Association of Mandatory Disclosure Policies and Laws With Physician-Industry Financial Relationships

Abstract

Beside the goal of increasing transparency to the public, disclosure policies and laws have been established with a goal to also reduce ethically questionable financial relationships between physicians and the medical industry. Data on these relationships should be reviewed to understand the association between these policies and laws and the attainment of reduced relationships. OBJECTIVE To assess whether disclosure policies and laws have been associated with a decrease in financial disclosure reporting by physicians. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study uses yearly data from 2008 through 2015 from the participants in the American Academy of Ophthalmology's Annual Meeting. Trends in financial disclosures over time were investigated for the association of disclosure policies and laws with potentially beneficial, as well as ethically questionable physician-industry ties. Linear regression models were used to estimate the annual change in financial disclosures and are reported with 95% CIs. EXPOSURES Disclosure policies and laws. MAIN OUTCOMES AND MEASURES The annual aggregate financial disclosures by type (ie, consultant, lecturer, employee, grant support, equity owner, patent holder). RESULTS Financial disclosures increased from 3966 in 2008 to 5266 in 2015 (P < .001). The number of disclosures reported in the categories consultant, equity owner, patents, and grant support all increased from 2008 to 2015 (consultant disclosures, 121 [95% CI, 88-155] per year; P < .001; equity owner disclosures, 32 [95% CI, 22-42] per year; P < .001; patent disclosures, 19 [95% CI, 13-26] per year; P < .001; grant support disclosures, 78 [95% CI, 48-107] per year; P < .001), while the employee and lecturer categories did not change significantly. The percentage of financial disclosures in the lecturer category decreased relative to the total (estimate, −1.1% [95% CI, −1.3% to −0.8%] per year; P < .001), owing to the number of financial disclosures for this category remaining stable while most other types increased. CONCLUSIONS AND RELEVANCE Disclosure was not associated with a chilling effect (decrease in financial disclosures associated with potentially beneficial physician-industry ties). Disclosure was associated with a possible disinfecting effect, whereby the percentage of ethically questionable disclosures (ie, lecturers) decreased, although the frequency remained stable. A permissive effect (physicians becoming more inclined to having industry relationships) was also observed. Thus, disclosure rules should be enhanced or alternative approaches to disclosure reconsidered to promote a decrease in ethically questionable relationships.

A Ray of Sunshine: Transparency in Physician-Industry Relationships Is Not Enough

“…In addition, the percentage of participants with at least one financial disclosure and the mean number of disclosures per participant increased over the time period. 29 This finding accords with social science studies, which have found that disclosure may enhance bias among presenters, who feel they have free reign to present industryfriendly information after having disclosed a COI. 30…”

Quantifying Conflict of Interest in the Choice of Anti-VEGF Agents

“…Disclosure has been recognized to be an important aspect in managing conflict of interest in scientific presentations, but insufficient. 20 , 21 Nevertheless, it is the first step and has not been taken in patient relations regarding the ophthalmologist’s choice of anti-VEGF drugs.…”

Disclosure as Only a Single Piece of the Puzzle

“…Furthermore, the findings of increased consultation disclosures over time, seemingly to replace lecture disclosures, worries the authors. 2 It is not easy to do research in this domain. Ultimately, one may be trying to measure a noneffect.…”

“…In this issue of JAMA Ophthalmology , Horstman et al have examined whether disclosure to a national association for presenters at their annual meeting was associated with increasing or decreasing rates of individual financial disclosures. They found that the rate of financial disclosures increased over time and thus did not observe what they describe as a chilling (negative) effect.…”

“…In addition, the increased rate of individual financial disclosures per speaker could represent the exact response desired (ie, greater transparency) and not a response of permissiveness, as suggested. Furthermore, the findings of increased consultation disclosures over time, seemingly to replace lecture disclosures, worries the authors …”