Wednesday, November 07, 2007

The AAOS Responds to Disclosure of Payments to Orthopedic Surgeons

We have previously posted ( here, here, and here) about the payments, often huge, that five manufacturers of prosthetic joints ((Biomet, DePuy Orthopaedics (a unit of Johnson & Johnson), Stryker Orthopedics,a unit of Stryker Inc, Zimmer Holdings, and Smith & Nephew) just revealed they made to orthopedic surgeons and various academic and other organizations. The lists are here: Biomet, DePuy, Smith & Nephew, Stryker, and Zimmer.

The American Academy of Orthopedic Surgeons and the American Association of Orthopedic Surgeons (AAOS) have responded, first with a letter by President James H. Beaty MD. Dr Beaty's main points were:
  • Disclosure is important, up to a point. "AAOS supports appropriate financial disclosures to patients regarding relationships between orthopedic surgeons and implant manufacturers."
  • There are good aspects to relationships between doctors and device manufacturers. "Many of our AAOS colleagues choose to work in partnership with implant manufacturers to provide consulting advice, conduct research, and educate orthopaedic surgeons and the public. A number of AAOS members are engaged in developing new medical devices to better serve patient needs."
  • It is not necessarily bad for physicians to receive money from commercial firms. "The appearance of a physician's name on any disclosure filing referenced above indicates only that he or she has received compensation from the implant manufacturer."
  • More detailed disclosure might be good. "Financial disclosures that display only the name of the physician and the aggregate dollar amount received without any explanation of the nature of the relationship and without educational context may be confusing and misleading to the public and patients."
  • In the future, AAOS members should better understand these issues. The letter alluded to a "webinair" on the subject to be conducted in November. It also alluded to a new patient discussion guide (found here). (I may discuss that guide further in another post.)

In my humble opinion, the letter was most remarkable for what it did not say.

Although it sought to justify why orthopedic surgeons should work with manufacturers, it did not explain why these relationships should include payments by the manufacturers to the physicians.

It did not discuss whether disclosures of these financial relationships were made in the time up to the release of the lists by the companies. It did not discuss disclosure to learners in the context of teaching, to readers of articles or attendees of talks, or to subjects in research trials. It did not criticize surgeons who had not disclosed prior to release of the lists.

Although the letter suggested that more detailed disclosure might be better than that which has taken place so far, it did not suggest that doctors who have received money should make such detailed disclosure, or criticize doctors who have not made such detailed disclosure in the past.

Finally, the letter did not advocate that doctors who receive payments from device manufacturers or other commercial firms actively disclose these payments going forward.

All in all, Dr Beaty's letter seemed to avoid more issues than it addressed. It was not exactly a ringing call for greater transparency, much less a condemnation of the opacity of past practices.

I could not help but notice that the letter was written on AAOS letterhead which listed current officers and board members. Ironically, several of these people appeared on the companies' payment disclosure lists. These include:

  • Dr Joseph Zuckerman, Second Vice-President, who was listed as the "individual provider" for the Musculoskeletal Research Center, which received $1-25,000 from Smith & Nephew (see list here.)
  • Dr William L Healy, Treasurer, received $25,001-$50,000 from DePuy (see here)
  • Dr Richard F Kyle, Past President, received $25,001-50,000 from Smith & Nephew (here) and $715,163 from Zimmer (here)
  • Dr Joseph C McCarthy, Chair, Board of Specialty Societies, received $475,000-500,000 from Stryker (here)
  • Dr William Robb III, Secretary, Board of Specialty Societies, received $75,000-100,000 from Smith & Nephew (here)
  • Dr Kevin J Bozic, Member at Large, received $2750 from Zimmer (here)
  • Dr Christopher D Harner, who was listed as rendering services for the University of Pittsburgh Department of Orthopedic Surgery, which received $100,000-124,999 from Biomet (here)

As we have noted before, " people who have conflicts of interest often find giving clear advice (or opinions) particularly difficult."

That is yet another argument for avoidance of the sorts of conflicts copiously disclosed in the lists of payments made by device manufacturers.


Anonymous said...

This appears to be a poor attempt by AAOS at damage control. Given the large dollar amounts, and the large number of physicians involved, I do not feel it takes a crystal ball to see additional regulation and price controls coming to this segment of medicine.

The larger dollar figures represent more than many patients lifetime incomes. Even some of the midlevel incomes represent more than a decades work for many primary care physicians. The general public does not differentiate among doctors and this will only make it more difficult for primary doctors to gain the financial security they desire.

The unintended consequences of this revelation will have a far reaching impact well beyond orthopedics.

Steve Lucas

Anonymous said...

I'm surprised the august AAOS did not respond in the manner we often witness in today's political arena by REFRAMING the discussion, and directing attention to the BENEFITS of nondisclosure and non-transparency, couched in semantics of Newspeak/Doublespeak.

Surely patients will fare better if they don't know that decisions regarding their care/treatment has been influenced by corporate propaganda and personal greed. Surely patients will have a superior outcome if they have confidence that device ABC is superior to XYZ (in their doctor's opinion), and their doctor ONLY uses ABC. Surely patients will have more face-time with their physician, if he isn't inundated with bothersome, mandatory disclosure paperwork.

Think about the BENEFITS!


Steve said...

Senator Grassley who started the investigation took in $250,000 and his son $500,000 for farm subsidies...people who live in glass houses...Also, how do you think ideas from doctors make it to industry? Are these ideas supposed to be free? How about feedback about implants and drugs? Free? Do you work for free?