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

Abstract

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. 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. 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. 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. 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. 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.