Striving To Report Author Conflicts Of Interest More Accurately

The Centers for Medicare and Medicaid Services (CMS) Open Payments Database (OPD) began publishing industry payments to physicians in 2013 as a legislative means to improve transparency in healthcare.¹ Unfortunately, many authors in peer-reviewed journal publications fail to disclose or inaccurately disclose conflicts of interest involving industry-reported payments. This oversight, be it intentional or unintentional, brings the results of research in such cases into question.

While all aspects of healthcare may have industry-related conflicts of interest, orthopedic surgeons number approximately 3 percent of all physicians but accounted for more than 20 percent of OPD reported payments in 2013.^2,3 Orthopedic surgeons are inherently tied to industry, so these results are to be expected. In a capitalist society, physicians should able to supplement their income ethically while serving as consultants, inventors, speakers or investors. Professional organizations and publications have well-defined conflict of interest policies for the intertwining of industry and physicians.

Boddapati and colleagues looked at the 335 articles published in the American Journal of Sports Medicine (AJSM) during 2016 and 172 articles met the inclusion criteria of the study.⁴ The number of eligible authors totaled 596 with 434 (72.8 percent) found in the CMS Open Payments Database. The study discovered “a majority of authors (82.9 percent) had inaccuracies in their self-disclosures, and in total, 22.6 percent of all money received from industry sources was not disclosed.” However, when researchers examined specific AJSM conflict of interest disclosure policies (conflicts of interest directly related to the published study), they found “discrepancies were far less prevalent, with only 25.3 percent of all authors having a discrepancy and the authors also noted a discrepancy with 21.8 percent of the disclosed payments from companies.

Author payments per year were a median of $1,692 and a mean of $76,941 with the three most common type of payment being food (81.3 percent), travel and lodging (45.4 percent), and consulting (31.8 percent).⁴ Authors receiving more than $500,000 (16.1 percent) had fewer reporting errors than those receiving less than $10,000 (85.3 percent). Interestingly enough, “this study did not assess whether authors with industry payments preferentially published studies pertaining to products from companies from which they received funding.” This seems like an important overlooked point although it’s possible this factor was outside of the purview of this study. 

Having an author with a conflict of interest pertaining to a peer-reviewed publication should not prevent an article’s publication. With proper disclosures, the article should stand on its own merits for publication. Although cross-checking the CMS Open Payments Database with reported/unreported conflicts of interest for submitted peer-reviewed publications would be laborious for the journals, it is not laborious for the authors. The responsibility should lie on the authors.

What should happen to authors who report in error? That is a difficult question but ultimately it falls upon the journals to determine the consequences. Despite the obliviousness to conflict of interest policies by our political leaders, medical research and thereby public interest require sound scientific results without bias, or at least require accurately reported potential bias.

References

1. Centers for Medicare and Medicaid Services. Open payments data. https://openpaymentsdata.cms.gov. Accessed April 14, 2018.
2. Iyer S, Derman P, Sandhu HS. Orthopaedics and the Physician Payments Sunshine Act: an examination of payments to US orthopaedic surgeons in the open payments database. J Bone Joint Surg. 2016; 98(5):e18.
3. Lopez J, Ahmed R, Bae S, et al. A new culture of transparency: industry payments to orthopedic surgeons. Orthopedics. 2016; 39(6):e1058-e1062.
4. Boddapati V, Fu MC, Nwachukwu BU, et al. Accuracy between AJSM author-reported disclosures and the Centers for Medicare and Medicaid Services Open Payments Database. Am J Sports Med. 2018; 46(4):969-976.