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Jacobs JW, Booth GS, Stephens LD, Adkins BD, Martin AA, Lundberg GD, Glover RT, Khan SS, Silver JK, Woo JS. Industry payments to American Society of Hematology Clinical Practice Guideline authors. Blood Adv 2024; 8:3549-3552. [PMID: 38569136 PMCID: PMC11261266 DOI: 10.1182/bloodadvances.2023012527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 04/05/2024] Open
Affiliation(s)
- Jeremy W. Jacobs
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Garrett S. Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Laura D. Stephens
- Department of Pathology, University of California San Diego, La Jolla, CA
| | - Brian D. Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Amarilis A. Martin
- Department of Pediatrics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stony Brook Children's Hospital, Stony Brook, NY
| | | | - Raeshun T. Glover
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Shazia S. Khan
- Department of Pathology, Yale School of Medicine, New Haven, CT
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT
| | - Julie K. Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, MA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA
| | - Jennifer S. Woo
- Department of Pathology, City of Hope National Medical Center, Irvine, CA
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Shepard S, Sajjadi NB, Checketts JX, Hughes G, Ottwell R, Chalkin B, Hartwell M, Vassar M. Examining the Public's Most Frequently Asked Questions About Carpal Tunnel Syndrome and Appraising Online Information About Treatment. Hand (N Y) 2024; 19:768-775. [PMID: 36564990 PMCID: PMC11284989 DOI: 10.1177/15589447221142895] [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] [Indexed: 12/25/2022]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Patients often search online for health information regarding common musculoskeletal complaints. Thus, the purpose of this study was to use language processing information from Google to assess the content of CTS frequently asked questions (FAQs) searched online and the transparency and quality of online CTS information. METHODS On March 11, 2021, we searched Google for 3 terms "carpal tunnel syndrome treatment," "carpal tunnel syndrome surgical treatment," and "carpal tunnel syndrome non-surgical treatment" until a minimum of 100 FAQs and their answer links were extracted from each search. We used Rothwell classification to categorize the FAQs. The Journal of the American Medical Association's benchmark criteria were used to assess information transparency. Information quality was assessed using the Brief DISCERN tool. RESULTS Our Google search returned 124 unique FAQs. Fifty-six (45.2%) were value based and most were related to the evaluation of treatment options (45/56, 80.4%). The most common source type was medical practices (26.6%). Nearly half of the answer sources (45.9%) were found to be lacking in transparency. One-way analysis of variance revealed a significant difference in mean Brief DISCERN scores among the 5 source types, F(4, 119) = 5.93, P = .0002, with medical practices averaging the worst score (13.73/30). CONCLUSIONS Patients are most commonly searching Google to gain information regarding CTS treatment options. Online sources such as medical practices should use widely accepted rubrics for ensuring transparency and quality prior to publishing CTS information.
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Affiliation(s)
- Samuel Shepard
- Oklahoma State University Center for Health Sciences, Tulsa, USA
| | | | | | - Griffin Hughes
- Oklahoma State University Center for Health Sciences, Tulsa, USA
| | | | - Brian Chalkin
- Oklahoma State University Medical Center, Tulsa, USA
| | - Micah Hartwell
- Oklahoma State University Center for Health Sciences, Tulsa, USA
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa, USA
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Waters P, Anderson R, Anderson JM, Scott J, Detweiler B, Streck S, Hartwell M, Torgerson T, Vassar M. Analysis of the Evidence Underpinning the American Academy of Orthopedic Surgeons Knee Osteoarthritis Clinical Practice Guidelines. Sports Health 2022; 15:11-25. [PMID: 35915571 PMCID: PMC9808825 DOI: 10.1177/19417381221112674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
CONTEXT Clinical practice guidelines (CPGs) are vital to establishing a standardized and evidence-based approach in medicine. These guidelines rely on the use of methodologically sound clinical trials, and the subsequent reporting of their methodology. OBJECTIVE To evaluate the completeness of randomized controlled trials (RCTs) underpinning CPGs published by the American Academy of Orthopedic Surgeons (AAOS) for management of osteoarthritis of the knee. DATA SOURCES We searched the most recent AAOS CPGs for surgical and nonsurgical management of osteoarthritis of the knee for RCTs. To estimate the necessary sample size, we performed a power analysis using OpenEpi 3.0 (openepi.com). STUDY SELECTION Two authors independently screened the reference sections of the included CPGs. Included studies met the definition of an RCT, were retrievable in the English language, and were cited in at least one of the included CPGs. STUDY DESIGN Meta-Analysis. LEVEL OF EVIDENCE Level 1a. DATA EXTRACTION We performed double-blind screening and extraction of RCTs included in the AAOS CPGs. We evaluated each RCT for adherence to the Consolidated Standards of Reporting Trials (CONSORT) 2010 checklist. A multiple regression analysis was conducted to assess CONSORT adherence against characteristics of included studies (ie, type of intervention, funding source, etc). RESULTS Our study included 179 RCTs. The overall adherence was 68.5% with significant differences between those published before and since the development of the 2010 CONSORT guidelines (P = 0.02). We found that RCTs receiving funding from industry/private sources as well as studies that included a conflict of interest statement showed more completeness than RCTs that reported receiving no funding (P < 0.01). CONCLUSION We found suboptimal CONSORT adherence for RCTs cited in AAOS CGPs for management of osteoarthritis of the knee. Therefore, the CPGs are likely supported by outdated evidence and lack of high-quality reporting. It is important that evidence used to guide clinical decision making be of the highest quality in order to optimize patient outcomes. In order for clinicians to confer the greatest benefits to their patients, CPGs should provide the totality of evidence and emphasize emerging high-quality RCTs to ensure up-to-date, evidence-based clinical decision-making.
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Affiliation(s)
- Philo Waters
- Philo Waters, BS, Oklahoma
State University Center for Health Sciences, 1111 W 17th St., Tulsa, OK 74107
() (Twitter: @PWaters04)
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Industry Payments Among Editorial Board Members of Orthopaedic Journals: An Open Payments Analysis From 2014 to 2019. J Am Acad Orthop Surg 2022; 30:621-628. [PMID: 35294411 DOI: 10.5435/jaaos-d-21-01214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/13/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Although industry payments to physicians and surgeons remain a subject of controversy, relationships between industry and orthopaedic surgeons continue to grow. Notably, recent analyses have demonstrated significant increases in the rate and magnitude of payments among orthopaedic surgeons, despite the passing of the Physician Payments Sunshine Act in 2010. Given the concerns regarding how these relationships may affect the peer-review process, our analysis aimed to evaluate how payments among editorial board members of orthopaedic journals have changed over a contemporary time frame. METHODS The Clarivate Analytics Impact Factor tool was used to identify all orthopaedic journals with a 2019 impact factor of ≥1.5. Editorial board members from these respective journals were identified from each journal's website. Subsequently, the Open Payments database by the Centers for Medicare and Medicaid Services was queried to identify industry payments received by these board members between 2014 and 2019. The quantity and magnitude of payments were then evaluated and compared over this study period. All monetary values were adjusted for inflation. RESULTS A total of 18 orthopaedic journals were included in our analysis. Of the 1,519 editorial board members identified, 711 (46.81%) received some form of industry payment in 2019. The total, average, and median payments over this study period decreased for 6 (31.6%), 7 (36.8%), and 8 of the included journals (44.44%), respectively. Six hundred twenty board members had higher average payments in 2019 than in 2014. CONCLUSION Our analysis demonstrated high rates of industry payments among editorial board members of high-impact orthopaedic journals. In addition, we demonstrated marked growth in the total, average, and median magnitude of these payments since the inception of the Open Payments database. Our findings encourage a continued need for transparency in related payments to ensure a fair and unbiased peer-review process, one that is separated from undue industry influence.
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Acuña AJ, Jella TK, Barksdale EM, Samuel LT, Kamath AF. Industry Payments Among Appropriate Use Criteria Voting Panels: An Open Payments Analysis. J Bone Joint Surg Am 2022; 104:e11. [PMID: 34506344 DOI: 10.2106/jbjs.21.00150] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although multiple studies have consistently demonstrated that orthopaedic surgeons receive greater transfers of value than other specialties, the industry payments of providers who are involved in the formation of practice guidelines have not been thoroughly explored. Therefore, the purpose of our analysis was to evaluate the industry payments of the authors of the Appropriate Use Criteria (AUC) from the American Academy of Orthopaedic Surgeons (AAOS). METHODS The publicly available AAOS web portal (OrthoGuidelines.org) was queried for all AUCs that had been released between January 1, 2013, and December 31, 2019, regarding the management of musculoskeletal pathologies. A cross-sectional analysis of the Centers for Medicare & Medicaid Services (CMS) Open Payments database was conducted to determine the number and total value of industry payments to AUC voting committee members during the year of voting for the AUC. Industry payments for each orthopaedic surgeon voting member were compared with payments received by orthopaedic surgeons nationwide who received any payment within the same year. The proportion of orthopaedic surgeon voting members who received any industry payment was compared with the proportion of orthopaedic surgeons nationwide who received payments. RESULTS Our analysis included a total of 18 different AUCs with 216 voting members, 157 of whom were orthopaedic surgeons. Of the orthopaedic surgeon voting members, 105 (67%) received industry payments, a rate roughly comparable with the national average among orthopaedic surgeons (74%). For 7 of 18 AUCs (39%), the median payment per orthopaedic surgeon voting member was above the median among orthopaedic surgeons receiving payments nationwide that year. Qualitatively, orthopaedic surgeon voting members were more likely to receive payments in the form of royalties, licenses, or speaking fees than orthopaedic surgeons nationwide. CONCLUSIONS AUC voting members receive payments at frequencies and magnitudes that are roughly comparable with orthopaedic surgeons nationwide. Whether voting panel members receiving payments at these rates is ideal or is in the best interest of patients is a policy decision for the AAOS and society at large. Our study confirms that payments are common and, thus, continued vigilance is justified.
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Affiliation(s)
- Alexander J Acuña
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Torgerson T, Wayant C, Cosgrove L, Akl EA, Checketts J, Dal Re R, Gill J, Grover SC, Khan N, Khan R, Marušić A, McCoy MS, Mitchell A, Prasad V, Vassar M. Ten years later: a review of the US 2009 institute of medicine report on conflicts of interest and solutions for further reform. BMJ Evid Based Med 2022; 27:46-54. [PMID: 33177167 DOI: 10.1136/bmjebm-2020-111503] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 01/17/2023]
Abstract
Conflicts of interest (COIs) in healthcare are increasingly discussed in the literature, yet these relationships continue to influence healthcare. Research has consistently shown that financial COIs shape prescribing practices, medical education and guideline recommendations. In 2009, the Institute of Medicine (IOM, now the National Academy of Medicine) published Conflicts of Interest in Medical Research, Practice, and Education-one of the most comprehensive reviews of empirical research on COIs in medicine. Ten years after publication of theIOM's report, we review the current state of COIs within medicine. We also provide specific recommendations for enhancing scientific integrity in medical research, practice, education and editorial practices.
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Affiliation(s)
- Trevor Torgerson
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Cole Wayant
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Lisa Cosgrove
- Department of Counseling Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Jake Checketts
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Rafael Dal Re
- Epidemiology Unit, Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad, Autónoma de Madrid, Madrid, Spain
| | - Jennifer Gill
- Division of Hematology Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Samir C Grover
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Gastroenterology, St Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Nasim Khan
- Division of Rheumatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Rishad Khan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Gastroenterology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Ana Marušić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Matthew S McCoy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aaron Mitchell
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vinay Prasad
- Division of Hematology Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Senior Scholar in the Center for Health Care Ethics, Oregon Health & Science University, Portland, Oregon, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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Rulon Z, Powers K, Anderson JM, Weaver M, Johnson A, Hartwell M, Vassar M. Conflicts of Interest Among Authors of Systematic Reviews and Meta-analyses Investigating Interventions for Melanoma: Cross-sectional Literature Study. JMIR DERMATOLOGY 2021; 4:e25858. [PMID: 37632810 PMCID: PMC10501528 DOI: 10.2196/25858] [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: 11/18/2020] [Revised: 02/11/2021] [Accepted: 04/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous studies have highlighted the potential influence that industry relationships may have on the outcomes of medical research. OBJECTIVE We aimed to determine the prevalence of author conflicts of interest (COIs) in systematic reviews focusing on melanoma interventions, as well as to determine whether the presence of these COIs were associated with an increased likelihood of reporting favorable results and conclusions. METHODS This cross-sectional study included systematic reviews with or without meta-analyses focusing on interventions for melanoma. We searched MEDLINE and Embase for eligible systematic reviews published between September 1, 2016, and June 2, 2020. COI disclosures were cross-referenced with information from the CMS (Centers for Medicare & Medicaid Services) Open Payments database, Dollars for Profs, Google Patents, the United States Patent and Trademark Office, and previously published COI disclosure statements. Results were quantified using descriptive statistics, and relationships were evaluated by Fisher exact tests. RESULTS Of the 23 systematic reviews included in our sample, 12 (52%) had at least one author with a COI. Of these 12 reviews, 7 (58%) reported narrative results favoring the treatment group and 9 (75%) reported conclusions favoring the treatment group. Of the 11 systematic reviews without a conflicted author, 4 (36%) reported results favoring the treatment group and 5 (45%) reported conclusions favoring the treatment group. We found no significant association between the presence of author COIs and the favorability of results (P=.53) or conclusions (P=.15). CONCLUSIONS Author COIs did not appear to influence the outcomes of systematic reviews regarding melanoma interventions. Clinicians and other readers of dermatology literature should be cognizant of the influence that industry may have on the nature of reported outcomes, including those from systematic reviews and meta-analyses.
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Affiliation(s)
- Zane Rulon
- Center for Health Sciences, Oklahoma State University, Tulsa, OK, United States
| | - Kalyn Powers
- College of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK, United States
| | - J Michael Anderson
- Center for Health Sciences, Oklahoma State University, Tulsa, OK, United States
| | - Michael Weaver
- College of Osteopathic Medicine, Kansas City University of Medicine and Biosciences, Joplin, OK, United States
| | - Austin Johnson
- Center for Health Sciences, Oklahoma State University, Tulsa, OK, United States
| | - Micah Hartwell
- Center for Health Sciences, Oklahoma State University, Tulsa, OK, United States
| | - Matt Vassar
- Center for Health Sciences, Oklahoma State University, Tulsa, OK, United States
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Under Disclosure of Conflicts of Interest Is Less Frequent in Senior Authors: A Cross-sectional Review of All Authors Submitting to JAAOS Between 2014 and 2018. J Am Acad Orthop Surg 2021; 29:455-461. [PMID: 33620174 DOI: 10.5435/jaaos-d-20-01270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/11/2021] [Indexed: 02/01/2023] Open
Abstract
The interactions between physicians and industry are necessary for advancement of clinical practice and improvement in medical devices. Physician-industry relationships also introduces financial conflicts of interest into research publications. Payments to physicians do not inherently introduce bias in research, but failure to disclose potential conflicts of interest can negatively impact the perceived integrity of authors, editors, and journals. The conflict of interest disclosure statement in all articles published in the Journal of the American Academy of Orthopaedic Surgery between 2014 and 2018 were compared to the financial payments indexed in the Center for Open Payments Database. Payment type, magnitude, and payer were obtained for each payment meeting inclusion criteria. Statistical comparisons were made using Mann-Whitney comparisons due to non-normal distribution of payment amounts. 704 articles involving 2596 authors were reviewed, with 1268 authors meeting inclusion criteria. 634 authors had accurate disclosure statements. The total amount of disclosed payments was $169 million, whereas undisclosed payments were $14.2 million. The amount of disclosed payments on a per-author basis, $55,844 ($12,559, $186,129), was significantly greater than undisclosed payments, $2,171 ($568, $7,238). The lowest rates of correct disclosure were in education (29.2%), gifts (38.7%) and honoraria (57.8%). First and middle authors disclosed correctly at a significantly lower rate than last authors. The magnitude of undisclosed payments was significantly lower than disclosed payments, indicating that these payments do not register with authors as significant enough to disclose.
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Thompson R, Paskins Z, Main BG, Pope TM, Chan ECY, Moulton BW, Barry MJ, Braddock CH. Addressing Conflicts of Interest in Health and Medicine: Current Evidence and Implications for Patient Decision Aid Development. Med Decis Making 2021; 41:768-779. [PMID: 33966538 DOI: 10.1177/0272989x211008881] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND More stringent policies for addressing conflicts of interest have been implemented around the world in recent years. Considering the value of revisiting conflict of interest quality standards set by the International Patient Decision Aid Standards (IPDAS) Collaboration, we sought to review evidence relevant to 2 questions: 1) What are the effects of different strategies for managing conflicts of interest? and 2) What are patients' perspectives on conflicts of interest? METHODS We conducted a narrative review of English-language articles and abstracts from 2010 to 2019 that reported relevant quantitative or qualitative research. RESULTS Of 1743 articles and 118 abstracts identified, 41 articles and 2 abstracts were included. Most evidence on the effects of conflict of interest management strategies pertained only to subsequent compliance with the management strategy. This evidence highlighted substantial noncompliance with prevailing requirements. Evidence on patient perspectives on conflicts of interest offered several insights, including the existence of diverse views on the acceptability of conflicts of interest, the salience of conflict of interest type and monetary value to patients, and the possibility that conflict of interest disclosure could have unintended effects. We identified no published research on the effects of IPDAS Collaboration conflict of interest quality standards on patient decision making or outcomes. LIMITATIONS Because we did not conduct a systematic review, we may have missed some evidence relevant to our review questions. In addition, our team did not include patient partners. CONCLUSIONS The findings of this review have implications for the management of conflicts of interest not only in patient decision aid development but also in clinical practice guideline development, health and medical research reporting, and health care delivery.
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Affiliation(s)
- Rachel Thompson
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Zoe Paskins
- School of Medicine, Keele University, Keele, Staffordshire, UK.,Haywood Academic Rheumatology Centre, Haywood Hospital, UK
| | - Barry G Main
- Centre for Surgical Research and National Institute for Health Research Bristol Biomedical Research Centre, School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | | | | | - Clarence H Braddock
- Deans Office, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
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Brems JH, Davis AE, Clayton EW. Analysis of conflict of interest policies among organizations producing clinical practice guidelines. PLoS One 2021; 16:e0249267. [PMID: 33930893 PMCID: PMC8087455 DOI: 10.1371/journal.pone.0249267] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/16/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Conflicts of interest (COI) jeopardize the validity of Clinical Practice Guidelines (CPGs). When the Institute of Medicine promulgated COI policies in 2011, few organizations met these requirements, but it is unknown if organizations have improved their policies since that time. We sought to evaluate current adherence to IOM standards of COI policies. METHODS AND FINDINGS We conducted a retrospective document review of COI policies and CPGs from organizations that published five or more CPGs between January 1, 2018 and December 31, 2019. Organizations were identified via CPG databases. COI policies were obtained from an internet search. We collected data on i) the number of organizations that have COI policies specific to CPG development, ii) the number of policies meeting each IOM standard and iii) the number of IOM standards met by each policy. COI disclosures from five CPGs of each organization were assessed for adherence to IOM standards. Among the 46 organizations that published 5 or more CPGs, 36 (78%) had a COI policy. Standard 2.2b (requiring divestment of financial COI) was met least frequently, by 2 of 36 (6%) organizations. Standard 2.1 (requiring disclosure of COI) was met most frequently, by 33 of 36 (92%) organizations. A total of 31 of 36 (86%) organizations met 4 or fewer of the 7 IOM standards. Among the 16 organizations limiting COI to a minority of the CPG panel (standard 2.4c) and the 15 organizations prohibiting COI among chairs or co-chairs (standard 2.4d), 12 (75%) and 10 (67%) organizations violated the respective standard in at least one CPG. The main limitations of our study are the exclusion of organizations producing fewer CPGs and ability to assess only publicly available policies. CONCLUSION Among organizations producing CPGs, COI policies frequently do not meet IOM standards, and organizations often violate their own policies. These shortcomings may undermine the public trust in and thus the utility of CPGs. CPG-producing organizations should improve their COI policies and their strategies to manage COI to increase the trustworthiness of CPGs.
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Affiliation(s)
- J. Henry Brems
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail:
| | - Andrea E. Davis
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Ellen Wright Clayton
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Law School, Vanderbilt University, Nashville, Tennessee, United States of America
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Cole WT, Hillman C, Corcoran A, Anderson JM, Weaver M, Torgerson T, Hartwell M, Vassar M. Financial Conflicts of Interest Among Systematic Review Authors Investigating Interventions for Achilles Tendon Ruptures. FOOT & ANKLE ORTHOPAEDICS 2021; 6:24730114211019725. [PMID: 35097455 PMCID: PMC8702762 DOI: 10.1177/24730114211019725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The primary aim of our study was to evaluate the effects of undisclosed financial conflicts of interest in Achilles tendon rupture repair-focused systematic reviews. METHODS Following a cross-sectional study design, we searched MEDLINE and Embase for Achilles tendon rupture repair systematic reviews. We performed screening and data extraction in a blind, triplicate fashion. Each systematic review was evaluated on the individual characteristics of the study, presence of undisclosed and disclosed conflicts of interest, favorability of results and conclusions, and the relationship between conflicts of interest and the favorability of results and conclusions. RESULTS Our search produced 172 total systematic reviews pertaining to Achilles tendon rupture repair; of those, only 12 were included in our study. Undisclosed conflicts of interest were found in half (6/12) of the included reviews. However, no significant association was found between conflict of interest and the favorability of results and conclusions. CONCLUSION Undisclosed conflicts of interests were discovered in a large percentage of our sample. This lack of disclosure did not appear to increase the likelihood of the systematic review results or conclusions reporting favorability of the intervention being investigated. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- W. Tanner Cole
- Oklahoma State University Center for Health Sciences, Office of Medical Student Research, Tulsa, OK, USA
| | - Cody Hillman
- Oklahoma State University Center for Health Sciences, Office of Medical Student Research, Tulsa, OK, USA
| | - Adam Corcoran
- Oklahoma State University Center for Health Sciences, Office of Medical Student Research, Tulsa, OK, USA
| | - J. Michael Anderson
- Oklahoma State University Center for Health Sciences, Office of Medical Student Research, Tulsa, OK, USA
| | - Michael Weaver
- Oklahoma State University Center for Health Sciences, Office of Medical Student Research, Tulsa, OK, USA
- College of Osteopathic Medicine, Kansas City University of Medicine and Biosciences, Joplin, MO, USA
| | - Trevor Torgerson
- Oklahoma State University Center for Health Sciences, Office of Medical Student Research, Tulsa, OK, USA
| | - Micah Hartwell
- Oklahoma State University Center for Health Sciences, Office of Medical Student Research, Tulsa, OK, USA
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Office of Medical Student Research, Tulsa, OK, USA
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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Tabatabavakili S, Khan R, Scaffidi MA, Gimpaya N, Lightfoot D, Grover SC. Financial Conflicts of Interest in Clinical Practice Guidelines: A Systematic Review. Mayo Clin Proc Innov Qual Outcomes 2021; 5:466-475. [PMID: 33997642 PMCID: PMC8105509 DOI: 10.1016/j.mayocpiqo.2020.09.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To systematically evaluate the prevalence of disclosed and undisclosed financial conflicts of interest (FCOI) among clinical practice guidelines (CPGs). Methods In this systematic review, we ascertained the prevalence and types of FCOI for CPGs from January 1, 1980, to March 3, 2019. The primary outcome was the prevalence of FCOI among authors of CPGs. FCOI disclosures were compared between medical subspecialties and societies producing CPGs. Results Among the 37 studies including 14,764 total guideline authors, 45% had at least one FCOI. The prevalence of FCOI per study ranged from 6% to 100%. More authors had FCOI involving general payments (39%) compared with research payments (29%). Oncology, neurology, and gastroenterology had the highest prevalence of FCOI compared with other medical specialties. Among the 8 studies that included the monetary values in US dollars of FCOI, average payments per author ranged from $578 to $242,300. Among the 10 studies that included data on undisclosed FCOI, 32% of authors had undisclosed industry payments. Conclusion There are numerous FCOI among authors of CPGs, many of which are undisclosed. Our study found a significant difference in FCOI prevalence based on types of FCOI and CPG sponsor society. Additional research is required to quantify the implications of FCOI on clinical judgment and patient care. Financial conflicts of interest (FCOI) may have an impact on the objectivity of clinical practice guidelines. Among the 37 studies included in this systematic review, 45% of the 14,764 guideline authors had an FCOI. Authors of oncology, neurology, and gastroenterology guidelines had higher prevalence of FCOI compared with other guidelines. Eight studies included monetary value of FCOI, which ranged from $578 to $242,300 per author. Little is known about the direct impact of FCOI on how authors of clinical practice guidelines vote on recommendations during guideline development.
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Affiliation(s)
- Sahar Tabatabavakili
- Department of Medicine, University of Toronto, Ontario, Canada.,Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Rishad Khan
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Michael A Scaffidi
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada.,Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Nikko Gimpaya
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - David Lightfoot
- Health Science Library, Unity Health Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Samir C Grover
- Department of Medicine, University of Toronto, Ontario, Canada.,Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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Löhrs L, Handrack M, Kopp I, Jessen F, Wagner E, Falkai P, Röh A, Strube W, Hasan A. Evaluation of evidence grades in psychiatry and psychotherapy guidelines. BMC Psychiatry 2020; 20:503. [PMID: 33046040 PMCID: PMC7552557 DOI: 10.1186/s12888-020-02897-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Information regarding the distribution of evidence grades in psychiatry and psychotherapy guidelines is lacking. Based on the German evidence- and consensus- based (S3) psychiatry and psychotherapy and the Scottish Intercollegiate Guidelines Network (SIGN) treatment guidelines, we aimed to specify how guideline recommendations are composed and to what extent recommendations are evidence-based. METHODS Data was collected from all published evidence- and consensus-based S3-classified psychiatry and psychotherapy guidelines. As control conditions, data from German neurology S3-classified guidelines as well as data from recent SIGN guidelines of mental health were extracted. Two investigators reviewed the selected guidelines independently, extracted and analysed the numbers and levels of recommendations. RESULTS On average, 45.1% of all recommendations are not based on strong scientific evidence in German guidelines of psychiatry and psychotherapy. A related pattern can be confirmed for SIGN guidelines, where the mean average of recommendations with lacking evidence is 33.9%. By contrast, in the German guidelines of neurology the average of such recommendations is 16.5%. A total of 24.5% of all recommendations in the guidelines of psychiatry and psychotherapy are classified as level A recommendations, compared to 31.6% in the field of neurology and 31.1% in the SIGN guidelines. Related patterns were observed for B and 0 level recommendations. CONCLUSION Guidelines should be practical tools to simplify the decision-making process based on scientific evidence. Up to 45% of all recommendations in the investigated guidelines of psychiatry and psychotherapy are not based on strong scientific evidence. The reasons for this high number remain unclear. Possibly, only a limited number of studies answer clinically relevant questions. Our findings thereby question whether guidelines should include non-evidence-based recommendations to be methodologically stringent and whether specific processes to develop expert-opinion statements must be implemented.
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Affiliation(s)
- Lisa Löhrs
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians Universität München, Nußbaumstraße 7, 80336, München, Germany.
| | - Mirjam Handrack
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians Universität München, Nußbaumstraße 7, 80336 München, Germany
| | - Ina Kopp
- grid.10253.350000 0004 1936 9756Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, Institut für Medizinisches Wissensmanagement, c/o Philipps-Universität Marburg, Marburg, Germany
| | - Frank Jessen
- grid.6190.e0000 0000 8580 3777Department of Psychiatry, University of Cologne, Medical Faculty, Cologne, Germany
| | - Elias Wagner
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians Universität München, Nußbaumstraße 7, 80336 München, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians Universität München, Nußbaumstraße 7, 80336 München, Germany
| | - Astrid Röh
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians Universität München, Nußbaumstraße 7, 80336 München, Germany
| | - Wolfgang Strube
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians Universität München, Nußbaumstraße 7, 80336 München, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Ludwig-Maximilians Universität München, Nußbaumstraße 7, 80336 München, Germany ,grid.7307.30000 0001 2108 9006Department of Psychiatry, Psychotherapy and Psychosomatics, Bezirkskrankenhaus Augsburg, University of Augsburg, Dr.-Mack-Straße 1, 86156 Augsburg, Germany
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The Policies for the Disclosure of Funding and Conflict of Interest in Surgery Journals: A Cross-Sectional Survey. World J Surg 2020; 45:97-108. [PMID: 32914281 DOI: 10.1007/s00268-020-05771-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Industry through its funding of research and through its relationships with study authors can influence the results of research. Most journals have policies for reporting funding and disclosing conflict of interest (COI) to mitigate the influence of industry on research. The objective of this study is to assess the policies of surgery journals for the reporting of funding and the disclosure of COI. METHODS We described the prevalence and characteristics of funding and COI policies of journals indexed under "Surgery" in the Journal Citation Reports. We extracted data from publicly available information and through simulation of manuscript submission. RESULTS Of the 186 eligible journals, 171 (92%) had policies for reporting of funding. None of the policies described procedures to deal with non-reporting or underreporting of funding. Of the 186 journals, 183 (99%) had a policy for disclosure of COI. All journals with a COI policy required disclosure of financial interest, while 96 (52%) required the disclosure of non-financial interests. Only 24 (13%) policies described how non-disclosure of COI affects the editorial process, and none described procedures to verify COI disclosure. Of the policies that required disclosing COI, 94 (51%) also required reporting the source of financial COI. CONCLUSIONS Most journals have policies for reporting of funding and disclosure of financial COI. However, many do not have clear policies for disclosing non-financial COI. Major limitations in the policies include the lack of processes for the verification of disclosed interests and for dealing with underreporting of funding and of COI.
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Wayant C, Walters C, Zaaza Z, Gilstrap C, Combs T, Crow H, Vassar M. Evaluation of Financial Conflicts of Interest Among Physician-Authors of American College of Rheumatology Clinical Practice Guidelines. Arthritis Rheumatol 2020; 72:1427-1434. [PMID: 32039569 DOI: 10.1002/art.41224] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 02/04/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Clinical practice guidelines (CPGs) underpin patient care, and ideally authors of these guidelines would be free from outside influence. However, it has been shown many times that authors of professional society CPGs receive large sums of money from industry drug companies, creating financial conflicts of interest. This study investigated industry payments catalogued in the Open Payments Database (OPD) that have been received by authors of the American College of Rheumatology (ACR) CPGs. METHODS Guidelines on the ACR web site that were published during or after August 2014 were used to retrieve the list of authors. All general, research, associated research, and ownership payments reported on the OPD between the date of publication of the CPG and 12 months prior were extracted in a parallel and blinded manner by 2 investigators. RESULTS Of the 89 US-based physician-authors from the 5 ACR CPGs identified within the study timeframe, 56 (62.9%) had received at least 1 payment according to OPD records. These 56 authors had received a median of $522 (interquartile range $119-2,500), which, combined, was a total of $9,728,751. Nineteen authors had received at least 1 industry payment relevant to the CPG recommendations, for a median amount of $748 and a total of $1,961,362 in relevant payments. Of the total relevant payments received, a significant proportion was undisclosed (for ACR CPGs during or after August 2014, undisclosed payments were $699,561, or 35.7% of the total). CONCLUSION Fewer than one-half of the US-based physician-authors of ACR CPGs during or after August 2014 had received guideline-relevant industry payments. Nonetheless, a substantial proportion of the money received was not disclosed. Conflict of interest disclosure is a bare minimum requirement, and more permanent solutions may include divestiture or inclusion of more nonconflicted authors.
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Affiliation(s)
- Cole Wayant
- Oklahoma State University Center for Health Sciences, Tulsa
| | - Corbin Walters
- Oklahoma State University Center for Health Sciences, Tulsa
| | - Zachary Zaaza
- Oklahoma State University Center for Health Sciences, Tulsa
| | | | - Tyler Combs
- Oklahoma State University Center for Health Sciences, Tulsa
| | - Hanna Crow
- Oklahoma State University Medical Center, Tulsa
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa
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El-Rayess H, Khamis AM, Haddad S, Ghaddara HA, Hakoum M, Ichkhanian Y, Bejjani M, Akl EA. Assessing concordance of financial conflicts of interest disclosures with payments' databases: a systematic survey of the health literature. J Clin Epidemiol 2020; 127:19-28. [PMID: 32622901 DOI: 10.1016/j.jclinepi.2020.06.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/21/2020] [Accepted: 06/28/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective of the study is to review the literature for studies that assessed the concordance of financial conflicts of interest disclosures with payments' databases and evaluate their methods. STUDY DESIGN AND SETTING We conducted a systematic survey of the health literature to identify eligible studies. We searched both Medline and EMBASE up to February 2017. We conducted study selection, data abstraction, and methodological quality assessment in duplicate and independently using standardized forms. We subcategorized 'nonconcordant disclosures' as either 'partially nonconcordant' or 'completely nonconcordant'. The main outcome was the percentage of authors with 'nonconcordant' disclosures. We summarized results by three levels of analysis: authors, companies, and studies. RESULTS We identified 27 eligible journal articles. The top two types of documents assessed were published articles (n = 13) and published guidelines (n = 9). The most commonly used payment database was the Open Payments Database (n = 16). The median percentage of authors with 'nonconcordant' disclosures was 81%; the median percentage was 43% for 'completely nonconcordant' disclosures. The percentage of 'nonconcordant' conflict of interest (COI) reporting by companies varied between 23% and 85%. The methods of concordance assessment, as well as the labeling and definitions of assessed outcomes varied widely across the included studies. We judged three of the included studies as high-quality studies. CONCLUSION Underreporting of health science researchers' financial COIs is pervasive. Studies assessing COI underreporting suffer from a number of limitations that could have overestimated their findings.
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Affiliation(s)
- Hebah El-Rayess
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Assem M Khamis
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sara Haddad
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hussein Abou Ghaddara
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Maram Hakoum
- Department of Family Medicine, Cornerstone Care Teaching Health Center, Morgantown, WV, USA
| | - Yervant Ichkhanian
- Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Michael Bejjani
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon; Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
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17
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Ross PR, Wood SM, Chung KC. Industry Funding and Self-Declared Conflict of Interest in Hand Surgery Publications. J Hand Surg Am 2020; 45:479-487. [PMID: 32245714 DOI: 10.1016/j.jhsa.2020.02.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 01/22/2020] [Accepted: 02/25/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Accurate financial disclosure is essential to prevent bias in scientific reporting. We aimed (1) to document the extent of industry financial payments to hand surgery literature authors and (2) to uncover discrepancies in author self-declared conflict of interest (COI). METHODS We screened all scientific and review articles published in 2017 from the American editions of 4 peer-reviewed journals (Journal of Hand Surgery [JHS], Journal of Bone and Joint Surgery [JBJS], Plastic and Reconstructive Surgery [PRS], and Journal of the American Academy of Orthopaedic Surgeons [JAAOS]) to identify authors of hand, wrist, elbow, and peripheral nerve topics. We compared self-reported disclosures with industry-reported payments on the Centers for Medicare and Medicaid Services' Open Payments Database (OPD) for 3 years prior to publication or per journal policy. We individually examined each for relevance of the corporate payer to the article's subject matter. RESULTS We found 630 eligible authors from 395 articles. The total amount of industry-reported payments over 3 years prior to publication was $24,396,607.80. The median total payments per author per year was $118.40, with interquartile range from $0 to $1,364; 68% of authors received some industry payment; the most common being food and beverage (66% of authors). Senior authors received significantly more industry payments (median, $2,985.67/y) than first and middle authors ($70.27 and $113.17, respectively). Of all authors examined, 58% had undisclosed payments, but only 14% were relevant to the article subject matter. Authors in JAAOS & JBJS, senior authors, and those receiving more than $500,000 from industry were less likely to accurately report all payments. CONCLUSIONS Industry payments to hand surgery authors were lower than those reported to other orthopedic specialties and tended to be concentrated in a few authors receiving large amounts. Relevant COI disclosure inaccuracies are infrequent within hand surgery literature. Uniform policies of complete disclosure across journals may remove author judgment regarding payment relevance to published material and help eliminate remaining COI errors. Authors may reference the OPD prior to submitting disclosures to prevent potential discrepancies and identify errors within the database. CLINICAL RELEVANCE Relationships with industry offer opportunities for innovation, education, and research, but overlooking COI self-reporting may erode confidence in the academic integrity of the hand surgery literature.
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Affiliation(s)
- Phillip R Ross
- Section of Plastic Surgery, Department of Surgery, Ann Arbor, MI.
| | | | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, Ann Arbor, MI
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Affiliation(s)
- Jake Checketts
- Department of Orthopedic Surgery, Oklahoma State University Center for Health Sciences, Tulsa, OK 74107, US
- Department of Psychiatry, Oklahoma State University Center for Health Sciences, US
| | - Matt Vassar
- Department of Psychiatry, Oklahoma State University Center for Health Sciences, US
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CORR® Curriculum-Orthopaedic Education: Teaching the Intricacies of the Surgeon-Industry Relationship. Clin Orthop Relat Res 2020; 478:225. [PMID: 32022763 PMCID: PMC7438130 DOI: 10.1097/corr.0000000000001100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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20
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Morse E, Berson E, Mehra S. Industry Involvement in Otolaryngology: Updates from the 2017 Open Payments Database. Otolaryngol Head Neck Surg 2019; 161:265-270. [DOI: 10.1177/0194599819838268] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To characterize drug and device industry payments to otolaryngologists in 2017 and compare them with payments from 2014 to 2016. Study Design Retrospective cross-sectional analysis. Setting 2017 Open Payments Database. Subjects and Methods We identified otolaryngologists in the Open Payments Database receiving nonresearch industry payments in 2017. We determined the total number and value of payments and the mean and median payments per compensated otolaryngologist. We characterized payments by census region, nature of payment, and sponsor subspecialty. Results A total of 8131 otolaryngologists received 66,414 payments totaling to $11.2 million in industry compensation in 2017. This is decreased from $14.5 million in 2016. The mean and median payment per compensated otolaryngologist was $1383 ($10,459) and $159 ($64-$420), respectively. Of the total compensation, 85% was received by the top 10th percentile of otolaryngologists. Speaking fees accounted for $3.1 million (28% of total payments), and food and beverage was the most common payment type (57,691 payments; 87%). Consulting fees decreased by $1 million from 2016 to 2017, and ownership interests decreased by $1.2 million from 2016 to 2017. The south had the highest total compensation value ($4.2 million), while the west had the highest mean payment value ($1561). Rhinology accounted for the highest proportion of payments of all otolaryngology subspecialties at $3.9 million (34%). Conclusion Industry payments to otolaryngologists decreased to $11.2 million in 2017 from $14.5 million in 2016. Much of the decrease can be attributed to decreases in consulting fees and ownership payments. It is important that otolaryngologists remain aware of changes in industry funding with each release of the Open Payments Database.
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Affiliation(s)
- Elliot Morse
- Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Elisa Berson
- Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Saral Mehra
- Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
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Grindal AW, Khan R, Scaffidi MA, Rumman A, Grover SC. Financial Conflicts of Interest in Inflammatory Bowel Disease Guidelines. Inflamm Bowel Dis 2019; 25:642-645. [PMID: 30295831 DOI: 10.1093/ibd/izy315] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Indexed: 12/09/2022]
Abstract
BACKGROUND Industry payments can lead to financial conflicts of interest (FCOI) among authors of clinical practice guidelines (CPGs). Guidelines for inflammatory bowel disease (IBD) may be at particularly high risk. We determined the prevalence of FCOI in IBD CPGs produced by various gastroenterology societies. METHODS We conducted a cross-sectional analysis of FCOI disclosure among CPGs related to the management of IBD. We ascertained the prevalence and types of FCOI for each guideline and determined adherence to National Academy of Medicine (NAM) standards. FCOI disclosures were compared between societies producing CPGs. RESULTS We identified 11 relevant CPGs with 173 total authors. There were 117 (68%) authors who declared a payment. A total of 107 (62%) authors declared FCOI related to a medication recommended in the guideline. There was a significant difference (P < 0.001) between the proportion of authors with FCOI between countries or regions. Authors of US CPGs had a significantly lower FCOI prevalence (19%) compared with other societies. Authors of UK CPGs had a significantly lower FCOI prevalence (56%) compared with Canadian (84%) and European (94%) CPGs. Three (27%) guidelines adhered to both NAM standards. CONCLUSIONS A substantial portion of authors of IBD CPGs had FCOI. Our study found a significant difference in FCOI prevalence based on CPG sponsor nationality. Most CPGs for IBD did not adhere to NAM standards for FCOI disclosure.
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Affiliation(s)
| | - Rishad Khan
- Division of Gastroenterology, University of Toronto, Toronto, Canada
| | | | - Amir Rumman
- Division of Gastroenterology, University of Toronto, Toronto, Canada
| | - Samir C Grover
- Division of Gastroenterology, University of Toronto, Toronto, Canada
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Vassar M, Bibens M, Wayant C. Transparency of industry payments needed in clinical practice guidelines. BMJ Evid Based Med 2019; 24:8-9. [PMID: 30042209 DOI: 10.1136/bmjebm-2018-111020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Michael Bibens
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Cole Wayant
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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Hughes JD, Shin JJ, Albers M, Musahl V, Fu FH. A Closer Look at the Relationship Between Industry and Orthopaedic Sports Medicine Surgeons. Orthop J Sports Med 2019; 7:2325967118823175. [PMID: 30733974 PMCID: PMC6344948 DOI: 10.1177/2325967118823175] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: A recent study demonstrated that discrepancies exist between disclosures reported by authors publishing in The American Journal of Sports Medicine and disclosures listed in the Physician Payments Sunshine Act–initiated Open Payments database, managed by the Centers for Medicare & Medicaid Services (CMS). However, no study to date has explored the relationship between the biopharmaceutical and device industry (industry) and the membership base of the American Orthopaedic Society for Sports Medicine (AOSSM). Purpose: To critically examine the relationship between orthopaedic sports medicine surgeons and industry. Study Design: Cross-sectional study. Methods: The publicly available CMS Open Payments database website was accessed to search for sports medicine orthopaedic surgeons in the United States who were members of the AOSSM. Financial data, specifically general, research, and ownership payments for 2015, were recorded for each surgeon. The American Academy of Orthopaedic Surgeons (AAOS) disclosures of each surgeon were then obtained. Descriptive statistics and simple proportions were calculated to summarize the collected data, including years in practice and amount of payment. Median values for general payments were compared to provide a more accurate reflection of payments transferred to a “typical” sports medicine surgeon. Results: A total of $58,113,561 in general payments, $3,996,051 in research payments, $72,481,814 in money invested, and $144,552,383 in interest earned from money invested were identified as being paid to 2274 surgeons (all amounts in US$). The distribution of total general payments received was skewed: 10% of surgeons received 95.4% ($55,463,183) of the total general payments. A total of 1433 surgeons had completed, up-to-date AAOS disclosures. Although 44% (635 surgeons) self-reported no financial conflict to the AAOS, the Open Payments database indicated some level of industry support to these surgeons. Unreported general payments totaled $1,393,212, or a median of $561 per surgeon (interquartile range, $10-$200,048). Conclusion: Although orthopaedic sports medicine surgeons received substantial payments from industry, most of the total general payments were given to a small proportion of people. The regional distribution of these payments did not differ significantly. Summary reports of data are largely skewed by outliers and should be interpreted with caution. However, a large percentage of these surgeons failed to reveal industry support of any kind in their AAOS disclosures, including meals and educational funding, demonstrating the importance of transparency and accuracy when completing financial disclosures.
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Affiliation(s)
| | - Jason J Shin
- UPMC Rooney Sports Complex, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Marcio Albers
- UPMC Rooney Sports Complex, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- UPMC Rooney Sports Complex, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Freddie H Fu
- UPMC Rooney Sports Complex, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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24
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Morse E, Fujiwara RJT, Mehra S. Increasing Industry Involvement in Otolaryngology: Insights from 3 Years of the Open Payments Database. Otolaryngol Head Neck Surg 2018; 159:501-507. [DOI: 10.1177/0194599818778502] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objectives To characterize industry payments to otolaryngologists in 2016 versus 2014 and 2015. Study Design Cross-sectional retrospective analysis. Setting Open Payments Database. Subjects and Methods Using the Open Payments Database, we identified otolaryngologists receiving payments from industry sponsors from 2014 to 2016. We characterized the number and value of payments per physician overall and by census region, as well as by sponsor subspecialty and payment type. Study years were compared via analysis of variance and Kruskal-Wallis tests. Trends in payments to otolaryngologists were compared with trends in 21 other specialties. Results Payment to otolaryngologists increased 67% from 2014 to 2016—from $8.7 million in 2014 to $9.9 and $14.5 million in 2015 and 2016, respectively ( P < .001). While mean payment per compensated otolaryngologist increased ($1095, $1243, and $1834 in 2014, 2015, and 2016, respectively, P < .001), median payments stayed relatively constant ($169, $165, and $172), suggesting an increasingly unequal distribution. Much of the increase is accounted for by an increased number of payments for consulting fees and physician ownership. Most payments were made by companies specializing in rhinology. Otolaryngology received the lowest industry compensation per physician among the surgical specialties examined and lower compensation than most nonsurgical specialties. The increase in payments to otolaryngologists was proportionally greater than all but 1 of the other 21 specialties examined. Conclusions Industry compensation to otolaryngologists is increasing and increasingly unequal, although it is still less than that in most other specialties. In otolaryngology, the Open Payments Database has not decreased physician-industry relationships as intended.
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Affiliation(s)
- Elliot Morse
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Rance J. T. Fujiwara
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Saral Mehra
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
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