Conflict of evidence or conflict of interest?

Abstract

We at EBSJ appreciate a substantial and mostly positive echo to the editorial titled “BMP: evidence in the name of science?” (EBSJ Volume 2, Issue 4). Thank you to all who have voiced their interest and support of our unique publication. Other publications have also echoed the desirability of a reevaluation of the methodology and conclusions of the article by Carragee et al titled: “A critical review of recombinant human bone morphogenic protein-2 trials in spinal surgery: emerging safety concerns and lessons learned.”[1] A particularly detailed vocal response has appeared in a trade publication named ‘Orthopaedics This Month’ by Robin Young, CFA, and is titled “Under Carragee The Spine Journal lives dangerously.”[2] This non-peer reviewed article extensively reviewed the data in The Spine Journal article as presented and then used public federal data sources on complications of spine fusions with and without BMP-2, and found a substantially lower incidence of reoperations in the BMP group. The author (who is the same person as the editor-in-chief and publisher) called for a formal reinvestigation of the BMP data and outright retraction of the assertions made in The Spine Journal article, which had stated that complications were suppressed or not presented by the investigators of the BMP-2 FDA trials. The purpose of this editorial message is, however, not to rehash the continued debate revolving around BMP-2 possibly being linked with increased rates of retrograde ejaculation (or not) and other complications (such as a suggested increased cancer rate with BMP-2) but to raise some thoughts on the underlying accusations of unresolved conflict of interest (COI) of its original investigators.