By Stacey Kusterbeck
Most physicians who mention specific devices or companies in social media posts have undisclosed financial conflicts, a recent study found.1
“Social media is a growing forum for sharing medical data, such as studies and cases, as well as new technology and medical devices. This is particularly true in procedural specialties such as interventional radiology,” says Thomas Webb, MD, the study’s lead author and an interventional radiology resident at University of Southern California.
Management of conflicts of interest (COIs) in the medical community largely has relied on self-regulation and disclosure. There is substantial — and growing — evidence that financial conflicts frequently go undisclosed by study investigators and guideline authors, however.2-4 “Since social media does not prompt physicians to disclose COIs and is less regulated, we suspected that there was likely under-disclosure of relevant COIs,” says Webb.
Webb and colleagues conducted a study to evaluate whether interventional radiologists and other endovascular specialists are adequately disclosing financial conflicts on social media posts. The researchers identified 80 posts on X (formerly Twitter) from 2021 that mentioned 100 specific companies or devices and used the Centers for Medicare and Medicaid Services’ Open Payment database to identify physicians who had received a payment from the company in the previous three years.
Financial conflicts were present more than half (53%) of the time. Physicians with posts on X where a specific device or company was named were almost four times as likely to have been paid by that company, compared to the paired control posts where no device or company was named. Of the 31 physicians with a financial conflict, the median payment was $2,270. Notably, none of the posts that named a specific device with a financial COI disclosed that relationship. “This further emphasized the need to highlight this ethical issue facing our community,” argues Webb.
It is not necessarily unethical that a physician has a financial relationship with a given company and posts about one of the company’s products. “The issue is not so much the existence of COIs, but the potential undue bias associated with them — and how we manage and protect against that bias,” says Webb. The potential ethical issue is if the physician is promoting a product over a safer, better product because of a financial relationship, whether consciously or unconsciously.
“This promotion may lead others to adopt an inferior treatment or technology, propagating that bias. Disclosure is an imperfect means of managing this bias but does allow others to weigh the promotion or endorsement in the light of that potential bias,” explains Webb.
Peer-reviewed publications often are governed by strict rules regarding disclosures of conflicts of interest. For example, some journals require authors to report any possible conflicts within the previous 36 months.
Social media remains largely insulated from these rules, however. “Medical social media is a relatively new phenomenon which has, so far, eluded the attention of bioethicists. With the explosion of medical posts, videos, and blogs, the potential for misinformation is high,” says Fabien Maldonado, MD, MSc, professor of medicine, thoracic surgery and mechanical engineering at Vanderbilt University and a core faculty member of the Vanderbilt Center for Biomedical Ethics and Society.
Compared to pharmaceuticals, for which commercialization requires randomized controlled studies, most devices are cleared through the U.S. Food and Drug Administration’s 510(k) pathway, which typically does not require evidence of improved patient outcomes.5
“Current regulatory pathways often allow for medical devices to be commercialized without evidence of improved patient outcomes,” notes Maldonado. In contrast, all new drugs are approved based on randomized controlled data. Thus, clinicians tend to rely heavily on anecdotal evidence and subjective opinions to inform their decisions about medical devices.
“Social media posts by recognized experts may have a disproportionate impact on patient care in this evidence-poor space,” explains Maldonado. That makes transparency about a physician’s financial conflicts even more of an ethical imperative.
Some financial conflicts are unavoidable and are even potentially beneficial. By partnering with industry, physicians can steer technological developments in the right direction and, ultimately, improve patient care. “But conflicts need to be managed in a way that fosters trust and transparency,” says Maldonado. Otherwise, patients and physician peers cannot know if bias is lurking behind positive social media posts. “Given the outsized influence of financial conflicts on personal beliefs and practices, transparency should be encouraged and, ultimately, regulated as it is already for peer-reviewed publications and grant applications,” concludes Maldonado.
The U.S. Federal Trade Commission has published guidelines about how to disclose financial relationships with specific brands on social media and makes no distinction on the dollar amount.6 “If you are posting about or promoting a specific medical device or company, it is worth pausing and considering whether there’s a relevant COI,” advises Webb.
The disclosure does not have to be extensive. Physicians can simply state in the post, “I have no relevant conflict.” If a conflict is present, physicians can state, “I give paid talks for company X” or “Paid consultant for Company X.”
“You can consider putting an additional disclaimer in the account bio section if the account is primarily used for the promotion of certain products,” suggests Webb.
- Webb T, Menard N, Hofmann HL, et al. The prevalence of financial conflict of interest disclosures by endovascular specialists on X (Twitter). J Vasc Interv Radiol 2024;35:1066-1071.
- Torjesen I. Oncology trial authors don’t fully disclose financial conflicts of interests, analysis finds. BMJ 2018;362:k3749.
- Futela D, Khunte M, Bajaj S, et al. Financial conflicts of interest among physician authors of ACR Appropriateness Criteria. Acad Radiol 2024;31:2562-2566.
- Jafar U, Usama M, Hase NE, et al. Analysis of conflicts of interest in studies related to robotics in gastrointestinal and abdominal wall surgery. J Am Coll Surg 2024;238:54-60.
- Maldonado F, Eberl J. Bearing the burden of “innovation”: The ontological implications of substantial equivalence and the FDA 510(K) pathway. Chest 2023;163:1225-1227.
- U.S. Federal Trade Commission. Disclosures 101 for social media influencers. Published November 2019. https://www.ftc.gov/system/files/documents/plain-language/1001a-influencer-guide-508_1.pdf
