Accuracy of Financial Disclosures Reported by Physicians
New England Journal of Medicine (Impact Factor: 55.87). 02/2010; 362(5):470; author reply 470. DOI: 10.1056/NEJMc0911065
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Article: Interest in Conflicts
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ABSTRACT: Financial relationships among the biomedical industries, physicians, and professional medical associations (PMAs) can be professional, ethical, mutually beneficial, and, most importantly, can lead to improved medical care. However, such relationships, by their very nature, present conflicts of interest (COIs). One of the greatest concerns regarding COI is continuing medical education (CME), especially because currently industry funds 40–60% of CME. COIs have the potential to bias physicians in practice, educators, and those in leadership positions of PMAs and well as the staff of a PMA. These conflicts lead to the potential to bias the content and type of CME presentations and thereby influence physicians' practice patterns and patient care. Physicians are generally aware of the potential for bias when industry contributes funding for CME, but they are most often unable to detect the bias. This may because it is very subtle and/or the educators themselves may not realize that they have been influenced by their relationships with industry. Following Accreditation Council for Continuing Medical Education guidelines and mandating disclosure that is transparent and complete have become the fallback positions to manage COIs, but such disclosure does not really mitigate the conflict. The eventual and best solutions to ensure evidence-based education are complete divestment by educators and leaders of PMAs, minimal and highly controlled industry funding of PMAs, blind pooling of any industry contributions to PMAs and CME, strict verification of disclosures, clear separation of marketing from education at CME events, and strict oversight of presentations for the presence of bias.
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ABSTRACT: Slide-based disclosure of potential conflicts of interest prior to presentations is practiced at most orthopaedic meetings to help audiences critically evaluate the data presented. These slides are often supplemented with a printed disclosure in program guides and occasionally on Internet sites. The fidelity and usefulness of this format have not been investigated. We report the practice of disclosure of potential conflicts of interest during the 2012 American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting to determine if the process is accomplishing its primary goal. Orthopaedic residents and fellow volunteers completed questionnaires related to the disclosures presented at symposia and instructional course lectures they attended at the 2012 AAOS Annual Meeting. The attendees were instructed to record the duration of time for which a disclosure slide remained visible to the audience. An attempt to count the words appearing on the disclosure slide, or photograph the disclosure slide so that a subsequent word count could be obtained, was also performed. One hundred and thirty-nine disclosures were observed across a range of subspecialties including adult reconstruction, hand and wrist, pediatrics, shoulder and elbow, sports medicine, trauma, and oncology. Of these, 125 (90%) included the required disclosure slide and underwent additional analysis. Ninety-five slides had a number of words that were countable, with an average of 19.6 words per slide; thirty slides were not presented long enough to permit an accurate word count or photograph. The average time that disclosure slides were viewable was 3.1 seconds. Only 52% of slides noted whether the author disclosures were related to the data presented; 59% of presenters failed to mention this fact verbally. Only 45% of studies with multiple authors included coauthor disclosures on the slide. Institutional disclosures were absent from slides and discussion in 85% of presentations. Slides disclosing potential conflicts of interest were included in 90% of the observed presentations. Despite these slides having been shown, they were ineffective in communicating these disclosures because of deficiencies in timing, format, and content. We recommend that the practice of required slide-based disclosure of potential conflicts of interest should be abandoned and be replaced with a standardized and objective practice of disclosure.