EDITORIAL
Conflicts of Interest Edward A. Luce, MD
T
he editorial entitled “Conflicts of Interest, Disclosures, Continuing Medical Education (CME) Credits, and Censorship”1 centers on an issue in medicine in general and plastic surgery in particular demanding address: financial conflicts of interest (COI). Although discussion was primarily one of the relationship of the Accreditation Council for Continuing Medical Education, our scientific meetings, and industry-sponsored research, the issue can be viewed more globally and as substantially more troubling.2 Financial COI have permeated not only plastic surgery CME in our national and regional meetings but also our scientific publications and community CME as well. Clinical reports of the efficacy of a particular device and/or technology by “consultants” paid by the corporation that produces and markets said device have appeared in both the Annals and Plastic and Reconstructive Surgery. Coauthors are frequently statisticians and medical writers in the employ of the corporation. The apogee (or nadir) of the crystal-clear essence of financial COI is the recent publication3 of the effectiveness of a scar reduction device, authored by officers, employees, and investors in the small corporation that produced the instrument. As best expressed in a letter to the Editor of Plastic and Reconstructive Surgery4 that succinctly states the difference is of enormous magnitude between the “…passive investor… quite another as an officer of a company with a fiduciary responsibility.” Full disclosure as defined in the editorial was “Clear, unambiguous, and complete descriptions of support, especially financial, provide a context for evaluating influence that may be presumed to be operative upon the recipient.” The presumption is that disclosure provides the basis for judgment by the readership of a scientific journal of the presence and degree of bias. Yet, said readers may accept at face value (“the benefit of doubt”) the information and conclusions presented or may not be equipped to judge “subtleties of design and interpretation.” More to the point, if we, the readers are asked to judge degree of bias, does not full disclosure imply the inclusion of the dollar amounts provided to paid consultants? Financial COIs are rife throughout our specialty including research, publications, and continuing medical education. Certainly, positive aspects of that interaction exist. The question and challenge for plastic surgery is to expel the detrimental aspects of financial conflicts of interest to ensure the integrity of our specialty and maintain public trust. REFERENCES 1. Lineaweaver W. Conflicts of interest, disclosures, CME credits, and censorship. Ann Plast Surg. 2015;74:1–2. 2. Luce EA. Financial conflict of interests in plastic surgery: background, potential for bias, disclosure, and transparency. Plast Reconstr Surg. 2015 Published ahead of print. 3. Weintraub J, Kaplan EN, et al. The embrace device significantly decreases scarring following scar revision surgery in a randomized controlled trail. Plast Reconstr Surg. 2014;133:398–405. 4. Swanson E. Letter to the Editor “Tension shielding with the embrace device: does it really improve scars?” Plast Reconstr Surg. 2014;134: 662e–664e.
Received January 7, 2015, and accepted for publication, after revision, January 11, 2015. From the University of Tennessee Health Center, Memphis, TN Conflicts of interest and sources of funding: none declared. Reprints: Edward A. Luce, MD, University of Tennessee Health Science Center Memphis, TN. E-mail: [email protected]. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0148-7043/15/7404–0387 DOI: 10.1097/SAP.0000000000000490
Annals of Plastic Surgery • Volume 74, Number 4, April 2015
www.annalsplasticsurgery.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
387
Conflicts of Interest Edward A. Luce, MD
T
he editorial entitled “Conflicts of Interest, Disclosures, Continuing Medical Education (CME) Credits, and Censorship”1 centers on an issue in medicine in general and plastic surgery in particular demanding address: financial conflicts of interest (COI). Although discussion was primarily one of the relationship of the Accreditation Council for Continuing Medical Education, our scientific meetings, and industry-sponsored research, the issue can be viewed more globally and as substantially more troubling.2 Financial COI have permeated not only plastic surgery CME in our national and regional meetings but also our scientific publications and community CME as well. Clinical reports of the efficacy of a particular device and/or technology by “consultants” paid by the corporation that produces and markets said device have appeared in both the Annals and Plastic and Reconstructive Surgery. Coauthors are frequently statisticians and medical writers in the employ of the corporation. The apogee (or nadir) of the crystal-clear essence of financial COI is the recent publication3 of the effectiveness of a scar reduction device, authored by officers, employees, and investors in the small corporation that produced the instrument. As best expressed in a letter to the Editor of Plastic and Reconstructive Surgery4 that succinctly states the difference is of enormous magnitude between the “…passive investor… quite another as an officer of a company with a fiduciary responsibility.” Full disclosure as defined in the editorial was “Clear, unambiguous, and complete descriptions of support, especially financial, provide a context for evaluating influence that may be presumed to be operative upon the recipient.” The presumption is that disclosure provides the basis for judgment by the readership of a scientific journal of the presence and degree of bias. Yet, said readers may accept at face value (“the benefit of doubt”) the information and conclusions presented or may not be equipped to judge “subtleties of design and interpretation.” More to the point, if we, the readers are asked to judge degree of bias, does not full disclosure imply the inclusion of the dollar amounts provided to paid consultants? Financial COIs are rife throughout our specialty including research, publications, and continuing medical education. Certainly, positive aspects of that interaction exist. The question and challenge for plastic surgery is to expel the detrimental aspects of financial conflicts of interest to ensure the integrity of our specialty and maintain public trust. REFERENCES 1. Lineaweaver W. Conflicts of interest, disclosures, CME credits, and censorship. Ann Plast Surg. 2015;74:1–2. 2. Luce EA. Financial conflict of interests in plastic surgery: background, potential for bias, disclosure, and transparency. Plast Reconstr Surg. 2015 Published ahead of print. 3. Weintraub J, Kaplan EN, et al. The embrace device significantly decreases scarring following scar revision surgery in a randomized controlled trail. Plast Reconstr Surg. 2014;133:398–405. 4. Swanson E. Letter to the Editor “Tension shielding with the embrace device: does it really improve scars?” Plast Reconstr Surg. 2014;134: 662e–664e.
Received January 7, 2015, and accepted for publication, after revision, January 11, 2015. From the University of Tennessee Health Center, Memphis, TN Conflicts of interest and sources of funding: none declared. Reprints: Edward A. Luce, MD, University of Tennessee Health Science Center Memphis, TN. E-mail: [email protected]. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0148-7043/15/7404–0387 DOI: 10.1097/SAP.0000000000000490
Annals of Plastic Surgery • Volume 74, Number 4, April 2015
www.annalsplasticsurgery.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
387
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