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Special Article | Health Care Reform

Financial Payments by Orthopedic Device Makers to Orthopedic Surgeons

Jason M. Hockenberry, PhD; Paula Weigel, MS; Andrew Auerbach, MD, MPH; Peter Cram, MD, MBA
Arch Intern Med. 2011;171(19):1759-1765. doi:10.1001/archinternmed.2011.454.
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Published online

Background There is ongoing concern over potential conflict of interest inherent in physician relationships with industry. However, there are limited empirical data detailing the prevalence and magnitude of these relationships. Our objective was to use data made available by a US Department of Justice (DOJ) lawsuit to describe the extent of orthopedic surgeons' financial relationships with implant manufacturers.

Methods We used data made available by the 2007 DOJ settlement with 5 major joint implant manufacturers to detail the number of orthopedic surgeons receiving payments, the size of these payments, the aggregate dollar amount, and the proportion going to academically affiliated orthopedic surgeons between 2007 and 2010.

Results In 2007, 1041 payments totaling in excess of $198 million were made to 939 orthopedic surgeons. In 2008, following the DOJ settlement, the implant makers made 568 payments totaling more than $228 million to 526 orthopedic surgeons (which included $109 million in one-time royalty buyouts by a single firm). The proportion of surgeons receiving payments who had academic affiliations rose from 39.4% in 2007 to 44.9% in 2008. Similar patterns were observed in 2009 and 2010 for 3 firms that continued to disclose by choice. We also noted substantial variation across firms in the details provided in the disclosed data.

Conclusions 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. There is a need for clearer specific requirements for disclosure to allow for meaningful long-term analyses to be performed.

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Figure 1. Frequency of payments by payment size over time. A, Payments for all 5 firms for 2007 and 2008 (Biomet Orthopedics [Warsaw, Indiana]; DePuy Orthopaedics, Inc [Warsaw, Indiana]; Smith & Nephew plc [London, England]; Stryker Orthopaedics [Mahwah, New Jersey]; and Zimmer, Inc [Warsaw, Indiana]). B, Payments for the 3 firms reporting across all 4 years, 2007 to 2010 (DePuy Orthopaedics Inc; Smith & Nephew plc; and Stryker Orthopaedics).

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Figure 2. Total of payments by payment size over time. A, Payments for all 5 firms for 2007 and 2008 (Biomet Orthopedics [Warsaw, Indiana]; DePuy Orthopaedics, Inc [Warsaw, Indiana]; Smith & Nephew plc [London, England]; Stryker Orthopaedics [Mahwah, New Jersey]; and Zimmer, Inc [Warsaw, Indiana]). B, Payments for the 3 firms reporting across all 4 years, 2007 to 2010 (DePuy Orthopaedics Inc; Smith & Nephew plc; and Stryker Orthopaedics).

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