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Association of Compensation From the Surgical and Medical Device Industry to Physicians and Self-declared Conflict of Interest

Educational Objective To characterize the association of industrial payments by device manufacturers, self-declared conflicts of interest, and the relevance of publications among physicians who receive the highest compensation.
Key Points

Question  What is the association between the physicians receiving the top compensation from surgical and/or medical device manufacturers and their academic affiliation, expertise, and disclosure of conflicts of interest?

Findings  A bibliometric analysis of the 100 physicians receiving the highest compensation from 10 large surgical and medical device manufacturers used payment information from the Centers for Medicare & Medicaid Services Open Payments Database. Conflicts of interest were declared by the authors in only 84 of 225 of the relevant 2016 publications (37.3%).

Meaning  A large discrepancy between self-declared conflict of interest and the Open Payments Data among the physicians receiving the highest compensation from surgical and medical device manufacturers needs to be addressed.

Abstract

Importance  Surgical and medical device manufacturers have a cooperative relationship with clinicians. When evaluating published works, one should assess the integrity and academic credentials of the authors, who serve as putative experts. A relationship with a relevant manufacturer may increase the potential risk for bias in relevant studies.

Objective  To characterize the association of industrial payments by device manufacturers, self-declared conflict of interest (COI), and relevance of publications among physicians receiving the highest compensation.

Design, Setting, and Participants  This population-based bibliometric analysis identified 10 surgical and medical device manufacturing companies and the 10 physicians receiving the highest compensation from each company using the 2015 Open Payments Database (OPD) general payments data. For each of the 100 physicians, the total amount of general payments, number of payments, institution type, and academic rank were recorded. Royalty or license payments were excluded. A search of PubMed identified articles published by each physician from January 1 through December 31, 2016, and their associated COI declaration. Scopus was used to identify bibliometric data reported as the h index (number of papers by a researcher with at least h citations each).

Main Outcomes and Measures  Discrepancy between self-declared COI and industry payments.

Results  The 100 physicians included in the sample population (88% men) were paid a total of $12 446 969, with a median payment of $95 993. Fifty physicians (50.0%) were faculty at academic institutions. The mean (SD) h index was 18 (18; range, 0-75) for the authors. In 2016, 412 articles were published by these physicians, with a mean (SD) of 4 (6) publications (range, 0-25) and median of 1 (36 physicians had no publications). Of these articles, 225 (54.6%) were relevant to the general payments received by the authors. Only in 84 of the 225 relevant publications (37.3%) was the potential COI declared by the authors.

Conclusions and Relevance  A high level of inconsistency was found between self-declared COI and the OPD among the physicians receiving the highest industry payments. Therefore, a policy of full disclosure for all publications, regardless of relevance, is proposed. No statistically significant association was demonstrated between academic rank or productivity and industrial payments.

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Article Information

Accepted for Publication: May 8, 2018.

Corresponding Author: Mehraneh D. Jafari, MD, Division of Colon and Rectal Surgery, Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd W, Ste 850, Orange, CA 92868 (jafarim@uci.edu).

Published Online: August 15, 2018. doi:10.1001/jamasurg.2018.2576

Author Contributions: Drs Ziai and Jafari had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Ziai, Pigazzi, Smith, Carmichael, Jafari.

Acquisition, analysis, or interpretation of data: Ziai, Pigazzi, Nouri-Nikbakht, Nepomuceno, Mills, Stamos.

Drafting of the manuscript: Ziai, Pigazzi, Nouri-Nikbakht, Carmichael, Stamos.

Critical revision of the manuscript for important intellectual content: Pigazzi, Smith, Nepomuceno, Mills, Jafari.

Statistical analysis: Ziai, Nouri-Nikbakht.

Administrative, technical, or material support: Ziai, Smith, Mills, Stamos.

Supervision: Pigazzi, Smith, Carmichael, Mills, Stamos, Jafari.

Conflict of Interest Disclosures: Dr Pigazzi reported consulting for Intuitive Surgical, Inc, Medtronic, Inc, Ethicon, Inc, Novadaq Technologies, Inc, and Medrobotics Corporation and receiving royalties from Richmond Enterprises. Dr Smith reported consulting for Stryker Corporation. Dr Carmichael reported receiving honoraria from Medrobotics Corporation, payments for educational services from Medtronic, Inc, and serving as a speaker for Johnson & Johnson and Novadaq Technologies, Inc. Dr Mills reported serving as a consultant for Ethicon Endo-Surgery, Inc, and Medtronic, Inc. Dr Stamos reported receiving author royalties from Elsevier, honorarium and consulting fees from Ethicon, Inc, Medtronic, Inc, and Novadaq Technologies, Inc, and having had stock options for Novadaq Technologies, Inc. Dr Jafari reported receiving educational grants from Medrobotics Corporation, Ethicon, Inc, and Intuitive Surgical, Inc, and consulting for Medrobotics Corporation. No other disclosures were reported.

Disclaimer: None of the companies had any role in the present study.

Meeting Presentation: This paper was presented at the Pacific Coast Surgical Association 89th Annual Meeting; February 17, 2018; Napa, California.

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