Industrial payments and publication bias

Academic Influence and Its Relationship to Industry Payments in Orthopaedic Surgery

These authors point out that the Hirsch index (h-index) quantifies research publication productivity for an individual, and has widely been considered a valuable measure of academic influence. The Hirsch index (h-index) mathematically adjusts for the total number of publications and the number of times each publication has been cited. In orthopaedic surgery, higher h-indices have been associated with higher academic rank.

In 2010, the Physician Payments Sunshine Act (PPSA) was introduced as a way to increase transparency regarding U.S. physician-industry relationships. The purpose of this study was to investigate the relationship between industry payments and academic influence as measured by the h-index and number of publications among orthopaedic surgeons for the year 2014. They also examined the relationship of the h-index to National Institutes of Health (NIH) funding.

Of 3,501 surgeons, 78.3% received nonresearch payments, 9.2% received research payments, and 0.9% received NIH support. Nonresearch payments ranged from $6 to $4,538,501, whereas research payments ranged from $16 to $517,007. 

Surgeons receiving NIH or industry research funding had a significantly higher mean h-index and number of publications than those not receiving such funding. Surgeons receiving nonresearch industry payments had a slightly higher mean h-index and number of publications than those not receiving these kinds of payments. Both the h-index and the number of publications had weak positive correlations with industry nonresearch payment amount, industry research payment amount, and total number of industry payments.

Academic surgeons who receive industry research support or NIH funding tend to have higher hindices.

For the overall population of orthopaedic surgery faculty, the h-index correlates poorly with the dollar amount and the total number of industry research payments. Regarding nonresearch industry payments, the h-index also appears to correlate poorly with the number and the dollar amount of payments. 

Comment: While the authors conclude that "These results are encouraging because they suggest that industry bias may play a smaller role in the orthopaedic literature than previously thought," this conclusion is not supported by their data. A high h-index indicates only that the author has a relatively large number of relatively often referenced publications - it does not demonstrate that these publications are unbiased. 

When industry supports research, industry influences what is investigated, how the research is done, and what conclusions of the research are published.  If the results of the research do not satisfy the needs of the supporting company, the company can withdraw funding.  In addition, the powerful effect of non-research funding can be easily imagined when viewing the table above.

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Why does industry give money to surgeons for research?

Increasing Industry Support Is Associated with Higher Research Productivity in Orthopaedic Surgery

These authors point out that orthopaedic surgeons receive a disproportionately small share of funding from the National Institutes of Health, but they receive the largest amount of funding from industry sources. They sought to examine the association between payments from industry partners and research productivity among orthopaedic research authors, as well as to identify predictors of high research productivity.

United States-based physicians who published an article in 2016 in The Journal of Bone & Joint Surgery or The American Journal of Sports Medicine were included in this study. These authors were queried in the Centers for Medicare & Medicaid Services Open Payments database (OPD) to determine the amount of industry payments received, and on Scopus, a bibliometric web site, to assess the quantity (total publication count) and quality (Hirsch index [h-index]) of each author’s research.

Of the 766 included authors, 494 (64.5%) received <$10,000 per year, 162 (21.1%) received between $10,000 and $100,000, and 110 (14.4%) received >$100,000 in total payments. The h-index increased significantly from a mean (and standard deviation) of 13.1 ± 12.9 to 20.9 ± 14.4, and to 32.3 ± 16.7, from the lowest to highest payment cohorts, as did total publication count. 

When authors were stratified by academic position (assistant professor, associate professor, full professor, and nonacademic), those who received more industry payments (>$100,000) had a higher h-index and total publication count at all academic levels relative to lower-earning (<$10,000) authors. 

Independent predictors of a high h-index included industry payments of between $10,000 and $100,000 (odds ratio [OR], 1.63; p = 0.048), payments of >$100,000 (OR, 5.87), associate professorship (OR, 6.53), full professorship (OR, 33.38), and last authorship (OR, 2.22) (p < 0.001 for all comparisons unless otherwise noted).

The authors point out that in addition to direct research funding, industry payments to orthopaedic surgeons include nonresearch financial payments for fellowship funding, consulting, speaking engagements, product development, and royalties. 1.7% of the number of payments directed toward orthopaedic  surgeons were for royalties (i.e. not for research support), but these payments accounted for 69.5% of the total monetary value that orthopaedic surgeons received. 

Comment: This article indicates that orthopaedic companies support publications by "thought leaders". It does not discuss why industry might do this and what effect this research support may have on the type of research or the conclusions of this research conducted by these investigators.  For example, is industry more likely to support (a) investigation of a non-operative approach to managing chronic cuff tears or (b) investigation of a new cuff repair technique using multiple suture anchors made by the supporting company? As another example, is industry likely to continue much desired research and personal support for a surgeon (a) if the surgeon's research reveals a relatively high complication rate for a new prosthesis or (b) if the surgeon's research reveals that osseous ingrowth by CT scan is better for this new component? What effect might this have on the direction of the surgeon's research?

We recognize the value of industrial support for orthopaedic research. We also recognize that

We're talking real money here (see this link): data from 2016

and see this link (link), where two of the top three recipients are orthopaedic surgeons

As discussed in Demographics of Disclosure of Conflicts of Interest at the AAOS, industrial payments to physicians may also affect the work presented at national meetings.

This article might well have included a discussion of these important aspects of the industry-investigator relationship. 

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Information about shoulder exercises can be found at this link.

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

See from which cities our patients come.

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How much money is your doctor receiving from which drug and implant companies?

Pharmaceutical and medical device companies are now required by law to release details of their payments to a variety of doctors and U.S. teaching hospitals for promotional talks, research and consulting, among other categories. There is a new public website that enables citizens to check on payments made by industry to individual physicians and surgeons, to see it, click on this link:

Dollars for Docs - How Industry Dollars Reach Your Doctors.

A visit to this site's home page reveals that $3.53 billion in payments (excluding research and ownership interests) were made between August 2013 to December 2014 to 681,432 doctors by 1,630 companies. This new transparency is a result of what is know as the Sunshine Act the purpose of which is to enable the public to view potential conflicts of interest.

Some of the top paying companies make orthopaedic devices and some of the top receiving doctors are orthopaedic surgeons.  The site can be searched by surgeon, company, and location.

To get an idea of the nature of these payments and their possible effects on the decisions that doctors make, see these two posts: disclosures of conflicts of interest and the demographics of these disclosures.

Here is some highly related content from CORR, that reviews the Sunshine Act Open Payments database released on December 19, 2014. They found that 15,376 orthopaedic surgeons received payments during the 5-month period, accounting for $109,846,482.  The top 10% of orthopaedic surgeons receiving payments (1538 surgeons) received at least $4,160 and accounted for 95% of total payments. Royalties and patent licenses accounted for 69% of all industry payments to orthopaedic surgeons. The authors of this paper state, "Whether there is a true return of value from these payments remains to be seen"

Readers - whether health care professionals, patients or public - are encouraged to visit the site to become with the information available there.

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Use the "Search" box to the right to find other topics of interest to you.


You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'



See from which cities our patients come.



See the countries from which our readers come on this post.