A Standardized, More Thorough Reporting of Disclosures in Plastic Surgery Literature.

Abstract

Sir: The focus on industry ties in biomedical research has increased after it was revealed that Dr. Jose Baselga, the chief medical officer of Memorial Sloan Kettering Cancer Center, failed to disclose millions of dollars in payments from drug companies and other health care companies in research articles and at national meetings.1 On resigning, Dr. Baselga stated, “It is my hope that this situation will inspire a doubling down on transparency in our field.” Other prominent institutions have publicly reiterated the need for physicians and researchers to fully disclose their conflicts of interest. Various evidence demonstrates that payments to physicians influence clinical practice, even within plastic surgery literature.2 These ties have become public record after the passage of the Physician Payments Sunshine Act in 2010. Two recent studies evaluated disclosures in the plastic surgery literature in comparison to the Open Payments database. One group demonstrated that over 10 months, nondisclosure occurred in 34.8 percent of articles, with 9.5 percent being considered relevant with potential harm from bias.3 A second group determined that 87 percent of authorships over a 3-year period had noted discrepancies between self-reported disclosures and the Open Payments database during that time.4 In 2011, a coordinated push for integrating evidence-based medicine into plastic surgery led to the creation of a standardized level-of-evidence rating scale by the American Society of Plastic Surgeons. A level-of-evidence pyramid with the assigned rating is now featured prominently on the first page of articles in Plastic and Reconstructive Surgery and allows readers to assess the strength of the data authors present. Likewise, we believe that a more detailed disclosure of conflict of interest should be standardized and included. Understanding the threat of potential harm from bias is a crucial study methodology aspect that should be treated similar to level of evidence. We believe that current disclosure practices at meetings and in journals do not meet transparency standards in pursuit of first-class research for the public good. To understand the scale of the relationship between physician and corporate entity, the dollar amount should be declared, and a standardized guideline determining its relevance as a potential for harm from bias should be stated. Perhaps a figure analogous to the level-of-evidence pyramid with a disclosure rating scale can be featured at the beginning of each article. Incorporating a measure of financial contribution and relevance can facilitate the audience’s ability to view already-public information and help them judge the veracity of the claims made. Moreover, nondisclosures are commonly attributable to authors assuming their financial conflict of interest is unrelated and therefore inconsequential in biasing the evidence presented.5 Standardizing this evaluation and having it verified by a third party can offer researchers a much less nebulous reporting protocol. There will likely be more public and governmental pressure for these disclosures, and we may be legislated into these changes. We believe our specialty should be at the forefront of this new era in transparency. We have always been a specialty of innovators and pioneers—this is simply another new territory where we can stake our flag. Disclosure The authors have no financial interest to declare in relation to the content of this work. David A. Daar, M.D., M.B.A.Vishal Thanik, M.D.Hansjörg Wyss Department of Plastic SurgeryNew York University School of MedicineNew York, N.Y.