A recent study showed that manufacturers of artificial hips and knees have continued to incentivize orthopedic surgeons with monetary rewards even after the companies ponied up more than $300 million in fines for the activity four years ago. The industry money could incline surgeons to choose particular products or downplay side effects in research.
The study, published Oct. 24 in the Archives of Internal Medicine, said the payments are largely tendered as consulting fees, royalties and research support.
“There is ongoing discussion of physician relationships with the pharmaceutical industry and medical device manufacturers,” the authors wrote in a background section of the article. “Our objective was to use data made available by a U.S. Department of Justice (DoJ) lawsuit to describe the extent of orthopedic surgeons’ financial relationships with implant manufacturers.”
The DoJ launched an investigation into the five largest manufacturers of artificial hips and knees in 2005—Biomet Orthopedics, DePuy Orthopedics, Smith & Nephew, Stryker Orthopedics and Zimmer. This ended with a settlement in 2007.
Lead study author Jason M. Hockenberry, PhD, of the department of health management and policy at the University of Iowa in Iowa City,
and colleagues used data made available by the settlement to examine the number of surgeons receiving payments, the amount of money paid and the types of payments made in the year prior to (2007), the year immediately following the DoJ settlement (2008), and the subsequent years (2009-2010).
In 2007, the five orthopedic device makers made 1,041 payments to 939 orthopedic surgeons totaling more than $198 million. In 2008, the year immediately following the settlement with the DoJ, the manufacturers made 568 payments to 526 orthopedic surgeons totaling more than $228 million.
In lieu of criminal charges, prosecutors required the five companies to disclose all their consulting agreements with doctors, post payment amounts on their websites and allow federal officials to monitor their actions. Three of the companies (DePuy, Stryker and Smith & Nephew) have continued to voluntarily disclose payment information.
According to the Patient Protection and Affordable Care Act passed last year, manufacturers must report payments of more than $10 by 2013, and this information will be freely available online. The DoJ has not announced its intentions on handling future cases.
“The impact of the DoJ settlement in the short term appears complex, with an increase in payments, a decline in the number of consultants, and an increase in the proportion of consultants drawn from academia,” Hockenberry and colleagues concluded. “There is a need for clearer specific requirements for disclosure to allow for meaningful long-term analyses to be performed.”