An analysis published in JAMA Ophthalmology showed that an increase in disclosure policies and laws concerning physician relationships with industry did not diminish financial disclosures although it was associated with a potential cleansing effect, as disclosures of ethically questionable relationships such as lecturers decreased. However, a possible permissive effect was noted.
Financial ties between physicians and pharmaceutical and medical device companies are of increasing concern, particularly when it comes to the influence these relationships can have on physician prescribing practices. Activities such as speakers’ bureaus and consulting arrangements may promote greater use of certain brand-name prescriptions and new devices and tests that may be of questionable value to patients. In recent years, state and federal laws have required ever-increasing disclosures, but it is uncertain whether this has resulted in greater transparency and more ethical behavior on the part of physicians. In fact, some have suggested there may be a permissive effect, in that physicians feel freer to pursue ethically questionable ties with industry because they know there is government-mandated full disclosure of their financial relationships.
Alyssa A. Horstman, BS, of the W.K. Kellogg Eye Center, department of ophthalmology and visual sciences, University of Michigan, Ann Arbor, and colleagues, conducted a cross-sectional study of yearly data from 2008 through 2015 from the participants in the American Academy of Ophthalmology Annual Meeting. The researchers investigated trends in financial disclosures to evaluate the association of disclosure policies and laws with potentially beneficial, as well as ethically questionable, physician-industry ties. They used linear regression models to estimate the annual change in financial disclosures.
The study did not find a decreasing number of financial disclosures of physician-industry ties. In fact, in the 8 years covered by the study, financial disclosures increased substantially, from 3966 to 5266 (P <.001).
The investigators argued that contrary to their intended effect, the current disclosure policies may have resulted in a permissive effect on physician-industry relationships as indicated by the increase in disclosures. While ethically questionable lecturing decreased as a percentage of overall financial disclosures, the number of lecturers increased. On the other hand, there were increases in potentially beneficial activities, including grants and patents that could lead to the development of new drugs and devices.
Study limitations include analyses of aggregated yearly data rather than data from individual presenters across years, as well as missing data.
The researchers maintained that disclosure rules should be enhanced or alternative approaches to disclosure considered to encourage decreases in ethically questionable relationships.
Horstmann AA, Niziol LM, Chimonas S, Lichter PR. Association of mandatory disclosure policies and laws with physician-industry financial relationships [published online February 28, 2019]. JAMA Ophthalmol. doi:10.1001/jamaophthalmol.2019.0085