Do Financial Conflicts of Interest Affect What Endovascular Specialists Post On Social Media?

Purpose: To evaluate if interventional radiologists and physicians from other specialties with financial conflicts of interest (COIs) with specific medical device companies reference the device or brand more positively or negatively on social media compared to physicians without COIs.

Methods/Materials: X (formerly known as Twitter) hashtags used by endovascular specialists were used to identify posts by US physicians mentioning a specific device or company. 13,809 posts between 10/7/2021 and 12/31/2021 were evaluated. The Centers for Medicare & Medicaid Services Open Payment database was used to identify financial COIs. A positive COI was pre-defined as receiving a payment from the device manufacturer or company within 12 months prior to posting on social media. Social media posts were independently assessed by an attending IR and two physician trainees without COIs for the poster’s sentiment towards the referenced brand or device. Sentiment was assessed on a 5-point scale (1: strongly negative, 2: negative, 3: neutral, 4: positive, 5: strongly positive ). Inter-rater agreement was measured with Krippendorff’s alpha. The mean score was used to determine if the device or company was referenced positively, negatively, or neutral. Posts were then grouped into physicians with positive COIs and those without COIs, and compared using a t-test.

Results: A random sample of 100 posts were analyzed, and 50% had positive COIs (50/100). The mean sentiment rating for posts where the author had a COI was 4.16, more positive than the sentiment rating of 3.54 in posts where the author did not have a COI (p < 0.001). Furthermore, conflicted posts were more likely to be strongly positive [52% vs 36%], less likely to be slightly positive [46% vs 42%], similarly likely to be neutral [20% vs 18%], and similarly likely to be slightly negative or strongly negative [2% vs 4%]. Krippendorff's alpha demonstrated strong inter-rater agreement (alpha = 0.947).

Conclusions: Physicians with financial COIs were more likely to reference a device or brand positively on medical social media, than physicians who had not received any payments. If authors are not disclosing these COIs, readers may not be able to weigh any potential bias in the posts.