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

Importance: Physicians contribute content to online databases, and other health care professionals use these websites to support their decision-making. Financial conflicts of interest (COI) have the potential to adversely impact evidence-based patient care. Objectives: To quantify the potential COI among content contributors to 2 popular point-of-care medical resources, UpToDate and DynaMed, overall and by gender, and to compare self-reported and industry-mandated disclosures. Design, Setting, and Participants: This cross-sectional study compiled an initial list of contributors for each website using the Centers for Disease Control and Prevention's Leading Causes of Death. The top 50 causes were used to identify relevant articles from each database from November 30 to December 7, 2020. The authors and editors of those articles were investigated. Data were analyzed from January 2021 to March 2022. Main Outcomes and Measures: Self-reported contributor disclosure status was compared with financial remuneration as reported in the Centers for Medicare & Medicaid Services Open Payments (OP) database from 2013 to 2018. Results: A total of 179 point-of-care database authors and editors were assessed. Combined, they received $77.7 million, with a mean of $583 218 (95% CI, $0-$4 679 651) and median (range) of $29 073 ($10-$17 517 315) each. Most of the compensation ($68.1 million [87.6%]) went to UpToDate contributors. Of 128 UpToDate contributors, 76 (59.4%) reported nothing to disclose, and among these, 44 contributors (57.9%) had a record of receiving a financial payment on OP. Women UpToDate contributors received 2.5% of the total compensation paid from industry. The top 10 UpToDate contributors who received the most financial remuneration earned $56.1 million combined, were all men, and only 1 had a nothing-to-disclose status. Of 51 DynaMed contributors, 42 (82.4%) reported nothing to disclose, and among these, 35 contributors (83.3%) had an OP entry (mean, $79 820; 95% CI, $0-$400 774; median [range], $1403 [$26-$630 424]). Among the top 10 DynaMed contributors, 8 (80.0%) were men. Six of the top 10 DynaMed contributors reported nothing to disclose yet had an OP entry. Conclusions and Relevance: This cross-sectional study found that contributors to point-of-care databases were the recipients of nearly $78 million from pharmaceutical companies and medical device manufacturers, and these payments were often not disclosed in association with contributed content. Although these findings do not necessarily suggest ethical lapses among the physicians studied, point-of-care resource websites, like UpToDate and DynaMed, should consider implementing more stringent COI policies and employ an unbiased team to verify self-reported disclosure statuses among content contributors against OP reports.

Quantification of Conflicts of Interest in an Online Point-of-Care Clinical Support Website.

Online medical reference websites are utilized by health care providers to enhance their education and decision making. However, these resources may not adequately reveal pharmaceutical-author interactions and their potential conflicts of interest (CoIs). This investigation: (1) evaluates the correspondence of two well-utilized CoI databases: the Centers for Medicare and Medicaid Services Open Payments (CMSOP) and ProPublica's Dollars for Docs (PDD) and (2) quantifies CoIs among authors of a publicly available point of care clinical support website which is used to inform evidence-based medicine decisions. Two data sources were used: the hundred most common drugs and the top fifty causes of death. These topics were entered into a freely available database. The authors (N = 139) were then input into CMSOP and PDD and compensation and number of payments were determined for 2013-2015. The subset of highly compensated authors that also reported "Nothing to disclose" were further examined. There was a high degree of similarity between CMSOP and PDD for compensation (R2 ≥ 0.998) and payment number (R2 ≥ 0.992). The amount received was 1.4% higher in CMSOP ($4,059,194) than in PDD ($4,002,891). The articles where the authors had received the greatest compensation were in neurology (Parkinson's Disease = $1,810,032), oncology (Acute Lymphoblastic Leukemia = $616,727), and endocrinology (Type I Diabetes = $377,388). Two authors reporting "Nothing to disclose" received appreciable and potentially relevant compensation. CMSOP and PDD produced almost identical results. CoIs were common among authors but self-reporting may be an inadequate reporting mechanism. Recommendations are offered for improving the CoI transparency of pharmaceutical-author interactions in point-of-care electronic resources.