Gender differences in the medical industries’ payments to physicians: a systematic review

Purpose This paper aims to explore gender differences in payments made to physicians by the pharmaceutical and medical device industries via the performance of a systematic review of articles based on the Open Payments Database (OPD). Design/methodology/approach Three databases (Scopus, Web of Science and PubMed) were searched for articles published from September 30, 2014 to May 10, 2019, using two search terms: “Sunshine Act” and “Open Payments.” The systematic review is reported according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Findings The search identified 359 abstracts. Thirty-nine articles were selected for full review, and 17 of these met the inclusion criteria. Although the articles considered are based on the same database, they adopt diverse approaches and analyses are conducted in different ways. A substantial proportion of the studies show total payments from the two industries to be higher for male physicians than for female physicians. However, a few exceptions exist, higher female mean or median values occurring for payments involving research, ownership, honoraria, grants, royalties/licenses and travel/lodgings. Also, in the case of obstetric–gynecological specializations, a higher proportion of women than men are shown to cooperate with the industries. Originality/value There is gender inequality in terms of industries’ funding for doctors. While analyses of secondary OPD data show that a gender inequality exists, they do not provide an understanding of why this occurs. However, from the exceptions identified, it can be speculated that this phenomenon is connected with greater adherence to ethical standards on the part of female physicians and/or the likelihood that fewer opportunities for industrial cooperation are extended to them.

Characterizing Potential Conflicts of Interest Among UpToDate and DynaMed Content Contributors

BACKGROUND: Financial conflicts of interest among physicians have the potential to negatively impact patient care. Physicians contribute content to two popular, evidence-based websites, UpToDate and DynaMed; while other physicians use these websites to influence their clinical decision making. Each website maintains a conflict-of-interest policy, and contributors are required to self-report a disclosure status. This research investigated the occurrence for potential conflicts of interest among the self-reported statuses of UpToDate and DynaMed content contributors. METHODS: An initial list of contributors for each website was compiled using the Centers for Disease Control and Preventions 2017 Leading Causes of Death. The top 50 causes were used to determine a relevant article with clinical implications from each database. All named authors and editors of those articles comprised our list of investigated contributors. Contributor disclosure status was then compared with public records of financial remuneration as reported in the Open Payments database maintained by the Centers for Medicare and Medicaid Services and ProPublicas Dollar for Docs website from 2013 to 2018. Descriptive analysis and Fishers exact tests were performed on the data. RESULTS: Of 76 UpToDate contributors, 57.9% reported nothing to disclose but had a record of receiving a financial payment on Open Payments, which was found to be statistically significant (p = 0.0002). Of DynaMeds 42 contributors who reported nothing to disclose, 83.3% had an entry on Open Payments. However, this was not statistically significant. The sum total of industry payments between 2013-2018 made to UpToDate contributors was $68.1 million. The top ten UpToDate contributors who received the most financial remuneration earned approximately $56.1 million (82.4% of all UpToDate renumeration), were all male, and only one had a nothing-to-disclose status. The sum total of compensation reported for the discordant UpToDate contributors between 2013-2018 was approximately $4.81 million (or 7.07% of the total monies reported to UpToDate contributors.) In that same time frame, DynaMed contributors received a sum total of $9.58 million from industry, while the top ten DynaMed contributors earned $8.88 million (or 92.8%) of that. The top ten DynaMed contributors were 80% male and 20% female, and six individuals reported nothing to disclose, yet had an Open Payments entry. The sum total of money reported for all discordant DynaMed contributors between 2013-2018 was approximately $2.79 million (or 29.2% of the total monies reported to DynaMed contributors). CONCLUSIONS: While this research does not ascertain that a conflict of interest or anything untoward, it does provide evidence that there was a significant difference between having an Open Payment entry among those who did versus those who did not disclose a conflict of interest. Websites such as UpToDate and DynaMed should consider implementing a more stringent conflict of interest policy and employ an unbiased team to verify self-reported disclosure statuses among its content contributors. Similarly, physicians who use such informational websites to inform their clinical decision making should look beyond a contributors self-reported disclosure status and verify relevant financial remuneration from the healthcare industry via Open Payments or Dollars for Docs.

Accuracy of Conflict-of-Interest Disclosures of Physician-Authors Publishing in High-Impact U.S. Medical Journals: A Comparison of the Journal of the American Medical Association and the New England Journal of Medicine

Objective: To assess the accuracy of self-reported financial conflict-of-interest (COI) disclosures in the New England Journal of Medicine (NEJM) and Journal of the American Medical Association (JAMA) within the requisite disclosure period prior to article submission. Design: Cross-sectional investigation. Data Sources: Original clinical-trial research articles published in NEJM (n = 206) or JAMA (n = 188) from January 1 to December 31, 2017; self-reported COI disclosure forms submitted to NEJM or JAMA with the authors published articles; Open Payments website (from database inception; latest search: August 2019). Main outcome measures: Financial data reported to Open Payments from 2014 to 2016 (time period that included all subjects requisite disclosure windows) were compared to self-reported disclosure forms submitted to the journals. Payments were defined as those not associated with a research study or formal research funding. Payment types were categorized as disclosed, undisclosed, indeterminate, or unrelated. Results: Thirty-one articles from NEJM and 31 articles from JAMA met inclusion criteria. The physician-authors (n = 118) received a combined total of $7.48 million. Of the 106 authors (89.8%) who received payments, 86 (81.1%) received undisclosed payments. The top 23 most highly compensated received $6.32 million, of which $3.00 million (47.6%) was undisclosed. Disclosure rates were the equivalent between the top 23 and the entire sample. Conclusions: High payment amounts, as well as high proportions of undisclosed financial compensation, regardless of amount received, comprised potential COIs for two influential US medical journals. Further research is needed to explain why such high proportions of general payments were undisclosed and whether journals that rely on self-reported COI disclosure need to reconsider their policies.

Conflict of Interest at Microsurgery Conferences: Disclosure of Its Extent and Nature

Background Industry relationships and conflicts of interest can impact research funding, topics, and outcomes. Little research regarding the role of biomedical companies at microsurgery conferences is available. This study evaluates the role of industry at conferences by comparing payments received by speakers at the American Society for Reconstructive Microsurgeons (ASRM) meeting with those received by speakers at the American Society of Aesthetic Plastic Surgeons (ASAPS) meeting, the American Society of Plastic Surgeons (ASPS) meeting, and an average plastic surgeon. It also compares payments made by different companies. Methods General payments received by speakers at the 2017 ASAPS, ASPS, and ASRM conferences were collected from the Open Payments Database. Mean payments received at each conference were calculated and the Mann–Whitney U test evaluated differences between conference speakers and the average plastic surgeon. The total amount of payments from each company was collected through the Open Payments Database, and Z-tests identified which companies paid significantly more than others. Results The mean (and median) general payments made to conference speakers at ASAPS (n = 75), ASPS (n = 247), and ASRM (n = 121) were $75,577 ($861), $27,562 ($1,021), and $16,725 ($652), respectively. These payments were significantly greater (p < 0.001 for all) than those of the average plastic surgeon ($4,441 and $327), but not significantly different from each other. Allergan contributed significantly more than other companies to speakers at ASPS and ASAPS, while LifeCell Corporation, Zimmer Biomet Holdings, and Axogen contributed significantly more to speakers at ASRM. Conclusion Payments to physicians at ASRM were significantly higher than those of an average plastic surgeon but not significantly different from those of speakers at ASAPS and ASPS. Certain companies paid significantly more than their peers at each conference. Given these findings, speakers should strive to make clear the nature and extent of their conflicts of interest when presenting at conferences.