Harvard neurologist starts new program for doctor education; Study finds journal authors often do not disclose ties to medical device companies

The Boston Globe reports on Dr. Martin Samuels, a Harvard Medical School neurologist, who started "a new company that he says will provide continuing medical education to doctors across the country — without funding from the pharmaceutical industry. … The venture is the latest development in an escalating national debate over the system for educating physicians. States require physicians to take continuing education courses to retain their medical licenses, but doctors often pay little or nothing for the instruction because many of the companies that offer it are partly funded by makers of drugs and medical devices. Samuels himself worked part time for such a company until last year, when he said he decided that commercial support created an unacceptable conflict. Critics say the reliance on industry funding allows drug and device companies to influence what is taught, potentially misleading physicians about the best treatments for patients and pushing up spending on prescription drugs" (Kowalczyk, 9/14).

In a separate piece, Bloomberg News/The Boston Globe report: "Fewer than half of the physicians who received $1 million or more in consulting fees from medical device companies including Johnson & Johnson, Stryker Corp., and Biomet Inc. in 2007 disclosed the financial ties in subsequent articles they wrote about the industry, a study shows." The report released yesterday in the Archives of Internal Medicine "focused on 40 orthopedic surgeon researchers who were given at least $1 million from a single company and another who received that much from two companies. The biggest payout was $8.9 million" (9/14).

USA Today: "This lack of disclosure appears to flout professional and medical journal standards requiring that doctors reveal any potential conflicts of interest that might influence their research or expert analysis, doctors say. 'The whole concept of disclosure is to alert readers to potential bias,' says Mary O'Connor, president of the American Association of Hip and Knee Surgeons. 'The fact that (the researchers) found a troubling amount of non-disclosure means to me that the profession needs to work harder to improve this.' ... Experts say it will become easier to trace corporate payments to doctors on Sept. 30, 2013, when the government launches an Internet database containing every gift or payment of $10 or more under the Physician Payment Sunshine Act. Today, consumers must search for the information on corporate websites"  (Sternberg, 9/13).

Reuters: "Members of Congress including Senator Charles Grassley, an Iowa Republican, have been pushing to limit the influence drugmakers have over the practice of medicine in the United States after investigations revealed that Harvard University psychiatrist Dr. Joseph Biederman and others failed to fully disclose payments from drug companies" (Steenhuysen, 9/13).

The New York Times: "'We found a massive, dramatic system failure,' said David J. Rothman, a professor and president of the Institute on Medicine as a Profession at Columbia University, who wrote the study with two others. … Professor Rothman called for stricter disclosure policies, including precise amounts of consulting payments. He said journal readers needed the information to consider the potential for bias. … The International Committee of Medical Journal Editors, responding to criticism, has proposed better disclosure policies in the last two years. But each journal sets its own policy, and critics say many of them have still not gone far enough. ... The study was based on disclosures by five medical device companies, mostly forced by government investigations. The companies paid about $250 million to consultants in 2007, including royalties, the study says. Zimmer paid $87 million; DePuy Orthopaedics, $63 million; Stryker, $45 million; Biomet, $27 million; and Smith & Nephew, $24 million" (Wilson, 7/13).

Milwaukee Journal Sentinel: The study authors used payment information posted by the five companies "in order to avoid criminal prosecution as part of a $311 million settlement with the U.S. Justice Department in 2007 over financial inducements paid to surgeons.The Justice Department said the industry routinely violated the anti-kickback law by paying orthopedic surgeons to exclusively use its products, arrangements that were not revealed to their patients or the hospitals at which the surgeons practiced. … Disclosing conflicts of interest is a bedrock principle of modern medicine. It alerts doctors and others who read medical journals to potential bias and allows them to weigh the credibility and value of the articles. In the last few years, lack of disclosure in several high-profile national cases has undermined the integrity of the medical field. … Eugene Carragee, editor of the Spine journal, said that because of sloppy financial disclosures in journals and conflicts of interest among doctors, the orthopedic field is in danger of losing the public's trust" (Fauber, 7/13).

Bloomberg Businessweek reports on another study in the Archives of Internal Medicine: "Public information about U.S. doctors' education, certification and malpractice claims may not be enough to help patients determine whether a physician provides high-quality care, a new study suggests. … In this study, the researchers analyzed claims 2004-05 data from 1.13 million adult patients to calculate performance scores of 10,408 Massachusetts physicians. They then gathered information about the same doctors from the Massachusetts Board of Registration in Medicine. They found that higher performance scores were associated with three characteristics: being female, board certification, and graduation from a domestic medical school. … They also said they found no significant association between malpractice claims and performance score. This suggests that malpractice claims may have more to do with a physician's communication style and other attributes rather than negligent care (Preidt, 7/13).

UPI: "Data on how well doctors deliver care, such as giving the right medications, are often impossible to find, U.S. researchers say. Dr. Anne-Marie Audet, vice president for health system quality and efficiency at the Commonwealth Fund in New York, says patients are urged to use research in selecting a physician -- but often the only information a patient has access to is what medical school they attended, years of experience and malpractice claims" (9/14).

The Fiscal Times: Two other recent studies show "that neither tort reform nor an increase in primary care physicians will bend the health care cost curve as proponents believe." One of the studies, published in the journal Health Affairs, concluded that medical malpractice lawsuits triggered physicians "to order unnecessary tests, give duplicative exams and perform dubious procedures (so-called defensive medicine) to avoid later claims that they missed a diagnosis through poor performance. But it pegged the total cost at just $55.6 billion a year or about 2.4 percent of health care costs. ... However, one of the 'big ideas' on the reform agenda for curbing the misplaced incentives of fee-for-service medicine came in for its own comeuppance last week. A new study from researchers at Dartmouth, whose renowned 'Atlas of Health' documents geographic patterns of overutilization across the U.S., showed that an increased emphasis on coordinating care delivery through primary care physicians may not improve the quality of care or achieve lower costs" (Goozner, 9/14).