Does industry funding mean more publications for subspecialty academic plastic surgeons?

A Review of Medical Student First-Author Publications in Plastic Surgery

The integrated plastic surgery residency match is a highly competitive process. If performed wisely, medical research is an opportunity to differentiate applications from peers, and productivity is closely evaluated by residency programs. In this study, the authors aimed to characterize medical student research productivity for integrated plastic surgery residency programs and their respective medical schools. To this end, the authors performed a retrospective review of senior author publications from the 81 integrated plastic surgery programs from January 1, 2016, to December 31, 2020. The primary outcome was a publication with a medical student as the first author. Secondary outcomes included the number of faculty from each program, the geographic region of the program, and the ranking of associated medical schools. It was found that the average number of medical student first-author publications and faculty members per institution were 14.0 and 11.0, respectively. There was a positive correlation between the number of faculty members and several medical student first-author publications for a program (R = 0.54, P < 0.0001). The average number of medical student first-author publications was higher in the top 25 programs than for the remaining programs (P < 0.001), and most medical student first-author publications in the United States were produced by 10 plastic surgery programs. From these findings, it was concluded that these programs associated with higher-ranking medical schools produce greater numbers of medical student first-author publications. These analyses of medical student academic productivity should be a highly useful guide for current and future medical students as they strategize their successful match into plastic surgery.

Analysis of Industry-Related Payments Among Physician Editors of Pathology Journals

OBJECTIVES

Gender inequities in editorial board representation and physician compensation are well documented, but few studies have focused on how editors of journals are compensated.

METHODS

In this cross-sectional study, we examined industry-related compensation (from 2014 to 2020) among physician editors of 35 pathology journals using publicly available data from the Centers for Medicare & Medicaid Services Open Payments Database.

RESULTS

Of the physician editors included, 135 (69.9%) were men and 58 (30.1%) were women. Similar percentages of men and women physicians who were eligible received payments (112/135 [83.0%] men and 51/58 [87.9%] women; P = .38, χ2 test). Of the total transfer of value ($211,192,532), 112 men received $192,727,555 (91.3%), and 51 women received $18,464,978 (8.7%). Mean total payment per person was $1,720,782 for men and $362,058 for women (P = .05). The payment range for men was $18-$47,568,400 and the range of payments for women was $31-$2,375,637.

CONCLUSIONS

The findings highlight significant gender inequities in industry-related payments to physician editors of pathology journals. The financial relationships of journal editors and industry deserve further study, particularly as they relate to advancing science and closing both workforce and patient care inequities.

Industry Payments to Plastic Surgeons, 2013 to 2018: Who's Getting Paid?

BACKGROUND

The Physician Payments Sunshine Act of 2010 mandated that all industry payments to physicians be publicly disclosed. To date, industry support of plastic surgeons has not been longitudinally characterized. The authors seek to evaluate payment trends from 2013 to 2018 and characteristics across plastic surgeon recipients of industry payments.

METHODS

The authors cross-referenced those in the 2019 American Society of Plastic Surgeons member database with Centers for Medicare & Medicaid Services Open Payments database physician profile identification number indicating industry funds received within the study period. We categorized surgeons by years since American Board of Plastic Surgery certification, practice region, and academic affiliation.

RESULTS

A sum of $89,436,100 (247,614 payments) was received by 3855 plastic surgeons. The top 1 percent of earners (n = 39) by dollar amount received 52 percent of industry dollars to plastic surgeons; of these, nine (23 percent) were academic. Overall, 428 surgeons (11 percent) were academic and received comparable dollar amounts from industry as their nonacademic counterparts. Neither geographic location nor years of experience were independent predictors of payments received. The majority of individual transactions were for food and beverage, whereas the majority of industry dollars were typically for royalties or license.

CONCLUSIONS

Over half of all industry dollars transferred went to just 1 percent of American Society of Plastic Surgeons members receiving payments between 2013 and 2018. Considerable heterogeneity exists when accounting for payment subcategories.

Conflict of Interest at Microsurgery Conferences: Disclosure of Its Extent and Nature

BACKGROUND

 Industry relationships and conflicts of interest can impact research funding, topics, and outcomes. Little research regarding the role of biomedical companies at microsurgery conferences is available. This study evaluates the role of industry at conferences by comparing payments received by speakers at the American Society for Reconstructive Microsurgeons (ASRM) meeting with those received by speakers at the American Society of Aesthetic Plastic Surgeons (ASAPS) meeting, the American Society of Plastic Surgeons (ASPS) meeting, and an average plastic surgeon. It also compares payments made by different companies.

METHODS

 General payments received by speakers at the 2017 ASAPS, ASPS, and ASRM conferences were collected from the Open Payments Database. Mean payments received at each conference were calculated and the Mann-Whitney U test evaluated differences between conference speakers and the average plastic surgeon. The total amount of payments from each company was collected through the Open Payments Database, and Z-tests identified which companies paid significantly more than others.

RESULTS

 The mean (and median) general payments made to conference speakers at ASAPS (n = 75), ASPS (n = 247), and ASRM (n = 121) were $75,577 ($861), $27,562 ($1,021), and $16,725 ($652), respectively. These payments were significantly greater (p < 0.001 for all) than those of the average plastic surgeon ($4,441 and $327), but not significantly different from each other. Allergan contributed significantly more than other companies to speakers at ASPS and ASAPS, while LifeCell Corporation, Zimmer Biomet Holdings, and Axogen contributed significantly more to speakers at ASRM.

CONCLUSION

 Payments to physicians at ASRM were significantly higher than those of an average plastic surgeon but not significantly different from those of speakers at ASAPS and ASPS. Certain companies paid significantly more than their peers at each conference. Given these findings, speakers should strive to make clear the nature and extent of their conflicts of interest when presenting at conferences.

Association between author conflicts of interest and industry-sponsorship with the favorability of outcomes of systematic reviews focusing on treatments of erectile dysfunction

BACKGROUND

Authors' conflicts of interest and industry sponsorship have been shown to influence study outcomes.

OBJECTIVE

We aimed to determine whether author conflicts of interest and industry sponsorship influenced the nature of results and conclusions of systematic reviews focusing on treatment interventions for erectile dysfunction.

MATERIALS AND METHODS

We searched PubMed and Embase for systematic reviews and meta-analyses focusing on erectile dysfunction treatments published between September 1, 2016, and June 2, 2020. Authors' conflicts of interest were collected from the systematic reviews' disclosure statements. These disclosures were verified using the information provided by the Open Payments, Dollars for Profs, Google Patents, and US Patent and Trademark Office databases and from previously published disclosure statements.

RESULTS

Our study included 24 systematic reviews authored by 138 authors. Nineteen authors (13.8%) were found to have conflicts of interest (disclosed, undisclosed, or both). No authors completely disclosed all conflicts. Nine reviews (37.5%) contained at least one author with conflicts of interest; of which eight reported narrative results favoring the treatment group, and seven reported conclusions favoring the treatment group. Of the 15 (62.5%) reviews without a conflicted author, 11 reported results favoring the treatment group, and 12 reported conclusions favoring the treatment group.

DISCUSSION

The results and conclusions of systematic reviews for erectile dysfunction treatments did not appear to be influenced by authors who reported conflicts of interest. However, our search algorithm relied on the US-based Open Payments database and a large percentage of reviews in our study were produced by authors with international affiliations. Our study results underscore the difficulties in conducting such analyses.

CONCLUSION

Although we found that undisclosed conflicts of interest (COI) were problematic among systematic reviews of erectile dysfunction treatment, only 14% of authors in our sample possessed them and these COI did not appear to influence the favorability of systematic review outcomes.

Majority of Most-Cited Articles in Top Plastic Surgery Journals Do Not Receive Funding

BACKGROUND

Plastic surgery faculty, residencies, and institutions are frequently judged on the quantity and quality of their research output. Some of the most impressive individuals in the specialty receive financial support in the form of grants and payments to help with research ideas.

OBJECTIVES

The authors sought to discern if funding directly correlates to greater impact in the top plastic surgery journals as measured by citations.

METHODS

Using the Web of Science database, the authors identified the 50 most-cited articles in each of the top plastic surgery journals from January 1975 to August 2020. The articles were scanned for funding sources and categorized as industry, federal, foundational, and institutional, while stratifying by decade.

RESULTS

Between 16 journals, 13.3% of the most-cited articles received funding, 2.6% of which came from industry, 5.4% from government, 4.4% from foundations, and 0.86% from institutions. The percentage of most-cited articles and the proportion that received funding were both correlated with decade (P = 0.0017 and P = 0.043, respectively). However, only the percentage of articles was found to significantly increase over time (P = 0.0068).

CONCLUSIONS

Although funding leads to meaningful publications, this study showed that financial support is not required to have an influence in plastic surgery research.

Glaucoma Publication Trends in Leading General Ophthalmology Journals During the Past Quarter Century: Where Are the Clinical Trials?

PRCIS

During the past quarter century, the rate of glaucoma-related publication in general ophthalmology journals increased due to higher representation in "experimentally oriented" journals. The rate of glaucoma randomized controlled clinical trial (RCT) articles decreased during the same time period.

PURPOSE

To evaluate trends in rate of glaucoma publications in leading general ophthalmology journals over the past quarter century.

MATERIALS AND METHODS

Q1 ophthalmology journals Web sites were reviewed. Only journals not limited to certain subspecialty were considered "general" and included in the analysis. In addition we categorized journals orientation as either "clinical" or "experimental." The PubMed search engine was used to collect publications from the selected journals between January 1, 1995 to December 31, 2019. Publications captured by "glaucoma" or "ocular hypertension" filters were considered glaucoma related. The fraction of glaucoma articles out of total number of articles within each year for each journal was calculated. A linear mixed effects model was applied to detect trends in glaucoma publication rates during the study period.

RESULTS

Eight journals were included: 4 "clinically oriented" and 4 "experimentally oriented." The PubMed search yielded 72,750 publications, of which 9329 (12.8%) considered "glaucoma related." Percentage of glaucoma publications remained stable within "clinically oriented" journals, and significantly increased within "experimentally oriented" journals (annual change of 0.3%, P<0.001). The number of glaucoma-related RCTs decreased significantly in each (annual change of -0.21% and -0.13%, respectively, P<0.05).

CONCLUSIONS

There has been a significant rise in the rates of glaucoma publications in "experimentally oriented" journals, while their representation in "clinically oriented" journals remained stable over the past quarter century. This change might be due to the increasing efforts to develop more advanced methods for evaluation and treatment in glaucoma, although still unable to address clinical demands. The decrease in glaucoma-related RCT articles might indicate reduced funding for such research.

Adipose Tissue-derived Stem cells in Plastic and Reconstructive Surgery: A Bibliometric Study

BACKGROUND

Due to the evolving nature of the applications of adipose tissue-derived stem cells (ADSCs) and the rapidly growing body of scientific literature, it is difficult to generate a manual compilation and systematic review of ADSCs in plastic and reconstructive surgery.

METHODS

Bibliographic records were retrieved from the Web of Science Core Collection and analyzed with CiteSpace.

RESULTS

We retrieved 691 publications and their references. We identified 52 research categories. Interdisciplinary studies were common. The journals clustered into 13 subnetworks. The top institutions were Stanford University; University of Pittsburgh; University of Tokyo; University of California, Los Angeles; University of California, Davis; New York University; Tulane University; and University of Michigan. National Institutes of Health and National Natural Science Foundation of China provided the most generous financial support. Studies clustered into 22 topics. Emerging trends may include improvement of fat grafting, and application of ADSCs in wound healing, scleroderma, and facial rejuvenation.

CONCLUSION

The present study provides a panoramic view of ADSCs in plastic and reconstructive surgery. Analysis of journals, institutions, and grants could help researchers in different ways. Researchers may consider the emerging trends when deciding the direction of their study.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Follow the money: Investigating gender disparity in industry payments among senior academics and leaders in plastic surgery

Introduction

Differences in academic qualifications are cited as the reason behind the documented gender gap in industry sponsorship to academic plastic surgeons. Gendered imbalances in academic metrics narrow among senior academic plastic surgeons. However, it is unknown whether this gender parity translates to industry payments.

Methods

We conducted a cross-sectional analysis of industry payments disbursed to plastic surgeons in 2018. Inclusion criteria encompassed (i) faculty with the rank of professor or a departmental leadership position. Exclusion criteria included faculty (i) who belonged to a speciality besides plastic surgery; (ii) whose gender could not be determined; or (iii) whose name could not be located on the Open Payment Database. Faculty and title were identified using departmental listings of ACGME plastic surgery residency programs. We extracted industry payment data through the Open Payment Database. We also collected details on H-index and time in practice. Statistical analysis included odds ratios (OR) and Pearson’s correlation coefficient (R).

Results

We identified 316 senior academic plastic surgeons. The cohort was predominately male (88%) and 91% held a leadership role. Among departmental leaders, women were more likely to be an assistant professor (OR 3.9, p = 0.0003) and heads of subdivision (OR 2.1, p = 0.0382) than men. Industry payments were distributed equally to male and female senior plastic surgeons except for speakerships where women received smaller amounts compared to their male counterparts (median payments of $3,675 vs $7,134 for women and men respectively, p<0.0001). Career length and H-index were positively associated with dollar value of total industry payments (R = 0.17, p = 0.0291, and R = 0.14, p = 0.0405, respectively).

Conclusion

Disparity in industry funding narrows at senior levels in academic plastic surgery. At higher academic levels, industry sponsorship may preferentially fund individuals based on academic productivity and career length. Increased transparency in selection criteria for speakerships is warranted.

Pediatric Publication Trends in Leading General Ophthalmology Journals for 20 Years

PURPOSE

To evaluate trends in the representation of pediatric-related articles in leading general ophthalmology journals for 20 years.

METHODS

A list of all relevant publications from five top-ranking general ophthalmology journals (Ophthalmology, JAMA Ophthalmology, American Journal of Ophthalmology, British Journal of Ophthalmology, and Acta Ophthalmologica) between January 1997 and December 2016 was retrieved using the PubMed search engine. Articles captured by the age filter "child: birth-18 years" were considered pediatric. The annual pediatric publication rate was calculated as the fraction of pediatric articles out of the total number of articles within each year for every journal. A linear mixed effects model was applied to determine the trend in the pediatric publication rate during the study period.

RESULTS

A total of 37,181 publications were included in the analysis, of which 7,828 (21.1%) were classified as "pediatric." During the study period, there was a statistically significant decrease in pediatric publication rates, with an annual absolute decrease of 0.23% (P = .01), yielding relative reduction by approximately 18% over the past two decades.

CONCLUSIONS

Representation of pediatric articles progressively decreased in general ophthalmology journals. This trend has major implications regarding exposure of non-pediatric ophthalmologists to the new developments in pediatric management. In addition, this may imply a difficulty to publish pediatric-related articles in high-ranking general ophthalmology journals. [J Pediatr Ophthalmol Strabismus. 2020;57(2):78-84.].

Researcher and Author Impact Metrics: Variety, Value, and Context

Numerous quantitative indicators are currently available for evaluating research productivity. No single metric is suitable for comprehensive evaluation of the author-level impact. The choice of particular metrics depends on the purpose and context of the evaluation. The aim of this article is to overview some of the widely employed author impact metrics and highlight perspectives of their optimal use. The h-index is one of the most popular metrics for research evaluation, which is easy to calculate and understandable for non-experts. It is automatically displayed on researcher and author profiles on citation databases such as Scopus and Web of Science. Its main advantage relates to the combined approach to the quantification of publication and citation counts. This index is increasingly cited globally. Being an appropriate indicator of publication and citation activity of highly productive and successfully promoted authors, the h-index has been criticized primarily for disadvantaging early career researchers and authors with a few indexed publications. Numerous variants of the index have been proposed to overcome its limitations. Alternative metrics have also emerged to highlight 'societal impact.' However, each of these traditional and alternative metrics has its own drawbacks, necessitating careful analyses of the context of social attention and value of publication and citation sets. Perspectives of the optimal use of researcher and author metrics is dependent on evaluation purposes and compounded by information sourced from various global, national, and specialist bibliographic databases.