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Haislup BD, Gupta S, Fleisher I, Murthi AM, Wright MA. Funding bias in shoulder arthroplasty research. J Shoulder Elbow Surg 2024; 33:e438-e442. [PMID: 38642875 DOI: 10.1016/j.jse.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/10/2024] [Accepted: 03/03/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Prior research has shown that industry funding can impact the outcomes reported in medical literature. Limited data exist on the degree of bias that industry funding may have on shoulder arthroplasty literature outside of the Journal of Shoulder and Elbow Surgery. The purpose of this study is to characterize the type and frequency of funding for recently published shoulder arthroplasty studies and the impact of industry funding on reported outcomes. We hypothesized that studies with industry funding are more likely to report positive outcomes than those without. MATERIALS AND METHODS We performed a retrospective study searching all articles with the term "shoulder arthroplasty," "reverse shoulder arthroplasty," "anatomic total shoulder arthroplasty," or "total shoulder arthroplasty" on PubMed from the years January 2020 to December 2022. The primary outcome of studies was coded as either positive, negative, or neutral. A positive result was defined as one in which the null hypothesis was rejected. A negative result was defined as one in which the result did not favor the group in which the industry-funded implant was used. A neutral result was defined as one in which the null hypothesis was confirmed. Article funding type, subcategorized as National Institutes of Health funding or industry funding was recorded. Author disclosures were recorded to determine conflicts of interest. Statistical analysis was conducted using the χ2 test and Fisher exact test. RESULTS A total of 750 articles reported on either conflict of interest or funding source and were included in the study. Of the total number of industry-funded studies, the majority were found to have a positive primary endpoint (58.1%, 104 of 179), as compared to a negative (7.8%, 14 of 179) or neutral endpoint (33.5%, 60 of 179) (P = .004). Overall, 363 articles reported an author conflict of interest, and the majority of these studies had positive primary endpoint (55.6%, 202 of 363) as compared to negative (9.1%, 33 of 363) or neutral endpoints (34.4%, 125 of 363) (P = .002). CONCLUSION The results of this study suggest that there is a significant relationship between conflicts of interest and the primary outcome of shoulder arthroplasty studies, beyond the overall positive publication bias. Studies with industry funding and author conflicts of interest both report positive outcomes more frequently than negative outcomes. Shoulder surgeons should be aware of this potential bias when choosing to base clinical practice on published data.
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Affiliation(s)
- Brett D Haislup
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Medstar Union Memorial Hospital, Baltimore, MD, USA.
| | - Suhasini Gupta
- University of Massachusetts, T.H. Chan School of Medicine, Worcester, MA, USA
| | | | - Anand M Murthi
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Medstar Union Memorial Hospital, Baltimore, MD, USA
| | - Melissa A Wright
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
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Tarwala R, Mercuri JJ, Iorio R, Karkare N. Ethical Considerations in Total Joint Arthroplasty. J Am Acad Orthop Surg 2023; 31:1001-1008. [PMID: 37561941 DOI: 10.5435/jaaos-d-22-00941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 07/03/2023] [Indexed: 08/12/2023] Open
Abstract
Hip and knee arthroplasty surgeries have excellent outcomes and notably improve quality of life. However, ethical issues permeate the practice of adult reconstruction, and as economics and technology evolve, these issues have become increasingly important. This article will review the currently published literature on ethical issues including industry influences, implants and instrumentations, surgical innovation, new technology adoptions, and healthcare policy-relevant issues, including patient cost sharing and bundled care programs. In addition, the direct marketing of implants from the manufacturer to the general public may falsely raise patient expectations concerning the long-term clinical outcome and performance of newer devices in the absence of long-term studies. This article will also focus on relevant contemporary ethical issues that do not necessarily have preexisting published literature or guidelines but, nonetheless, are crucial for adult reconstruction surgeons to address. These issues include access to care and challenges with orthopaedic resident and fellow education. Surgeons must understand the ethical issues that can arise in their clinical practice and how those issues affect patients. Clinicians are tasked with making the best-reasoned judgment possible to optimize their patients' outcomes. Still, the ability to standardize treatment while optimizing individual outcomes for unique patients remains a challenge.
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Affiliation(s)
- Rupesh Tarwala
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY (Tarwala), the Division of Adult Hip and Knee Reconstruction, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Scranton, PA (Mercuri), the Harvard Medical School, Brigham and Women's Hospital, Boston, MA (Iorio), and Lenox Hill Hospital, New York, NY (Karkare)
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Khouri AN, Walley KC, Baumann AN, Anastasio AT, Bae SH, Ruch D. Does Academic Productivity Correlate With Industry Payments in Hand Surgery Fellowship Programs in the United States? Cureus 2023; 15:e47369. [PMID: 38022301 PMCID: PMC10657487 DOI: 10.7759/cureus.47369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Hand surgeons and the industry share a common goal to improve the care of patients. However, industry support remains controversial, and the current relationship with fellowship programs remains unclear. This study explores the relationship between industry support and research productivity among hand surgeons in the academic setting. METHODS The Open Payments database, created by the Centers for Medicare and Medicaid Services (CMS) as a result of the Sunshine Act, was used to identify supplemental income paid to physicians of hand surgery fellowships in the United States. Both lifetime individual physician and aggregated fellowship Sunshine Act supplemental income (2015-2021) were collected for review. Supplemental income only reflects royalties, consulting fees, or food and does not include direct research funding. H-index was collected through the Scopus website as a proxy for academic productivity. RESULTS Six hundred and thirty-four faculty physicians (90.8%) from 94 hand surgery fellowships (100%) were included in the study. The mean individual physician lifetime supplemental income was $67,272 (median $341,861), whereas the mean individual physician H-index was 12.5 (median 9.0). There was a significant and weak positive correlation between individual physician H-index and lifetime income (p<0.001). Similarly, there was a significant and moderately positive correlation between the combined fellowship H-index and total lifetime income (p<0.001). CONCLUSION Research productivity of an orthopedic hand fellowship group and individual academic hand surgeon correlate with overall industry support from indirect research funding. Further work is required to better understand the advantages and disadvantages of industry support of academically productive hand surgeons at hand surgery fellowships.
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Affiliation(s)
| | | | | | | | - Seung-Ho Bae
- Orthopedic Surgery, Duke University, Durham, USA
| | - David Ruch
- Orthopedic Surgery, Duke University, Durham, USA
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Donoughe JS, Safavi KS, Rezvani A, Healy N, Jupiter DC, Panchbhavi VK, Janney CC. Industry Payments to Foot and Ankle Surgeons and Their Effect on Total Ankle Arthroplasty Outcomes. FOOT & ANKLE ORTHOPAEDICS 2021; 6:24730114211034519. [PMID: 35097468 PMCID: PMC8702911 DOI: 10.1177/24730114211034519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The Centers for Medicare & Medicaid Services (CMS) Open Payments public database provides a means for increased transparency of physicians’ financial relationships with industry. Total ankle arthroplasty is a procedure with long-term clinical implications and variable outcomes. We compared physician-reported conflict-of-interest (COI) disclosures in the journal Foot & Ankle International (FAI) to CMS database information to evaluate for discrepancies. Methods: Articles published in FAI reporting clinical outcomes of total ankle arthroplasty from 2015 and 2019 were reviewed. Payment information in the CMS database was cross-referenced with disclosure statements and International Committee of Medical Journal Editors (ICMJE) forms associated with the manuscript. Statistical analysis was performed to determine if industry payments were appropriately disclosed or influenced outcomes. Results: We reviewed 173 articles pertaining to ankle arthroplasty, with 27 meeting inclusion criteria. Of 120 total authors with 98 unique authors, 114 (95%) disclosed appropriately in disclosure statements. Twenty-two studies (82%) had appropriate declarations for the entire manuscript. For the 27 senior authors, only 2 discrepancies between manuscript disclosure and the Open Payments public database were noted, showing 13 total disclosures in the Open Payments public database vs 11 disclosed in the manuscript. There was no relationship between industry payments and the outcome of the manuscript (P = .725). Conclusion: The majority of author disclosure statements accurately reflected the Open Payments public data. Additionally, payments were not significantly associated with positive outcomes reported for the specific implant. Overall, authors publishing on ankle arthroplasty in FAI are disclosing appropriately. Level of Evidence: Level IV, systematic review; survey study; literature review.
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Affiliation(s)
- J. Scott Donoughe
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA, USA
| | | | - Aryan Rezvani
- Texas A&M College of Medicine, College Station, TX, USA
| | - Nicholas Healy
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA, USA
| | - Daniel C. Jupiter
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, TX, USA
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
| | - Vinod K. Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
| | - Cory C. Janney
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA, USA
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Somerson JS, Comley MC, Mansi A, Neradilek MB, Matsen FA. Industry payments to authors of Journal of Shoulder and Elbow Surgery shoulder arthroplasty manuscripts are accurately disclosed by most authors and are not significantly associated with better reported treatment outcomes. J Shoulder Elbow Surg 2020; 29:667-673. [PMID: 31899091 DOI: 10.1016/j.jse.2019.09.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Author transparency in disclosing potential conflicts of interest when reporting outcomes for shoulder arthroplasty implants is important. Using the Centers for Medicare & Medicaid Services Open Payments Program (OPP) database, we analyzed articles in the Journal of Shoulder and Elbow Surgery to evaluate (1) discrepancies between the stated conflicts of interest and associated payments recorded in the database, (2) the magnitude and types of payments received, and (3) possible relationships between industry financial support and positive study outcomes. METHODS Articles reporting clinical outcomes of shoulder arthroplasty from 2016 and 2017 were reviewed. Articles identifying a specific shoulder arthroplasty implant and having at least 1 author based in the United States were included. Payment types, amounts, and sources were extracted from disclosure statements in the manuscript and considered relevant if they were received from the implant manufacturer. Published disclosure statements were compared against the OPP database. Study outcomes demonstrating a clinical benefit were considered "positive." Payments to authors reporting positive outcomes were compared with those reporting nonpositive outcomes. RESULTS Implant manufacturers provided $16,051,261 to authors of shoulder arthroplasty publications over a 2-year period. Approximately half of senior authors (46%) received royalty payments, more than 90% of which ($14,910,873; 93%) were reported in disclosure statements. Although authors of articles with positive outcomes received greater payments than those reporting nonpositive outcomes, these differences were not statistically significant. CONCLUSION The majority of author disclosure statements accurately reflected the OPP data. Payments were not significantly associated with positive outcomes reported for the specific implant.
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Affiliation(s)
- Jeremy S Somerson
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA.
| | - Matthew C Comley
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
| | - Ahmed Mansi
- School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | | | - Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
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Nesello PFT, Baroni AC, Selistre LDS. Level of Evidence and Industry Sponsorship Associated with Favorable Outcomes in Publications on Platelet-Rich-Plasma Therapy in Musculoskeletal Disorders. Rev Bras Ortop 2019; 55:263-268. [PMID: 32616969 PMCID: PMC7316539 DOI: 10.1055/s-0039-1700834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/16/2018] [Indexed: 10/25/2022] Open
Abstract
Platelet-rich plasma is derived from centrifuging whole blood. There is increasing interest in the sports medicine and athlete community about providing endogenous growth factors directly to the injury site, using autologous blood products such as platelet-rich plasma. The aim of the present study is to evaluate the association between research financing, conflict of interests, level of evidence and author affiliation with the interpretation of results in articles published on platelet-rich plasma therapy in musculoskeletal ailments. A review of the current literature was performed. The outcome was classified as favorable or unfavorable. The declaration of conflict of interests and the type of funding was extracted from each article. The financing was classified as industry-sponsored; not industry-sponsored; or unidentifiable. The level of evidence was categorized from I to IV. Higher positive outcomes were observed in 134 studies with industry sponsorship compared with not industry-sponsored studies (odds ratio [OR]: 0.26; 95% confidence interval [95%CI]: 0.08-0.85; p < 0.05). Compared with level of evidence I, levels II and IV increase the probability of positive outcomes by 12.42 times ( p < 0.01) and 10.97 times ( p < 0.01) respectively. Proportionally, industry-sponsored studies are more likely to present positive results, as well as articles with a lower quality of evidence.
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Affiliation(s)
- Pietro Felice Tomazini Nesello
- Instituto de Medicina do Esporte e Ciências Aplicadas ao Movimento Humano, Universidade de Caxias do Sul, Caxias do Sul, RS, Brasil
| | - Allan Cassio Baroni
- Instituto de Medicina do Esporte e Ciências Aplicadas ao Movimento Humano, Universidade de Caxias do Sul, Caxias do Sul, RS, Brasil
| | - Luciano da Silva Selistre
- Departamento de Bioestatística, Hospital Geral, Universidade de Caxias do Sul, Caxias do Sul, RS, Brasil
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Narain AS, Hijji FY, Yom KH, Kudaravalli KT, Singh K. Cervical disc arthroplasty: do conflicts of interest influence the outcome of clinical studies? Spine J 2017; 17:1026-1032. [PMID: 28343045 DOI: 10.1016/j.spinee.2017.03.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/10/2017] [Accepted: 03/20/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Cervical disc arthroplasty (CDA) is an emerging technique for the treatment of cervical degenerative disease. Multiple studies have investigated the outcomes of CDA, particularly in comparison with cervical arthrodesis techniques such as anterior cervical discectomy and fusion (ACDF). As many entities have financial interests in CDA implants, it is imperative to consider the influence of conflicts of interest on the results of studies investigating the efficacy of CDA. PURPOSE This study aimed to determine if there is an association between the presence of conflicts of interest among study authors and the reported outcome of studies involving CDA. STUDY DESIGN This is a systematic review of clinical CDA publications until October 2016. OUTCOME MEASURE The outcome measures are presence of conflicts of interest, level of evidence, and outcome for all included studies. METHODS PubMed and MEDLINE databases were searched for articles presenting clinical, radiographic, and cost outcomes of CDA. Data extracted from each article included title, authors, publication year, level of evidence, prosthesis type, number of operative levels, presence of conflicts of interest, and outcome. Conflicts of interest were determined by the presence of any conflicts for any author within manuscript disclosure sections or through Open Payments reporting. Outcomes of each study were graded as either favorable, unfavorable, or equivocal. The presence of conflicts of interest was tested for an association with the level of evidence and study outcome using Pearson chi-square analysis, Fisher exact test, or logistic regression for categorical variables. The authors report no conflicts of interest directly related to this work, and have not received any funds in support of this work. RESULTS A total of 98 articles were included in this analysis. In total, 44.9% (44) of articles had the presence of a conflict of interest, whereas 55.1% (54) of articles did not. Conflicted studies were more likely to present level I evidence and less likely to present level IV evidence than non-conflicted studies (p<.001). Furthermore, conflicted studies were more likely to report favorable outcomes after CDA than non-conflicted studies (90.9% vs. 74.1%, p=.040). CONCLUSIONS The results of this study suggest that the majority of conflicted and non-conflicted studies report favorable results in patients undergoing CDA. However, conflicted studies were also more likely to report favorable outcomes compared with non-conflicted studies. Individual clinicians must critically review published studies for potential conflicts of interest before incorporating CDA into their practice.
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Affiliation(s)
- Ankur S Narain
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite #300, Chicago, IL 60612, USA
| | - Fady Y Hijji
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite #300, Chicago, IL 60612, USA
| | - Kelly H Yom
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite #300, Chicago, IL 60612, USA
| | - Krishna T Kudaravalli
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite #300, Chicago, IL 60612, USA
| | - Kern Singh
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite #300, Chicago, IL 60612, USA.
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Abstract
Background Norway has no prospective surveillance system to monitor the outcome of knee cartilage surgery. In 2004 the Norwegian Registry of Knee Ligament (NKLR) was successfully established, and has yielded useful information on the treatment of patients with both knee ligament and combined knee injuries. Patients with focal cartilage defects (FCDs) in their knees have reduced function and the treatment is difficult. There are geographical variations in treatment, and the generalizability from randomized controlled studies is low. These patients would benefit from a standardized long-time follow-up through a cartilage surgery register. The aim of the present study was to describe the development and report baseline challenges during the setting up of a pilot of a knee cartilage surgery register. Methods The study was designed as a prospective cohort study in the form of a register. Patients with full-thickness FCDs in the knee with International Cartilage Repair Society (ICRS) grade 3–4 on arthroscopy were included. The pilot included two hospitals; Oslo University Hospital (OUS), Ullevål and Akershus University Hospital (Ahus). Results We registered 58 patients with isolated FCDs, whereas 16 additional patients with full-thickness FCDs were registered through the NKLR. The patient cohort of patients with isolated FCDs consisted of 65% men and had a mean age of 29.8 years. The data are incomplete and the compliance varies from 18 to 73%. The distribution of mean KOOS scores were similar to previous patient cohorts with FCDs, with low scores for the KOOS Sport/Recreation and Quality of Life subscales. Conclusion The level of compliance demonstrated a large difference between the two participating hospitals. The compliance for the isolated FCDs were low in both locations, although it reached an acceptable level in one hospital when patients with combined injuries from the NKLR were included. The forms were incompletely filled out by the surgeons postoperatively and need to be revised prior the establishment of a nation-wide register. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1638-6) contains supplementary material, which is available to authorized users.
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Foughty Z, Antalis MS, Ringenberg J, Hall AD. Funding sources and financial disclosures, and their relationship to study outcomes and level of evidence in the Journal of Shoulder and Elbow Surgery. J Shoulder Elbow Surg 2017; 26:e193-e197. [PMID: 28395946 DOI: 10.1016/j.jse.2017.02.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 02/02/2017] [Accepted: 02/07/2017] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS/BACKGROUND Concern exists regarding the reliability of published manuscripts due to influence of industry funding and author financial conflicts of interest (COI). We aim to determine whether COI affect the outcome of a research study or the level of evidence (LOE). METHODS We reviewed 244 consecutive original articles in Journal of Shoulder and Elbow Surgery from January 2014 to December 2014. Articles included only those available in the printed journal. For LOE, 178 articles from the Shoulder and Elbow section were used (basic science articles were excluded). COI was determined by comparing financial disclosures and stated funding sources to the study content. RESULTS COI were present in 44 of 244 articles (18%); of these, 24 (55%) had positive outcomes. Of the 200 without COI, 128 (64%) had positive outcomes. This difference in proportions was determined to be significant (P = .007). COI were present in 27 shoulder and elbow articles; of these, only 1 was LOE I or II (4%). Of the 151 without COI, 34 (23%) were LOE I or II. This difference in proportions was determined to be significant (P = .023). CONCLUSION We found that Journal of Shoulder and Elbow Surgery articles with COI are neither more likely to have positive outcomes nor higher LOE than those with no COI. Although the χ2 analysis found a statistically significant relationship between COI and study outcomes, the study outcomes were more often positive in articles without COI. This is contrary to previously published analyses that found outcomes to be more positive in articles with COI.
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Affiliation(s)
- Zachary Foughty
- Department of Orthopedics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | | | - Jonathan Ringenberg
- Department of Orthopedics, Indiana University School of Medicine, Indianapolis, IN, USA
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Industry Funding for Neurosurgery Research. World Neurosurg 2017; 104:999-1003. [PMID: 28549640 DOI: 10.1016/j.wneu.2017.05.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/13/2017] [Indexed: 11/20/2022]
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Abstract
PURPOSE OF REVIEW Cervical disc replacement (CDR) has emerged as a motion-preserving alternative to anterior cervical discectomy and fusion in selected cases. Despite favorable literature, CDR is not universally accepted because of concerns regarding bias in the existing literature. The purpose of this review is to identify the possible biases in the disc replacement literature. RECENT FINDINGS Recent studies that compare CDR and ACDF have demonstrated equivalent or superior outcomes, lower rates of secondary surgery, and equivalent safety at medium- and long-term follow-up. In our review, we identified four types of bias that may affect the CDR literature: publication bias, external validity, confounding bias, and financial conflicts of interest. Bias, whether intentional or unintentional, can impact the interpretation and outcome of CDR studies. Recognition of this issue is critical when utilizing the existing literature to determine the efficacy of CDR and designing future studies.
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Hannon CP, Chalmers PN, Carpiniello MF, Cvetanovich GL, Cole BJ, Bach BR. Inconsistencies Between Physician-Reported Disclosures at the AAOS Annual Meeting and Industry-Reported Financial Disclosures in the Open Payments Database. J Bone Joint Surg Am 2016; 98:e90. [PMID: 27869631 DOI: 10.2106/jbjs.15.01119] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to determine the rate and type of inconsistencies between disclosures self-reported by physicians at a major academic meeting in the United States and industry-reported disclosures in the Open Payments database for a concordant time period. METHODS Disclosures for every first and last author from the United States with a medical degree of a podium or poster presentation at the 2014 American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting were collected and were compared with the disclosures reported in the Open Payments database to determine if any inconsistencies were present and, if so, within which category. RESULTS In total, 1,925 total AAOS presenters were identified, and 1,113 met the inclusion criteria. Based on AAOS disclosures, 432 (39%) should have been listed within the Open Payments database. There were 125 presenters (11%) who reported an AAOS disclosure and thus should have been included in the Open Payments database, but were not included. An additional 259 presenters (23%) had ≥1 AAOS disclosures that were not reported or were improperly categorized in the Open Payments database. Inconsistencies were more common for authors who had significantly more poster presentations (p < 0.001), podium presentations (p = 0.01), total presentations (p < 0.001), and AAOS disclosures (p < 0.001) and a significantly higher value of payments in the Open Payments database (p < 0.001). CONCLUSIONS In this sample, there was a 35% rate of inconsistency between physician-reported financial relationships for presenters at the AAOS Annual Meeting and industry-reported relationships published in the Open Payments database.
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Affiliation(s)
- Charles P Hannon
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri
| | - Matthew F Carpiniello
- Department of Surgery, Mount Sinai St. Luke's Roosevelt Hospital Center, New York, NY
| | - Gregory L Cvetanovich
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Bernard R Bach
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Harshavardhana NS, Dormans JP. Observational Analysis of Changing Trends in Level of Evidence of Scoliosis Research Society Annual Meeting Podium Presentations in the New Millennium (2001-2013). Spine Deform 2016; 4:193-199. [PMID: 27927502 DOI: 10.1016/j.jspd.2015.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 08/31/2015] [Accepted: 10/30/2015] [Indexed: 11/17/2022]
Abstract
STUDY DESIGN Observational quantitative evaluation of all Scoliosis Research Society annual meeting (SRS-AM) podium presentations over a 6-year period in the new millennium for changing trends in Level of Evidence (LoE). OBJECTIVES To report the LoE of SRS-AM podium presentations over a 13-year period in the new millennium and to compare the trends in LoE over a 3-year period between the two decades, that is, 2001-2003 versus 2011-2013. SUMMARY OF BACKGROUND DATA LoE is a rating system introduced by the American Academy of Orthopaedic Surgeons (AAOS) in 2003 to reflect the quality of clinical studies. No study has looked into any of AAOS-affiliated spinal specialist societies' LoE, hence this study. METHODS The SRS-AM proceedings books from two 3-year periods, 2001-2003 and 2011-2013, were retrieved. Two orthopedic surgeons independently graded each abstract on two occasions, 1 month apart, assigning them LoE from I to V, in accordance with the stringent guidelines published by AAOS. They also categorized all studies into types (ie, therapeutic, prognostic, diagnostic, economic or decision-modeling analysis, or LoE not applicable). Any disagreement between the two assessors over the LoE or the nature of study was discussed, and agreed upon by consensus. Thus, analyzed abstracts of the two groups were subsequently compared and subjected to statistical tests to determine significance. RESULTS 637 free-papers from six annual meeting proceedings (264 in Group I and 373 in Group II) were analyzed in total. LoE I and II studies have more than doubled (p<.0001), and LoE IV studies have fallen by half in 2011-2013 as compared to 2001-2003. CONCLUSION The SRS-AM podium presentation has shown an increase in LoE I and II studies in the new millennium. SRS is the first AAOS-affiliated subspecialty society to have undertaken an in-depth analysis of its AM podium presentations, setting a standard for other societies to emulate. LEVEL OF EVIDENCE Not applicable.
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Nwachukwu BU, Schairer WW, O'Dea E, McCormick F, Lane JM. The Quality of Cost-Utility Analyses in Orthopedic Trauma. Orthopedics 2015; 38:e673-80. [PMID: 26270752 DOI: 10.3928/01477447-20150804-53] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/23/2014] [Indexed: 02/03/2023]
Abstract
As health care in the United States transitions toward a value-based model, there is increasing interest in applying cost-effectiveness analysis within orthopedic surgery. Orthopedic trauma care has traditionally underemphasized economic analysis. The goals of this review were to identify US-based cost-utility analysis in orthopedic trauma, to assess the quality of the available evidence, and to identify cost-effective strategies within orthopedic trauma. Based on a review of 971 abstracts, 8 US-based cost-utility analyses evaluating operative strategies in orthopedic trauma were identified. Study findings were recorded, and the Quality of Health Economic Studies (QHES) instrument was used to grade the overall quality. Of the 8 studies included in this review, 4 studies evaluated hip and femur fractures, 3 studies analyzed upper extremity fractures, and 1 study assessed open tibial fracture management. Cost-effective interventions identified in this review include total hip arthroplasty (over hemiarthroplasty) for femoral neck fractures in the active elderly, open reduction and internal fixation (over nonoperative management) for distal radius and scaphoid fractures, limb salvage (over amputation) for complex open tibial fractures, and systems-based interventions to prevent delay in hip fracture surgery. The mean QHES score of the studies was 79.25 (range, 67-89). Overall, there is a paucity of cost-utility analyses in orthopedic trauma; however, the available evidence suggests that certain operative interventions can be cost-effective. The quality of these studies, however, is fair, based on QHES grading. More attention should be paid to evaluating the cost-effectiveness of operative intervention in orthopedic trauma.
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Nwachukwu BU, Bozic KJ, Schairer WW, Bernstein JL, Jevsevar DS, Marx RG, Padgett DE. Current status of cost utility analyses in total joint arthroplasty: a systematic review. Clin Orthop Relat Res 2015; 473:1815-27. [PMID: 25267271 PMCID: PMC4385366 DOI: 10.1007/s11999-014-3964-4] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/16/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Total joint arthroplasty (TJA), although considered to be highly beneficial, is associated with substantial costs to the US healthcare system. Cost utility analysis has become an increasingly important means to objectively evaluate the value of a healthcare intervention from the perspective of both extending the quantity and improving the quality of life. Relatively little is known about the overall cost utility analysis evidence base in TJA. QUESTIONS/PURPOSES The goals of this review were to (1) determine the cost utility of TJA interventions; (2) critically assess the quality of published US-based cost utility analyses using the Quality of Health Economic Studies instrument; and (3) determine what characteristics were common among studies receiving a high quality score. METHODS A systematic review of the literature using the MEDLINE database was performed to compile findings and critically appraise US-based cost utility analysis studies for total hip and knee arthroplasty. Based on review of 676 identified articles, 23 studies were included. We used the Quality of Health Economic Studies instrument to assess study quality and one-sided Fisher's exact tests were applied to analyze the predictors of high-quality cost utility analysis. RESULTS Very few studies compare the cost utility of TJA versus nonoperative intervention; however, the available evidence suggests that TJA can be cost-saving and is highly cost-effective compared with conservative management of end-stage arthritis. The majority of identified studies are focused on the cost utility of new implant technologies or comparisons among surgical alternatives. These studies suggest that the upfront costs associated with new technologies are cost-effective when there is a major reduction in a future cost. The quality of identified studies is quite high (Quality of Health Economic Studies Instrument score: mean 86.5; range, 63-100). National funding source (p = 0.095) and lifetime horizon for analysis (p = 0.07) correlate with high-quality evidence but do not reach significance. CONCLUSIONS Over the past 15 years, there has been a major increase in the volume of cost utility analyses published in total hip and knee arthroplasty. The quality of cost utility analyses published during that period is good. As increasing attention is paid to value in US health care, more attention should be paid to understanding the cost utility of TJA compared with nonoperative treatment modalities. Future studies may also look to incorporate patient willingness to pay.
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MESH Headings
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/economics
- Arthroplasty, Replacement, Hip/instrumentation
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/economics
- Arthroplasty, Replacement, Knee/instrumentation
- Cost Savings
- Cost-Benefit Analysis
- Health Care Costs
- Hip Prosthesis/economics
- Humans
- Knee Prosthesis/economics
- Odds Ratio
- Treatment Outcome
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Affiliation(s)
- Benedict U Nwachukwu
- Department of Academic Training, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA,
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Middleton SD, Jenkins PJ, Muir AY, Anakwe RE, McEachan JE. Variability in local pressures under digital tourniquets. J Hand Surg Eur Vol 2014; 39:637-41. [PMID: 23735809 DOI: 10.1177/1753193413492059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The UK National Patient Safety Agency issued a rapid response report in 2009 following reports of complications related to digital tourniquet use and inadvertent retention. In their guidance, they recommend the use of CE marked digital tourniquets and advise against the use of surgical gloves. There are a number of different commercially available non-pneumatic digital tourniquets, but little clear data relating to their comparable physical properties, clinical efficacy or safety. The aim of this study was to investigate the variability of pressures exerted by non-pneumatic digital tourniquets. A Tekscan FlexiForce(®) force sensor was used to measure applied force and to calculate the surface pressures under: the Toe-niquet™; T-Ring™ and surgical glove 'roll down' tourniquets in finger models. The lowest mean pressures were produced by the larger glove sizes (size 8) (25 mmHg), while the highest pressures were produced by the Toe-niquet (1560 mmHg). There was a significant overall difference in pressures exerted under tourniquets when comparing tourniquet type (p<0.001) and finger size (p<0.001) with these techniques. It is difficult to anticipate and regulate pressures generated by non-pneumatic tourniquets. Safe limits for application time and surface pressures are difficult to define. Further work is required to model the pressure effects of commercially available digital tourniquets and to identify which are most effective but safe.
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Affiliation(s)
- S D Middleton
- Orthopaedic Department, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - P J Jenkins
- Orthopaedic Department, Queen Margaret Hospital, Dunfermline, UK
| | - A Y Muir
- Edinburgh Orthopaedic Engineering Centre, University of Edinburgh, Edinburgh, UK
| | - R E Anakwe
- The Hand and Upper Limb Service, Imperial College NHS Trust, London, UK
| | - J E McEachan
- Orthopaedic Department, Queen Margaret Hospital, Dunfermline, UK
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Harris JD, Erickson BJ, Cvetanovich GL, Abrams GD, McCormick FM, Gupta AK, Verma NN, Bach BR, Cole BJ. Development of a Valid and Reliable Knee Articular Cartilage Condition-Specific Study Methodological Quality Score. Orthop J Sports Med 2014; 2:2325967113512606. [PMID: 26535295 PMCID: PMC4555619 DOI: 10.1177/2325967113512606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Condition-specific questionnaires are important components in evaluation of outcomes of surgical interventions. No condition-specific study methodological quality questionnaire exists for evaluation of outcomes of articular cartilage surgery in the knee. PURPOSE To develop a reliable and valid knee articular cartilage-specific study methodological quality questionnaire. STUDY DESIGN Cross-sectional study. METHODS A stepwise, a priori-designed framework was created for development of a novel questionnaire. Relevant items to the topic were identified and extracted from a recent systematic review of 194 investigations of knee articular cartilage surgery. In addition, relevant items from existing generic study methodological quality questionnaires were identified. Items for a preliminary questionnaire were generated. Redundant and irrelevant items were eliminated, and acceptable items modified. The instrument was pretested and items weighed. The instrument, the MARK score (Methodological quality of ARticular cartilage studies of the Knee), was tested for validity (criterion validity) and reliability (inter- and intraobserver). RESULTS A 19-item, 3-domain MARK score was developed. The 100-point scale score demonstrated face validity (focus group of 8 orthopaedic surgeons) and criterion validity (strong correlation to Cochrane Quality Assessment score and Modified Coleman Methodology Score). Interobserver reliability for the overall score was good (intraclass correlation coefficient [ICC], 0.842), and for all individual items of the MARK score, acceptable to perfect (ICC, 0.70-1.000). Intraobserver reliability ICC assessed over a 3-week interval was strong for 2 reviewers (≥0.90). CONCLUSION The MARK score is a valid and reliable knee articular cartilage condition-specific study methodological quality instrument. CLINICAL RELEVANCE This condition-specific questionnaire may be used to evaluate the quality of studies reporting outcomes of articular cartilage surgery in the knee.
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Affiliation(s)
- Joshua D. Harris
- Houston Methodist Center for Orthopaedics & Sports Medicine, Houston, Texas, USA
- Rush University Medical Center, Chicago, Illinois, USA
| | | | | | - Geoffrey D. Abrams
- Rush University Medical Center, Chicago, Illinois, USA
- Orthopedic Surgery, Stanford University and Veterans Administration–Palo Alto, Palo Alto, California, USA
| | - Frank M. McCormick
- Rush University Medical Center, Chicago, Illinois, USA
- Holy Cross Hospital, Oakland Park, Florida, USA
| | - Anil K. Gupta
- Rush University Medical Center, Chicago, Illinois, USA
- Florida Orthopaedic Institute, Tampa, Florida, USA
| | | | | | - Brian J. Cole
- Rush University Medical Center, Chicago, Illinois, USA
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Amiri AR, Kanesalingam K, Cro S, Casey ATH. Does source of funding and conflict of interest influence the outcome and quality of spinal research? Spine J 2014; 14:308-14. [PMID: 24231776 DOI: 10.1016/j.spinee.2013.10.047] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 10/21/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND/CONTEXT There has been longstanding controversy surrounding the influence of funding source on the conduct and outcome of medical research. In 2011, a systematic review of the use of recombinant bone morphogenetic protein-2 revealed underreporting of unfavorable outcomes in some industry-sponsored trials. We hypothesize that Industrial funding and the presence of potential conflict of interest will be associated with low levels of evidence (LOE) and greater proportions of favorable outcomes in spinal research. PURPOSE The aim of this study is to investigate the association between funding source and potential conflict of interest on the LOE and study outcome in the current spinal research. STUDY DESIGN/SETTING Systematic review of all the spinal publications in five leading spinal, orthopedics, neurosurgery, and general medical journals during 2010 (print and online). Supplements were included. OUTCOME MEASURE Outcome and the LOE of research papers. METHODS Two reviewers independently assessed all publications. Commentaries, editorials, letters, open operating theatres, case reports, narrative reviews, and study protocols were excluded. The self-reported potential conflict of interest and type of funding was extracted from each paper. Funding type was classified as foundation, industry, public, intramural, multiple (including industry), multiple (without industry), and unfunded. The outcome of each study was classified as favorable, unfavorable, equivocal, or not applicable. Clinical publications were ranked using the LOE guidelines produced by the Oxford Center for Evidence-Based Medicine. RESULTS Overall, 1356 papers were analyzed, out of which 864 were suitable for LOE grading. There was good interobserver reliability for assignment of LOE grade, κ=0.897 (p<.01) and study outcome κ=0.804 (p<.01). A significant association was found between LOE and source of funding (p<.01). Industry-funded studies had the greatest proportion of level IV evidence (65%). There was a significant association between the funding source and study outcome (p=.01). The proportion of industry-funded studies with favorable outcomes (88%) was higher than that of publicly and foundation-funded studies (73% and 74%, respectively). The associated odds ratio for reporting favorable outcomes in industry-funded studies compared with studies with public and foundation funding was 2.7 (95% confidence interval [CI], 1.4-5.3), and 2.6 (95% CI, 1.3-5.2), respectively. A significant association between LOE and study outcome (p<.01) was also identified. Level I studies had the highest proportions of unfavorable (14%) and equivocal (23%) outcomes. Level IV studies had the highest proportion of favorable outcome (85%). There was no association between self-reported conflict of interest and LOE (p=.83) or study outcome (p=.25). CONCLUSION We demonstrated a significant association between source of funding, study outcome, and LOE in spinal research. A large proportion of industry funded research was shown to provide level IV evidence and report favorable outcome.
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Affiliation(s)
- Amir Reza Amiri
- Spinal Injury Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
| | - Kavitha Kanesalingam
- Academic Surgery Unit, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - Suzie Cro
- Medical Research Council Clinical Trial Unit, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Adrian T H Casey
- Spinal Injury Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
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Harris JD, Erickson BJ, Abrams GD, Cvetanovich GL, McCormick FM, Gupta AK, Bach BR, Cole BJ. Methodologic quality of knee articular cartilage studies. Arthroscopy 2013; 29:1243-1252.e5. [PMID: 23623292 DOI: 10.1016/j.arthro.2013.02.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 01/26/2013] [Accepted: 02/20/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE (1) To evaluate the quality of knee articular cartilage surgery literature using established methodologic quality instruments, and (2) to assess whether study quality has improved with time. METHODS A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies of autologous chondrocyte implantation (ACI), osteochondral autograft and allograft transplant, and microfracture were analyzed. Study methodologic quality was assessed by the level of evidence and 9 different methodologic quality questionnaires. Comparisons were made between different surgical technique groups by use of Student's t tests. Assessment of study quality improvement with time was performed by comparison of the Coleman Methodology Score (CMS) from the included studies (2004 to present) and CMS from a prior study assessing quality of articular cartilage studies (1985 to 2004). Furthermore, assessment of study quality improvement with time was performed over the period of the included studies (2004 to present). RESULTS We included 194 studies (11,787 subjects). Most evidence was Level IV (76%) and nonrandomized (91%). ACI was the most commonly reported technique (62% of studies). Only 34% of studies denied the presence of a financial conflict of interest. The mean subject age was 33.5 ± 8.2 years, and the mean length of follow-up was 3.7 ± 2.3 years. By use of study quality questionnaires, the methodologic quality of articular cartilage studies was poor. However, study quality (after 2004) was significantly improved versus that reported from a prior study (before 2004) using the CMS (P < .01). The mean level of evidence, CMS, CONSORT (Consolidated Standards of Reporting Trials) score, and Jadad score showed no significant improvement over the period of the included studies (P > .05). The quality of randomized controlled trials (RCTs) was significantly higher than that of non-RCTs (P < .05). The most common study weaknesses included blinding, subject selection process, study type, sample size calculation, and outcome measures and assessment. CONCLUSIONS The methodologic quality of knee articular cartilage surgery studies was poor overall and also for individual techniques (ACI, osteochondral autograft transplant, osteochondral allograft transplant, and microfracture). However, the overall quality of the investigations in this review (after June 2004) has significantly improved in comparison to those published before 2004. The quality of RCTs was significantly higher than that of non-RCTs. Level of evidence, CMS, CONSORT score, and Jadad score did not significantly improve with later publication date within the period of the studies analyzed. Methodologic quality deficiencies identified in this investigation may be used to guide future articular cartilage studies' design, conduct, and reporting. LEVEL OF EVIDENCE Level IV, systematic review of studies with Levels of Evidence I-IV.
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Affiliation(s)
- Joshua D Harris
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL 60612, USA.
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Matsen FA, Jette JL, Neradilek MB. Demographics of disclosure of conflicts of interest at the 2011 annual meeting of the American Academy of Orthopaedic Surgeons. J Bone Joint Surg Am 2013; 95:e29. [PMID: 23467877 DOI: 10.2106/jbjs.k.01514] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is growing concern regarding conflicts of interest in orthopaedic research and education. Because of their potential influence on orthopaedic practice, conflicts of interest among participants in the educational programs of the American Academy of Orthopaedic Surgeons (AAOS) are of particular interest. METHODS We analyzed the voluntarily disclosed conflicts of interest listed in the Final Program of the 2011 Annual Meeting of the AAOS for the relevant program committees as well as for presentations in the disciplines of pediatric orthopaedic surgery, spine, and sports medicine/arthroscopy. RESULTS Conflicts of interest were disclosed by participants for each of the program committees and for over 75% of the presentations. Conflicts of interest were disclosed for 100% of the featured symposia, 80% of the scientific exhibits, 76% of the podium presentations, and 75% of the posters. Over half (53%) of the disclosures were for paid consultancy, 51% were for research support for the principal investigator, 41% were for paid presentations, 39% were for royalties, and 39% were for stock. The highest number of disclosures for an individual author was thirty-seven. The number of disclosures per author was significantly (p < 0.001) correlated to the number of presentations per author. Disclosures were associated with 379 different companies; relationships with a relatively small number (twenty-six, 7%) of these companies were listed in the disclosures for 67% of the presentations. CONCLUSIONS Voluntarily disclosed conflicts of interest were common at the 2011 AAOS Annual Meeting, especially for the featured symposia. In view of the previously documented frequency of undisclosed conflicts of interest, as well as the previously documented effects of conflicts of interest on research design, conduct, and conclusion, it may be time to consider improved strategies for ensuring the accuracy and completeness of disclosure and for managing the biasing effects of conflicts of interest.
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Affiliation(s)
- Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA 98195-6500, USA.
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Disclosure of funding source and conflict of interest: exposure of biases affecting evidence and clinical utility of plastic surgery publications. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-011-0672-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chung KC, Kotsis SV, Berger RA, Van Ummersen G. The relationship between industry and surgery. J Hand Surg Am 2011; 36:1352-9. [PMID: 21664768 DOI: 10.1016/j.jhsa.2011.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 04/20/2011] [Accepted: 05/01/2011] [Indexed: 02/02/2023]
Abstract
This article examines industry's involvement in medicine, particularly with respect to surgeons and clinical research, as well as continuing medical education. We describe some historical events involving industry and how these events have led to guidelines by various organizations to handle conflicts of interest. We also review the advantages and disadvantages of collaborating with industry and provide practical guides for interactions with industry in terms of clinical research, continuing medical education, and clinical practice. With careful consideration to protect all parties involved, collaboration with industry can be advantageous to surgeons, industry, and patients.
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Affiliation(s)
- Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI 48109-0340, USA.
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Sayo A, Jennings RG, Van Horn JD. Study factors influencing ventricular enlargement in schizophrenia: a 20 year follow-up meta-analysis. Neuroimage 2011; 59:154-67. [PMID: 21787868 DOI: 10.1016/j.neuroimage.2011.07.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 06/23/2011] [Accepted: 07/04/2011] [Indexed: 12/13/2022] Open
Abstract
A meta-analysis was performed on studies employing the ventricular-brain ratio to compare schizophrenic subjects to that of normal controls. This was a follow-up to a similar meta-analysis published in 1992 in which study-, in addition to clinical-, factors were found to contribute significantly to the reported difference between patients with schizophrenia and controls. Seventy-two (N=72) total studies were identified from the peer reviewed literature, 39 from the original meta-analysis, and 33 additional studies published since which met strict criteria for inclusion and analysis - thus representing ~30 years of schizophrenia ventricular enlargement research. Sample characteristics from schizophrenics and controls were coded for use as predictor variables against within sample VBR values as well as for between sample VBR differences. Additionally, a number of factors concerning how the studies were conducted and reported were also coded. Obtained data was subjected to unweighted univariate as well as multiple regression analyses. In particular, results indicated significant differences between schizophrenics and controls in ventricular size but also the influence of the diagnostic criteria used to define schizophrenia on the magnitude of the reported VBR. This suggests that differing factors of the diagnostic criteria may be sensitive to ventricular enlargement and might be worthy of further examination. Interestingly, we observed an inverse relationship between VBR difference and the number of co-authors on the study. This latter finding suggests that larger research groups report smaller VBR differences and may be more conservative or exacting in their research methodology. Analyses weighted by sample size provided identical conclusions. The effects of study factors such as these are helpful for understanding the variation in the size of the reported differences in VBR between patients and controls as well as for understanding the evolution of research on complex clinical syndromes employing neuroimaging morphometrics.
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Affiliation(s)
- Angelo Sayo
- Laboratory of Neuro Imaging (LONI), Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, 635 Charles E. Young Drive SW, Suite 225, Los Angeles, CA 90095-7334, USA
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Robertson CT. The money blind: how to stop industry bias in biomedical science, without violating the First Amendment. AMERICAN JOURNAL OF LAW & MEDICINE 2011; 37:358-387. [PMID: 21847885 DOI: 10.1177/009885881103700207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The pharmaceutical and medical device industries use billions of dollars to support the biomedical science that physicians, regulators, and patients use to make healthcare decisions--the decisions that drive an increasingly large portion of the American economy. Compelling evidence suggests that this industry money buys favorable results, biasing the outcomes of scientific research. Current efforts to manage the problem, including disclosure mandates and peer reviews, are ineffective. A blinding mechanism, operating through an intermediary such as the National Institutes of Health, could instead be developed to allow industry support of science without allowing undue influence. If the editors of biomedical journals fail to mandate that industry funders utilize such a solution, the federal government has several regulatory levers available, including conditioning federal funding and direct regulation, both of which could be done without violating the First Amendment.
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