Discrepancies in self-reported financial conflicts of interest disclosures by physicians: a systematic review

Abstract

BackgroundThere is a high prevalence of financial conflicts of interest (COI) between physicians and industry.ObjectivesTo conduct a systematic review with meta-analysis examining the completeness of self-reported financial COI disclosures by physicians, and identify factors associated with non-disclosure.Data sourcesMEDLINE, Embase and PsycINFO were searched for eligible studies up to April 2020 and supplemented with material identified in the references and citing articles.Data extraction and synthesisData were independently abstracted by two authors. Data synthesis was performed via systematic review of eligible studies and random-effects meta-analysis.Main outcomes and measuresThe proportion of discrepancies between physician self-reported disclosures and objective payment data was the main outcome. The proportion of discrepant funds and factors associated with non-disclosure were also examined.Results40 studies were included. The pooled proportion of COI discrepancies at the article level was 81% (range: 54%–98%; 95% CI 72% to 89%), 79% at the payment level (range: 71%–89%; 95% CI 67% to 89%), 93% at the authorship level (range: 71%–100%; 95% CI 79% to 100%) and 66% at the author level (range: 8%–99%; 95% CI 48% to 78%). The proportion of funds discrepant was 33% (range: 2%–77%; 95% CI 12% to 58%). There was high heterogeneity between studies across all five analyses (I2=94%–99%). Most undisclosed COI were related to food and beverage, or travel and lodging. While the most common explanation for failure to disclose was perceived irrelevance, a median of 45% of non-disclosed payments were directly or indirectly related to the work. A smaller monetary amount was the most common factor associated with nondisclosure.ConclusionsPhysician self-reports of financial COI are highly discrepant with objective data sources reporting payments from industry. Stronger policies are required to reduce reliance on physician self-reporting of financial COI and address non-compliance.

Evaluation of Financial Conflicts of Interest and Quality of Evidence Underlying the American Diabetes Association Clinical Practice Guidelines: The Standards of Medical Care in Diabetes, 2021

“…The Internal Committee of Medical Journal Editors (ICMJE) and many clinical practice guideline-developing organizations including the American Gastroenterological Association (AGA) and the American Society of Clinical Oncology (ASCO) have expanded the FCOI declaration policy to a longer lookback period such as three years before publication [12,20]. As our study showed, the shorter lookback period underestimated the magnitude of FCOIs among guideline authors, though the shorter ADA COI declaration period might have led to a more accurate COI declaration than other clinical guidelines previously documented [13,17,29,31,34,38,[44][45][46]. However, longer look-back periods, such as three years prior to guideline publication, were established based on the many previous cases of potential harm to patients caused by FCOIs and the increased public demand for greater transparency [1,4,5].…”

Australian Clinical Trial Authors’ Declarations of Industry Ties

“…Similarly to US and Danish studies, COI disclosures of Australian authors are often incomplete. 3 These discrepancies highlight the need for more transparent and comprehensive COI reporting. Our study adds to the evidence that underreporting of COI is likely widespread globally.…”

Examination of Potential Industry Conflicts of Interest and Disclosures by Contributors to Online Medical Resource Databases

“…Conflicts of interest (COI) were defined by the Institute of Medicine’s Committee on Conflict of Interest in Medical Research, Education, and Practice as a set of “circumstances that create a risk that professional judgments or actions regarding a primary interest will be unduly influenced by a secondary interest.” 1 Prior quantitative bioethics research has characterized COI among physician authors of biomedical 2 and pharmacology textbooks, 3 psychiatry’s Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition), 4 and clinical practice guidelines. 5 , 6 However, there is limited research on the potential COI among authors and editors of online clinical resources, such as UpToDate and DynaMed. 7 , 8 , 9 …”

“…1 Prior quantitative bioethics research has characterized COI among physician authors of biomedical 2 and pharmacology textbooks, 3 psychiatry's Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition), 4 and clinical practice guidelines. 5,6 However, there is limited research on the potential COI among authors and editors of online clinical resources, such as UpToDate and DynaMed. [7][8][9] UpToDate and DynaMed are online, subscription-based products used by physicians to assist in clinical decision-making.…”

“…A systematic review by Taheri et al determined that physician self-reporting of COI was highly discrepant with OP and DFD information, but that it was currently unclear if men or women were more likely to have discrepant reports. Examination of the 31 contributors to a nonsubscription-based (ie, free with registration) online point-of-care database for potential COI identified 19 discordant authors (61.3%) who self-reported nothing to disclose but had an OP entry .…”