Payments from medical device makers to orthopedic surgeons dropped between 2007 and 2010 after payment disclosure became a requirement – there was a reduction in both the total amount paid and the number of individual payments, researchers from The University of Iowa and Iowa City Veterans Affairs Medical System reported in Archives of Internal Medicine – part of a Health Care Reform series the journal is publishing. The authors added that payments to orthopedic surgeons from orthopedic device manufacturers is “complex”.

Since disclosure requirement there has also been a rise in the percentage of consultants with academic affiliations.

As background information, the authors explained:

“There is ongoing discussion of physician relationships with the pharmaceutical industry and medical device manufacturers. Our objective was to use data made available by a U.S. Department of Justice (DOJ) lawsuit to describe the extent of orthopedic surgeons’ financial relationships with implant manufacturers.”

The Department of Justice carried out an investigation in 2005 into payments made by the five biggest artificial hip and knee manufacturers to orthopedic surgeons. A settlement was reached with the companies two years later.

Jason M. Hockenberry, Ph.D. and team gathered and analyzed DoJ 2007 data on financial payments from five major device implant makers to orthopedic surgeons.

They were specifically looking out for:

  • How many surgeons received money?
  • How much money was received?
  • Types of payments made during the 12 months leading up to 2007
  • Types of payments made during the 12 months after the DoJ settlement
  • Details of payments made subsequently (three companies voluntarily continued provided data)

Below are some highlighted details on their findings:

  • 2007 – 1,041 payments were made by 5 device manufacturers to 939 orthopedic surgeons – the total was over $198 million.
  • 2008 (12 months following the DoJ settlement) – 568 payments were made to 526 surgeons – the total was just over $228 million (includes $109 million in royalty buyouts)

The following data comes from the three companies that provided data for a full four years:

  • 2007 – $212,740 was paid out (mean) average
  • 2008 – $193,943 was paid out (mean) average
  • 2009 – $246,867 was paid out (mean) average
  • 2010 – $233,108 was paid out (mean) average

In 2007, the percentage of surgeons who received payments and had academic affiliations was 39.4%. This rose to 44.9% in 2008. Data provided by the three companies showed similar patterns for the two subsequent years.

The researchers concluded:

“Although mandating disclosure of consulting payments and efforts by academic institutions to ‘monitor their own’ seem prudent, universal and detailed disclosure with standardized reporting formats and data elements would make these data more useful to patients, providers and policymakers. There is a need for clearer specific requirements for disclosure to allow for meaningful long-term analyses to be performed.”

In the same journal, Dr. Robert Steinbrook, of Yale School of Medicine, wrote:

“According to the study, the approximately 1,000 physicians who received payments in 2007 represent only about 4 percent of the orthopedic surgeons in the United States,” notes Steinbrook. “Unfortunately, the public data provide no information about how the payments relate to research and device development, the choice of hip or knee implant or other aspects of patient care.

The disclosure of industry payments should not divert attention from the real issues with regard to conflict of interest,” writes Steinbrook. “These are the minimization or elimination of financial ties between physicians and industry in areas other than research support, bona fide consulting related to basic and clinical research, and legitimate payments related to intellectual property. Although many well-publicized examples with regard to conflict of interest involve physicians in specific fields, such as orthopedics or psychiatry, the issues are similar for all specialties.

In the United States, the rules regarding the disclosure of industry payments are about to change. With mandatory disclosure of payments and amounts imminent, there should be many new opportunities to better control conflicts of interest in medicine.”

Written by Christian Nordqvist