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Bagsby D, Ireland PH, Meneghini RM. In reply. J Arthroplasty 2014; 29:2233-4. [PMID: 25175845 DOI: 10.1016/j.arth.2014.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 07/30/2014] [Indexed: 02/01/2023] Open
Affiliation(s)
- Deren Bagsby
- Department of Orthopaedic Surgery, Indiana University Health Physicians, Indiana University School of Medicine, Indianapolis, Indiana
| | - Phillip H Ireland
- Department of Orthopaedic Surgery, Indiana University Health Physicians, Indiana University School of Medicine, Indianapolis, Indiana
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University Health Physicians, Indiana University School of Medicine, Indianapolis, Indiana
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Abstract
STUDY DESIGN Systematic review. OBJECTIVE To evaluate the cost-effectiveness of lumbar or cervical spinal arthrodesis using biological substitutes and extenders compared with iliac crest autograft for the treatment of degenerative spinal conditions. SUMMARY OF BACKGROUND DATA The cost-effectiveness of using bone graft substitutes and extenders for spinal fusion compared with using iliac crest autograft is not yet well established. METHODS A systematic search of PubMed/MEDLINE, the Cochrane Collaboration Library, EMBASE, the CRD (Centre for Reviews and Dissemination) database, and Tuft's CEA registry for literature published through December 2013 was performed to identify full formal economic analyses comparing the use of biological grafts with iliac crest bone graft in spinal fusion for thoracolumbar or cervical degenerative, deformity, and traumatic spinal conditions. Economic outcomes such as cost per improved outcome or cost per quality-adjusted life year were reported in the context of the model type, analytic perspective clinical comparisons, and sensitivity analyses employed. RESULTS The search strategy yielded 88 citations, and 6 full economic analyses ultimately met our inclusion criteria. For the comparison of recombinant human bone morphogenetic protein-2 to iliac crest bone graft in the lumbar spine, data from 4 cost-effectiveness studies and 1 cost-utility study provided discordant conclusions that varied with type of data used, cost-measurement methods, and study design. In the cervical spine, one study suggested that from a societal perspective, anterior cervical discectomy and fusion (ACDF) with allograft is similarly cost-effective as ACDF with autograft. CONCLUSION The results suggest that compared with use of iliac crest bone graft in lumbar spinal fusion, use of recombinant human bone morphogenetic protein is not cost-effective from a payer perspective with higher upfront costs, but it may be cost-effective from a societal perspective due to a decrease in lost productivity. The data in this study also suggest that from a societal perspective, ACDF with allograft is similarly cost-effective to ACDF with autograft. LEVEL OF EVIDENCE 3.
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Velez RP, Becker KL, Davidson P, Sloand E. A quality improvement intervention to address provider behaviour as it relates to utilisation of CA-MRSA guidelines. J Clin Nurs 2014; 24:556-62. [PMID: 25219676 DOI: 10.1111/jocn.12684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2014] [Indexed: 01/26/2023]
Abstract
AIMS AND OBJECTIVES To evaluate the impact of a provider focused quality improvement educational intervention on appropriate prescribing for community associated methicillin-resistant Staphylococcus aureus infection. BACKGROUND Patient, provider and health system factors contribute to appropriate antibiotic prescription. Achieving appropriate prescribing is critical in decreasing the burden of antibiotic resistance. Knowledge of appropriate prescribing for community associated methicillin-resistant Staphylococcus aureus infection is the first step in shifting prescriber behaviour to evidence-based recommendations. DESIGN Quality Improvement Project. METHOD Following a review of best practice guidelines and application of the Stetler Research Utilization model, a brief educational intervention was delivered using voice over PowerPoint. Items in the educational intervention included indications for screening, particularly focusing on the role of watch and wait after culturing for simple abscesses. The intervention was delivered in a for-profit, nonacademic, urgent care setting, and assessed prescribing providers' knowledge and practice. RESULTS Out of 48 medical doctor, physician assistant and nurse practitioner providers, 18 (37·5%) participated; 12 of the 18 (67%) participants showed an increase in knowledge. Forty three per cent of prescribers' charts demonstrated improved practice through use of the guidelines. Out of 18 prescribers, 44% sent a total of 21 cultures for abscesses. There was no difference in practice behaviours between professional groups. CONCLUSIONS In spite of the increase in knowledge scores, this improvement in knowledge did not translate in dramatic change in practice, although trends in a positive direction were noted. RELEVANCE TO CLINICAL PRACTICE This quality improvement project underscores the complexity of changing prescriber behaviour and the need for ongoing interventions.
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Surgeon-industry conflict of interest: survey of North Americans' opinions regarding surgeons consulting with industry. Spine J 2014; 14:584-91. [PMID: 23973098 DOI: 10.1016/j.spinee.2013.06.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 02/22/2013] [Accepted: 06/01/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Surgeon-industry conflict of interest (COI) has become a source of considerable interest. Professional medical societies, industry, and policy makers have attempted to regulate potential COI without consideration for public opinion. PURPOSE The objective of this study was to report on the opinions of individuals representing the general public regarding surgeon-industry consulting relationships. STUDY DESIGN/SETTING Web-based survey. METHODS Survey was administered using a "spine Web site," and opinions are collected on surgeon-industry consulting and regulation. Associations among responses to similar questions were assessed to ensure validity and subgroup analysis performed for respondent age, sex, education, insurance, employment, and patient status. RESULTS Six hundred ten of 642 surveys had complete data. The sample population comprised more females and was older and more educated than the American population. About 80% of respondents felt it was ethical and either beneficial or of no influence to the quality of health care if surgeons were consultants for surgical device companies. Most felt disclosure of an industry relationship was important and paying surgeons royalties for devices, other than those they directly implant, would not affect quality of care. Respondents support multidisciplinary surgeon-industry COI regulation and trust doctors and their professional societies to head this effort. CONCLUSIONS Despite the known potential negative impact of surgeon-industry COI on patient care, this study revealed that this does not seem to be reflected in the opinion of the general public. The respondents felt that disclosure is deemed one of the most important means of self-regulation and COI management, which is in agreement with current trends of most spine societies and journals that are increasing the stringency of disclosure policies.
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Koletzko B, Benninga MA, Godfrey KM, Hornnes PJ, Kolaček S, Koletzko S, Lentze MJ, Mader S, McAuliffe FM, Oepkes D, Oddy WH, Phillips A, Rzehak P, Socha P, Szajewska H, Symonds ME, Taminiau J, Thapar N, Troncone R, Vandenplas Y, Veereman G. Public-private collaboration in clinical research during pregnancy, lactation, and childhood: joint position statement of the Early Nutrition Academy and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 2014; 58:525-30. [PMID: 24399212 DOI: 10.1097/mpg.0000000000000284] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This position statement summarises a view of academia regarding standards for clinical research in collaboration with commercial enterprises, focussing on trials in pregnant women, breast-feeding women, and children. It is based on a review of the available literature and an expert workshop cosponsored by the Early Nutrition Academy and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Clinical research collaborations between academic investigators and commercial enterprises are encouraged by universities, public funding agencies, and governmental organisations. One reason is a pressing need to obtain evidence on the effects, safety, and benefits of drugs and other commercial products and services. The credibility and value of results obtained through public-private research collaborations have, however, been questioned because many examples of inappropriate research practice have become known. Clinical research in pregnant and breast-feeding women, and in infants and children, raises sensitive scientific, ethical, and societal questions and requires the application of particularly high standards. Here we provide recommendations for the conduct of public-private research collaborations in these populations. In the interest of all stakeholders, these recommendations should contribute to more reliable, credible, and acceptable results of commercially sponsored trials and to reducing the existing credibility gap.
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Affiliation(s)
- Berthold Koletzko
- *Dr von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany †Emma Children's Hospital/Academic Medical Centre, Department of Pediatric Gastroenterology & Nutrition, Amsterdam, The Netherlands ‡MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK §Gynecology and Obstetrics, Hvidovre Hospital, Copenhagen, Denmark
- Children's Hospital Zagreb University Medical School, Zagreb, Croatia ¶Children's Hospital Medical Center, University Hospitals, Bonn, Germany #European Foundation for the Care of Newborn Infants, Munich, Germany **UCD Obstetrics & Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland ††Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands ‡‡Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, West Perth, Australia §§UCL Institute of Child Health, London, UK
- Children's Memorial Health Institute ¶¶Department of Paediatrics, Medical University of Warsaw, Poland ##Academic Division of Child Health, School of Clinical Sciences, University of Nottingham, Nottingham, UK ***European Medicine Agency, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands †††UCL Institute of Child Health, Great Ormond Street Hospital, London, UK ‡‡‡Department of Paediatrics, Universita degli Studi di Napoli Frederico II, Naples, Italy §§§Department of Paediatrics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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DiPaola CP, Dea N, Dvorak MF, Lee RS, Hartig D, Fisher CG. Surgeon-industry conflict of interest: survey of opinions regarding industry-sponsored educational events and surgeon teaching. J Neurosurg Spine 2014; 20:313-21. [DOI: 10.3171/2013.11.spine13168] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Conflict of interest (COI) as it applies to medical education and training has become a source of considerable interest, debate, and regulation in the last decade. Companies often pay surgeons as faculty for educational events and often sponsor and give financial support to major professional society meetings. Professional medical societies, industry, and legislators have attempted to regulate potential COI without consideration for public opinion. The practice of evidence-based medicine requires the inclusion of patient opinion along with best available evidence and expert opinion. The primary goal of this study was to assess the opinion of the general population regarding surgeon-industry COI for education-related events.
Methods
A Web-based survey was administered, with special emphasis on the surgeon's role in industry-sponsored education and support of professional societies. A survey was constructed to sample opinions on reimbursement, disclosure, and funding sources for educational events.
Results
There were 501 completed surveys available for analysis. More than 90% of respondents believed that industry funding for surgeons' tuition and travel for either industry-sponsored or professional society educational meetings would either not affect the quality of care delivered or would cause it to improve. Similar results were generated for opinions on surgeons being paid by industry to teach other surgeons. Moreover, the majority of respondents believed it was ethical or had no opinion if surgeons had such a relationship with industry. Respondents were also generally in favor of educational conferences for surgeons regardless of funding source. Disclosures of a surgeon-industry relationship, especially if it involves specific devices that may be used in their surgery, appears to be important to respondents.
Conclusions
The vast majority of respondents in this study do not believe that the quality of their care will be diminished due to industry funding of educational events, for surgeon tuition, and/or travel expenses. The results of this study should help form the basis of policy and continued efforts at surgeon-industry COI management.
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Affiliation(s)
- Christian P. DiPaola
- 1Department of Orthopedics, Spine Division, University of Massachusetts Medical Center, Worcester, Massachusetts; and
| | - Nicolas Dea
- 2Department of Orthopaedics, Division of Spine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marcel F. Dvorak
- 2Department of Orthopaedics, Division of Spine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert S. Lee
- 2Department of Orthopaedics, Division of Spine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dennis Hartig
- 2Department of Orthopaedics, Division of Spine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles G. Fisher
- 2Department of Orthopaedics, Division of Spine, University of British Columbia, Vancouver, British Columbia, Canada
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Milner LC, Cho MK. Focusing on Cause or Cure?: Priorities and Stakeholder Presence in Childhood Psychiatry Research. AJOB Empir Bioeth 2014; 5:44-55. [PMID: 24729931 DOI: 10.1080/21507716.2013.811315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Biomedical research is influenced by many factors, including the involvement of stakeholder groups invested in research outcomes. Stakeholder involvement in research efforts raise questions of justice as their specific interests and motivations play a role in directing research resources that ultimately produce knowledge shaping how different conditions (and affected individuals) are understood and treated by society. This issue is highly relevant to child psychiatry research where diagnostic criteria and treatment strategies are often controversial. Biological similarities and stakeholder differences between attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) provide an opportunity to explore this issue by comparing research foci and stakeholder involvement in these conditions. METHODS A subset of ADHD and ASD research articles published between 1970-2010 were randomly selected from the PubMed database and coded for research focus, funding source(s), and author-reported conflicts of interest (COIs). Chi-square analyses were performed to identify differences between and within ADHD and ASD research across time. RESULTS The proportion of ADHD research dedicated to basic, description, and treatment research was roughly similar and remained stable over time, while ASD research showed a significant increase in basic research over the past decade. Government was the primary research funder for both conditions, but for-profit funders were a notable presence in ADHD research, while joint-funding efforts between non-profit and government funders were a notable presence in ASD research. Lastly, COIs were noted more frequently in ADHD than in ASD research. CONCLUSIONS Our study shows significant differences in research foci and funding sources between the conditions, and identifies the specific involvement of for-profit and non-profit groups in ADHD and ASD, respectively. Our findings highlight the relationship between stakeholders outside the research community and research trajectories and suggest that examinations of these relationships must be included in broader considerations of biomedical research ethics.
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Affiliation(s)
- Lauren C Milner
- Center for the Integration of Research on Genetics and Ethics (CIRGE), Stanford Center for Biomedical Ethics, Stanford University, 1215 Welch Road, Modular A, Stanford, CA 94305
| | - Mildred K Cho
- Center for the Integration of Research on Genetics and Ethics (CIRGE), Stanford Center for Biomedical Ethics, Stanford University, 1215 Welch Road, Modular A, Stanford, CA 94305, Tel: (650) 725-7993,
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Sagberg LM, Jakola AS, Solheim O. Quality of life assessed with EQ-5D in patients undergoing glioma surgery: what is the responsiveness and minimal clinically important difference? Qual Life Res 2013; 23:1427-34. [PMID: 24318084 DOI: 10.1007/s11136-013-0593-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2013] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the responsiveness of EQ-5D 3L in patients undergoing intracranial glioma surgery and estimate the minimal clinically important difference (MCID). MATERIALS AND METHODS EQ-5D 3L index values from 164 patients who underwent glioma surgery in the period 2007-2012 were analysed. Responsiveness and MCID were estimated using a combination of distribution-based and anchor-based methods. Karnofsky performance status served as an anchor. RESULTS Patients who improved functionally did not report significantly higher EQ-5D 3L scores post operatively with a standardized response mean (SRM) of 0.04 (p = 0.13). Patients who deteriorated functionally reported significantly lower EQ-5D 3L scores post operatively with a SRM of 0.72 (p < 0.001). With different approaches, we determined a range of MCID values from 0.13 to 0.15. CONCLUSIONS EQ-5D 3L is responsive to changes when glioma patients are deteriorating functionally after surgery but not responsive when the patients are improving. The MCID values for EQ-5D 3L in glioma surgery seem higher than reported MCID values for other types of cancers.
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Affiliation(s)
- Lisa Millgård Sagberg
- Department of Neuroscience, Norwegian University of Science and Technology, 7491, Trondheim, Norway,
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Abstract
The evidence-based medicine (EBM) paradigm, introduced in 1992, has had a major and positive impact on all aspects of health care. However, widespread use has also uncovered some limitations; these are discussed from the perspectives of two clinicians in this, the first of a two part narrative review. For example, there are credible reservations about the validity of hierarchical levels of evidence, a core element of the EBM paradigm. In addition, potential and actual methodological and statistical deficiencies have been identified, not only in many published randomized controlled trials but also in systematic reviews, both rated highly for evidence in EBM classifications. Ethical violations compromise reliability of some data. Clinicians need to be conscious of potential limitations in some of the cornerstones of the EBM paradigm, and to deficiencies in the literature.
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Menezes AS, Barnes A, Scheer AS, Martel G, Moloo H, Boushey RP, Sabri E, Auer RC. Clinical Research in Surgical Oncology: An Analysis of ClinicalTrials.gov. Ann Surg Oncol 2013; 20:3725-31. [DOI: 10.1245/s10434-013-3054-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Indexed: 01/19/2023]
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