Number of consultants, number of surgeons not disclosing payments, and value of these payments varied from company to company (Table 3). The company with the most consultants listed 185 AAOS members, of which 37% had not disclosed payments (average, $39,604). Second was the company that listed 108 members; 39% had not disclosed payments (average, $38,426). The third company listed 102 members, of which 56% had not disclosed payments (average, $217,340). The company with the fourth most consultants listed 84 members; 43% had not disclosed payments (average, $9841). Next to last was the company listing 42 members, of which 52% had not disclosed payments (average, $160,634). The company with the fewest consultants listed 28 members; 61% had not disclosed payments (average $85,388).
Of AAOS members who attended the 2011 annual meeting, 94% fully disclosed industry payments (Table 1). Only 7% of the membership either failed to disclose or incompletely disclosed this relationship. In 36 cases (26%), members disclosed a financial relationship with at least 1 orthopedic company, but this relationship was not listed on the company’s website. One of the companies was responsible for 47% of the underreporting.
Discussion
In this study, we evaluated whether surgeons fully disclosed (on the website for the AAOS disclosure program) payments they received from orthopedic companies. Overall compliance was poor, with 44% of surgeons not disclosing payments. The percentage of surgeons disclosing corporate relationships and payments received varied among orthopedic companies. It is unclear whether this reflects partial reporting, or AAOS disclosure policy being mandatory only for select members rather than the entire membership.
This study had a few limitations, none of which had a substantive impact on the results or conclusions. First, we could not determine how many AAOS members who were required to disclose actually disclosed. There is no mechanism for determining which members are involved in activities that require disclosure. Nonetheless, the intent of the policy is to make collaborations between orthopedic surgeons and industry transparent in order to address concerns about potential conflicts of interest. That 44% of AAOS members did not disclose their relationships cannot be considered a success. Second, information was available on the websites of only 6 of the top 15 orthopedic companies—a result stemming from the DOJ’s failure to specify how long these companies must continue posting disclosures. In this study, the lowest nondisclosure rate was 37%, and there is no reason to suspect that any other group of surgeon-consultants would be any more compliant with AAOS’s policy.
There are few reports on the effects of the DOJ settlement on the behavior of surgeon-consultants who are AAOS members. Hockenberry and colleagues10 found that, since the settlement, surgeon payments have increased, number of consultants has decreased, and the proportion of consultants from academia has increased. They thought their findings confirmed concerns that orthopedic device makers would deliberately select high-volume orthopedic surgeons as consultants in order to increase sales of their implants and gain market share at the expense of their competitors. The authors thought that AAOS had some power to address disclosure through its influence on its members, but that influence may not be enough. Jegede and colleagues11 found that a significant percentage (41%) of orthopedic surgeons who received corporate payments and presented at the AAOS annual meeting were inconsistent in submitting disclosure information. Results of the present study suggest that AAOS policy is weak and does not adequately address the issue and provide full transparency, either within the organization or to the public, of all its members’ industry relationships.
As the preeminent provider of musculoskeletal education to orthopedic surgeons and others, and with a membership totaling almost 39,000, AAOS is one of the most important orthopedic societies in the world. AAOS has clearly stated that one of its goals is to increase transparency by making its surgeon disclosure program available to AAOS members and the public. However, it can be completely transparent only if all its members are required to disclose their corporate relationships. This study demonstrated that AAOS’s policy of mandatory disclosure for select members and voluntary disclosure for all other members is ineffective. We found that 44% of members failed to disclose industry-derived payments. This inadequate level of compliance runs contrary to the AAOS goal of increasing transparency of surgeon–industry consulting by making its surgeon disclosure program available to AAOS members and the public. The AAOS disclosure program and the potential consequences of noncompliance need to be reevaluated by the organization if it wants its program to succeed.