Saturday, September 25, 2010

What Disclosure? Failure of Present Journal Policies in Orthopedics

Again, apologies for being behind the times in just getting to last week's news. Duff Wilson in the New York Times--
--nicely summarized a new study published on-line in the Archives of Internal Medicine (subscription required) by our friends over at the Institute on Medicine as a Profession at Columbia University.

Susan Chimonas, Zachary Frosch, and David Rothman started out with the information sprung loose in 2007 by a court settlement involving 5 device manufacturers. From those data the authors identified 41 orthopedic surgeons who had been paid at least $1M by these companies. They figured quite resonably that while somebody could quibble about how big a deal it is if a doc fails to disclose (say) $5000 in consulting fees, it's hard to dismiss more than a million smackers as chicken feed. They then tracked all the journal articles published by those 41 folks in the subsequent year. Overall, 25 of 32 who published articles in 2008 (I suppose the rest were too busy counting their money to publish anything) failed to disclose this income in at least one of the articles they published. The exact rate of disclosure varied a good deal but at best it was about half. The existence of a strong editorial policy at that journal on disclosure of conflicts had no relationship to whether these conflicts were actually disclosed.

The authors suggest that the present system of disclosure in medical journals (assuming orthopedic journals to be representative) is clearly not working. They point out that by 2013, the new health reform law will require that pharmaceutical and device companies post relevant physician payments to a standard online national database. It will then be much easier for journals independently to confirm whether an author has a conflict and how much money is involved. The authors also recommend that the "how much" be part of the disclosure, again suggesting that the doc who rakes off a cool million might be in a somewhat different position with regard to potential bias than the guy who runs off with $10K 0r $20K.

Chimonas S. Frosch Z, Rothman DJ. From disclosure to transparency: the use of company payment data. Archives of Internal Medicine, DOI 10.1001/archinternmed.2010.341, published online 13 Sept. 2010.

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