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Many Doctors Still Don't Disclose Consulting Fees

Potential for conflict of interest in recommending products to patients, experts say

WEDNESDAY, Oct. 7 (HealthDay News) -- Despite regulations requiring orthopedic doctors to disclose financial interests in products and consulting fees from device makers, about 30 percent fail to do so, a new study shows.

Disclosure of payments to doctors by device manufacturers and pharmaceutical companies has been hotly debated for many years. Recently, most medical journals and professional societies have instituted policies mandating disclosure of possible conflicts of interest, but the problem persists, experts say.

"In a high-tech field like orthopedics, surgeon relationships with industry are common," said lead researcher Dr. Mininder Kocher, an associate professor of orthopedic surgery at Brigham and Women's Hospital in Boston.

These relationships help advance innovation and can benefit patients, especially as federal dollars for research are decreasing, Kocher said.

"The disadvantage is the suppression of negative results and restriction of investigators," he said. "There is also a risk to the doctor-patient relationship of trust."

Kocher thinks that doctors should disclose any financial relationship they have with companies to journals, professional organizations, the public and to patients.

"Right now, the norm is self-disclosure," Kocher said. "There are problems with self-disclosure. Sometimes physicians intentionally do not self-disclose, other times it's confusing."

The solution is to mandate that all medical device companies make public who they give money and gifts to, Kocher said.

The report is published in the Oct. 8 issue of the New England Journal of Medicine.

For the study, Kocher's team looked at reports of payments made to doctors by five makers of replacement hip and knee joints. The disclosure of these payments was part of a settlement with the U.S. Department of Justice, Kocher said.

The researchers compared these reports with doctors who gave presentations at the 2008 annual meeting of the American Academy of Orthopaedic Surgeons. A total of 344 doctors who presented papers at the meeting had received payments from industry, Kocher said.

The study found that almost 30 percent of the doctors failed to disclose direct financial arrangements with these companies, and 50 percent didn't disclose payments that indirectly related to their presentations.

Doctors who received $10,000 or more or were given gifts were more likely to disclose payments, the researchers noted.

According to the study, the most common reasons doctors gave for not disclosing financial gain from these companies were that the payment was not related to their presentation, they didn't understand the disclosure requirements or disclosure of the payment was missing from the meeting program.

Diana Zuckerman, president of the National Research Center for Women & Families, said that "this is really quite sad. It's amazing, after all these years and all the publicity, people are still not being honest."

Zuckerman thinks the claim that policies are confusing is a smokescreen. "Anybody capable of going to medical school or getting a doctorate are perfectly capable of understanding what these conflict-of-interest guidelines are," she said.

It is impossible to know how many of these omissions are intentional, Zuckerman said. Many doctors think that they are above being influenced by consulting fees and other perks from companies, she said.

Who knows "whether it's arrogance or naivete, or just not wanting to be bothered to think about it," she said.

Zuckerman also thinks the only way that doctors will disclose potential conflicts of interest is if companies are required by law to make payments to doctors public.

"If the companies had to make the information public and if then nonprofit organizations like ours and others made that information more widely available, so people would actually see it, that would be very helpful," she said.

More information

For more about conflict of interest in medicine, visit the Institute of Medicine.

SOURCES: Mininder Kocher, M.D., associate professor, orthopedic surgery, Brigham and Women's Hospital, Boston; Diana Zuckerman, Ph.D., president, National Research Center for Women & Families, Washington, D.C.; Oct. 8, 2009, New England Journal of Medicine

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