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Financial Disclosure
Editorials
601
Financial Disclosure Imagine this scene. While waiting in the surgeon’s lounge to start your next case, you see that the TV is tuned to Bloomberg News. TH, a financial ‘‘talking head’’, is being interviewed. TH recommends that the XYZ stock be purchased. Critical thinker that you are, you wonder if TH has a vested financial interest in XYZ stock. Does TH own shares of XYZ, does TH’s employer have a business relationship with XYZ (e.g. does it underwrite the sale of XYZ stock), will TH benefit in some way from his recommending the purchase of XYZ? Fortunately, Bloomberg News requires that all interviewees complete a financial disclosure that is displayed on the screen while the talking heads are talking. Is financial disclosure needed in JPRAS? Recent developments in the United States suggest so. In 2007, five of the largest orthopaedic equipment manufacturers agreed to pay out over $310 million in penalties to settle United States governmental accusations that they used fake consulting agreements and other means to induce orthopaedic surgeons to use their products. Four of the five companies were charged with criminal conspiracy and were subject to 18 months of federal monitoring as part of a deferred prosecution agreement.1 Despite the ongoing government investigation, the American Academy of Orthopaedic Surgeons has revamped its policy on disclosure of potential financial conflicts to patients.2 Although many editors have propounded reasons for policy, none has done so as succinctly and elegantly as Morain did when he wrote: ‘‘But a complete disclosure of the nature of any financial connection is the sine qua non of integrity because there are varying degrees of interest that the author may have in the product. An author who receives a nominal consultant fee from the manufacturer has a lesser 1 2 3 4 5 6
degree of financial interest than one who receives royalties for every one sold. Editors know this because the letters from the latter are more venomous. And readers need to know it as welldnot because the author lacks integrity for holding a conflict but because the author can demonstrate his/her integrity only by disclosing the fullness of that conflict. To the extent that this disclosure represents an incentive to other investigators to challenge the results with further research, the system becomes self-corrective. Any claim to financial privacy is spurious.’’3 The degree of disclosure mandated by medical journals ranges from the non-existent to the exhaustive.4,5 Indeed, the BMJ policy on ‘‘competing interests’’ is so comprehensive that it requires not only authors but also referees to answer questions of potential financial gain or loss, as well as questions concerning ‘‘personal rivalry’’.6 To protect the integrity of JPRAS and to enable you, the reader, to make more intelligent decisions regarding the merit of the manuscripts published here, a new financial disclosure policy is being instituted. M. Felix Freshwater University of Miami Miller School of Medicine, Division of Plastic Surgery, 9100 S Dadeland Boulevard Ste 502, Miami FL 33156-7815, USA E-mail address: [email protected] ª 2008 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. doi:10.1016/j.bjps.2008.04.018
http://www.nytimes.com/2007/09/28/business/28devices.html Accessiblity verified April 16, 2008. http://online.wsj.com/article/SB119552347946098696.html. Morain WD: Conflicts of Compounding Interest. Ann Plast Surg 47: 505, 2001. http://www.sagepub.com/journalsProdManSub.nav?prodIdZJournal201891 Accessibilty verified April 16, 2008. http://resources.bmj.com/bmj/authors/checklists-forms/competing-interests Accessibilty verified April 16, 2008. Ibid.
Can competition and the fear of litigation drive one to retirement? The article written by Rod J. Rohrich, Mary H. McGrath and Thomas W. Lawrence of the American Society of Plastic Surgeons Workforce Task Force and published in Plastic Reconstructive Surgery regarding practice pattern, satisfaction and retirement plans of Plastic Surgeons over the age of 50 in the United States of America, is indeed a very thoroughly researched document of gloom and doom.1
Though the Plastic Surgeons there are, on one hand more satisfied in their clinical practice than their contemporaries in other specialities, yet they are retiring earlier because of rising malpractice costs, insufficient reimbursement, stress of practice and, hold your breath, increasing competition! So much for the famous Yankee tenacity which made the youngest continent in the world the most prosperous and
601
Financial Disclosure Imagine this scene. While waiting in the surgeon’s lounge to start your next case, you see that the TV is tuned to Bloomberg News. TH, a financial ‘‘talking head’’, is being interviewed. TH recommends that the XYZ stock be purchased. Critical thinker that you are, you wonder if TH has a vested financial interest in XYZ stock. Does TH own shares of XYZ, does TH’s employer have a business relationship with XYZ (e.g. does it underwrite the sale of XYZ stock), will TH benefit in some way from his recommending the purchase of XYZ? Fortunately, Bloomberg News requires that all interviewees complete a financial disclosure that is displayed on the screen while the talking heads are talking. Is financial disclosure needed in JPRAS? Recent developments in the United States suggest so. In 2007, five of the largest orthopaedic equipment manufacturers agreed to pay out over $310 million in penalties to settle United States governmental accusations that they used fake consulting agreements and other means to induce orthopaedic surgeons to use their products. Four of the five companies were charged with criminal conspiracy and were subject to 18 months of federal monitoring as part of a deferred prosecution agreement.1 Despite the ongoing government investigation, the American Academy of Orthopaedic Surgeons has revamped its policy on disclosure of potential financial conflicts to patients.2 Although many editors have propounded reasons for policy, none has done so as succinctly and elegantly as Morain did when he wrote: ‘‘But a complete disclosure of the nature of any financial connection is the sine qua non of integrity because there are varying degrees of interest that the author may have in the product. An author who receives a nominal consultant fee from the manufacturer has a lesser 1 2 3 4 5 6
degree of financial interest than one who receives royalties for every one sold. Editors know this because the letters from the latter are more venomous. And readers need to know it as welldnot because the author lacks integrity for holding a conflict but because the author can demonstrate his/her integrity only by disclosing the fullness of that conflict. To the extent that this disclosure represents an incentive to other investigators to challenge the results with further research, the system becomes self-corrective. Any claim to financial privacy is spurious.’’3 The degree of disclosure mandated by medical journals ranges from the non-existent to the exhaustive.4,5 Indeed, the BMJ policy on ‘‘competing interests’’ is so comprehensive that it requires not only authors but also referees to answer questions of potential financial gain or loss, as well as questions concerning ‘‘personal rivalry’’.6 To protect the integrity of JPRAS and to enable you, the reader, to make more intelligent decisions regarding the merit of the manuscripts published here, a new financial disclosure policy is being instituted. M. Felix Freshwater University of Miami Miller School of Medicine, Division of Plastic Surgery, 9100 S Dadeland Boulevard Ste 502, Miami FL 33156-7815, USA E-mail address: [email protected] ª 2008 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. doi:10.1016/j.bjps.2008.04.018
http://www.nytimes.com/2007/09/28/business/28devices.html Accessiblity verified April 16, 2008. http://online.wsj.com/article/SB119552347946098696.html. Morain WD: Conflicts of Compounding Interest. Ann Plast Surg 47: 505, 2001. http://www.sagepub.com/journalsProdManSub.nav?prodIdZJournal201891 Accessibilty verified April 16, 2008. http://resources.bmj.com/bmj/authors/checklists-forms/competing-interests Accessibilty verified April 16, 2008. Ibid.
Can competition and the fear of litigation drive one to retirement? The article written by Rod J. Rohrich, Mary H. McGrath and Thomas W. Lawrence of the American Society of Plastic Surgeons Workforce Task Force and published in Plastic Reconstructive Surgery regarding practice pattern, satisfaction and retirement plans of Plastic Surgeons over the age of 50 in the United States of America, is indeed a very thoroughly researched document of gloom and doom.1
Though the Plastic Surgeons there are, on one hand more satisfied in their clinical practice than their contemporaries in other specialities, yet they are retiring earlier because of rising malpractice costs, insufficient reimbursement, stress of practice and, hold your breath, increasing competition! So much for the famous Yankee tenacity which made the youngest continent in the world the most prosperous and