Concordance Between Dermatologist Self-reported and Industry-Reported Interactions at a National Dermatology Conference
Physician-industry interactions are prevalent. Accurate reporting allows for transparency regarding potential conflicts of interest. We sought to compare the self-reported interactions in the American Academy of Dermatology (AAD) Annual Meeting disclosures with the industry-reported interactions in the Open Payments (OP) database. We performed a retrospective review of the 2014 OP database and the presenter disclosures for the AAD 73rd Annual Meeting in 2015. We examined general, research, and associated research payments for 768 dermatologists, totaling $35,627,365 in 2014. Although differences in the categorization and requirements for disclosure between the AAD and the OP database may account for much of the discordance, dermatologists should be aware of potentially negative public perceptions regarding transparency and prevalence of physician-industry interaction. Dermatologists should review their industry-reported interactions listed in the OP database and continue to disclose conflicts of interest as accurately as possible.
Practice Points
- There is heightening public attention to conflicts of interest since the start of the government-mandated reporting of physician-industry interactions.
- When compared with an industry-reported physician-interaction database, approximately two-thirds of dermatologists who presented at a national dermatology conference self-disclosed all interactions.
- This rate of discordance is consistent with other specialties, but it may reflect differences in the database reporting methods.
Second, each dermatologist was assigned to an overall disclosure category of dermatologist-level concordance based on the status for all his/her interactions. Categories included no disclosure (no industry interactions in OP and the AADMP), concordant (all industry interactions reported in OP and the AADMP match), overdisclosure only (no industry interactions on OP but self-reported interactions present in the AADMP), and discordant (not all OP interactions were disclosed in the AADMP). The discordant category was further divided into with overdisclosure and without overdisclosure, depending on the presence or absence of industry relationships listed in the AADMP but not in OP, respectively.
,To ensure uniformity, one individual (A.F.S.) reviewed and collected the data from OP and the AADMP. Information on gender and academic affiliation of study participants was obtained from information listed in the AADMP and Google searches. Data management was performed with Microsoft Excel software (Microsoft Excel 2010, Version 14.0, Microsoft Corporation). The New York University School of Medicine’s (New York, New York) institutional review board exempted this study.
Results
Of the 938 presenters listed in the AADMP, 768 individuals met the inclusion criteria. The most commonly cited type of relationship with industry listed in the AADMP was serving as an investigator, consultant, or advisory board member, comprising 34%, 26%, and 18%, respectively (Table 1). The forms of payment most frequently reported in the AADMP were honoraria and grants/research funding, comprising 49% and 25%, respectively (Table 2).
In 2014, there were a total of 20,761 industry payments totaling $35,627,365 for general, research, and associated research payments in the OP database related to the dermatologists who met inclusion criteria. There were 8678 payments totaling $466,622 for food and beverage and 3238 payments totaling $1,357,770 for travel and lodging. After excluding payments for f/b/t/l, there were 8845 payments totaling $33,802,973, with highest percentages of payment amounts for associated research (67.1%), consulting fees (11.5%), research (7.9%), and speaker fees (7.2%)(Table 3). For presenters with industry payments, the range of disbursements excluding f/b/t/l was $6.52 to $1,933,705, with a mean (standard deviation) of $107,997 ($249,941), a median of $18,247, and an interquartile range of $3422 to $97,375 (data not shown).
In assessing interaction-level concordance, 63% of all payment amounts in OP were classified as concordant disclosures. Regarding the number of OP payments, 27% were concordant disclosures, 34% were underdisclosures due to f/b/t/l payments, and 39% were underdisclosures due to non–f/b/t/l payments. When f/b/t/l payment entries in OP were excluded, the status of concordant disclosure for the amount and number of OP payments increased to 66% ($22,242,638) and 63% (5549), respectively. The percentage of payment entries with concordant disclosure status ranged from 43% to 71% depending on the payment amount. Payment entries at both ends of the spectrum had the lowest concordant disclosure rates, with 43% for payment entries between $0.01 and $100 and 58% for entries greater than $100,000 (Table 4). The concordance status also differed by the type of interactions. None of the OP payments for gift and royalty or license were disclosed in the AADMP, as there were no suitable corresponding categories. The proportion of payments with concordant disclosure for honoraria (45%), education (48%), and associated research (61%) was lower than the proportion of payments with concordant disclosure for research (90%), speaker fees (75%–79%), and consulting fees (74%)(Table 5).
In assessing dermatologist-level concordance including all OP entries, the number of dermatologists with no disclosure, overdisclosure only, concordant disclosure, discordant with overdisclosure, and discordant without overdisclosure statuses were 234 (30%), 70 (9%), 9 (1%), 251 (33%), and 204 (27%), respectively. When f/b/t/l entries were excluded, those figures changed to 347 (45%), 108 (14%), 79 (10%), 157 (20%), and 77 (10%), respectively. The characteristics of these dermatologists and their associated industry interactions by disclosure status are shown in the eTable. Dermatologists in the discordant with overdisclosure group had the highest median number and amount of OP payments, followed by those in the concordant disclosure and discordant without overdisclosure groups. Additionally, discordant with overdisclosure dermatologists also had the highest median and mean number of unique industry interactions not on OP, followed by those in the overdisclosure only and no disclosure groups. Academic and private practice settings did not impact dermatologists’ disclosure status. The percentage of female and male dermatologists in the discordant group was 25% and 36%, respectively.
Dermatologists reported a total of 1756 unique industry relationships in the AADMP that were not found on OP. Of these, 1440 (82%) relationships were from 236 dermatologists who had industry payments on OP. The remaining 316 relationships were from 108 dermatologists who had no payments on OP. Although 114 companies reported payments to dermatologists on OP, dermatologists in the AADMP reported interactions with an additional 430 companies.
