In order for fellow orthodontists, as well as the general public, to adequately assess for conflicts of interest and general bias, all monetary contributions from companies and organizations made either directly or indirectly to doctors must be publicly disclosed in some fashion. The Physician Payments Sunshine Act, passed in 2010, was an attempt to provide greater transparency; however, the law doesn’t adequately cover all streams of income that can flow from manufacturers and distributors. This means that many doctors are on the honor system to provide this information and it allows for some to keep the origins of their income concealed.
Each year, the previous year’s data for Open Payments is submitted from manufacturers by March 31st, and they allow a 45 day process for dispute and review before the information is published to the Open Payments Database on June 30th. If you are interested, these payments made directly to doctors can be looked up for anyone you are curious about using the Open Payments Data Search Engine. Our concern however are the payments that are going unreported and do not appear on the site.
While the Sunshine Act requires medical product manufacturers to disclose to the Centers for Medicare and Medicaid Services (CMS) any payments or other transfers of value made to physicians or teaching hospitals, transfers of value that are made to a third party that isn’t a doctor or teaching hospital do not need to be disclosed creating the potential for abuse.
Clever individuals and groups are able to essentially ‘launder’ money provided by companies through educational organizations, industry magazines, educational grants for meetings or forums, vendor fees at the same meetings, internet groups, etc. because these entities do not have reporting requirements under Sunshine regardless of whether or not the entities are owned by a doctor or a group of doctors. In the instances where these entities are doctor-controlled, once the money goes in they are able to reroute the funds to themselves, pay it out to affiliated doctors or speakers, or pass the funds between other organizations and groups that are aligned with their interests and working towards the same end. Furthermore, preferred pricing on products extended to key accounts are not adequately disclosed.
Naturally, we are beginning to see more and more organizations like this popping up with affiliated doctors organizing themselves into what can only be described as “mutual admiration societies” to help establish credibility and coordinate promotional efforts. Since the industry money is being ‘cleaned’ by passing it through or amongst these entities first, these doctors can also technically deny that they receive compensation from these companies, and without them opening their books completely it essentially impossible to distinguish funds that are provided by manufacturers from those that are earned by other means (ticket sales, membership fees, etc.). They are basically on the honor system to disclose any potential conflicts of interest.
There are plenty of other forms of bias out there that can cloud research and recommendations, but financial conflicts are an extremely important disclosure to make. The dilemma we now face as a specialty is that we simply may not be able to get straight answers from the types of entities we have outlined here on the sources and extent industry financing the receive. Therefore, we must consider the information flowing from these organizations, and their affiliated doctors, with increased skepticism and challenge.
In the interests of greater transparency, we list all disclosures of any financial relationships our doctors have either directly or indirectly with companies or any of the entities in question on our Speakers page under the About tab.