Reply: Financial Conflicts of Interest in Plastic Surgery: Background, Potential for Bias, Disclosure, and Transparency.
487e Reply: Financial Conflicts of Interest in Plastic Surgery: Background, Potential for Bias, Disclosure, and Transparency Sir: Thank you for the opportunity to respond to Dr. Lineaweaver's comments on "Financial Conflicts of Interest in Plastic Surgery: Background, Potential for Bias, Disclosure, and Transparency."1 He and I have engaged debate on this topic recently in the Annals of Plastic Surgery. Dr. Lineaweaver's position,2 provocative of my response,3 is that full disclosure of financial conflicts of interest including the monetary amounts paid to the disclosure is not feasible, as proposed in the original piece,1 and the exclusion of individuals with financial conflict of interest from full participation in the process of scientific research and the peer review of same would be censorship. In order, consider the purpose of disclosure: to enable the reading or listening audience to judge the presence of bias and the degree of bias, if present or, in Dr. Lineaweaver's words, "[w]ith disclosures, academic presentations and publications should be considered on their merits, and the professional audience be allowed to weigh the value of the material against presumption of bias based on disclosures." That standard would dictate full disclosure, not qualified as "[t]he authors have no financial interest to declare in relation to the content of this article" or "[t]he authors have no sources of funding to report related to this submission." Full disclosure would, by logic, if the audience is to judge degree of bias, include a quantitative (monies paid) yardstick of magnitude of such a conflict. To do so would not require reductio ad absurdum objections of filed Internal Revenue Service returns, notarized statements, and so forth, but a statement of income accrued because, after all, the reporting system for disclosures in general is honor based.4 The standard of requirement of full disclosure on each and every occasion eliminates the potential for qualification by the author and should be adopted by our journals tout de suite. The second element of discussion that "extreme disclosure requirements" equates to censorship begs the question of implementation of appropriate exclusion of individuals with a defined financial conflict of interest from participation in the process of development of scientific literature either as editor, editorial board membership, peer review, publication of papers, or discussion of same. Censorship, if the objective is suppression of information, is anathema to scientific investigation, publication for scrutiny, and discussion of same. What is proposed is protection of that scientific process from bias induced by financial conflicts of interest, not censorship. Nor is that which is under discussion here a broad definition of "conflict" generated by, for example, fee for medical care or a desire to climb the academic ladder but rather the necessity for a full definition of financial conflicts of interest. Certainly, paid consultancy, partor full time employee of academic participant and a source of financial support or interest relevant to the participant's work. Defining or validating dollar amounts would be complicated, and ultimately could function more as gossip than useful standards of judgment. With disclosures, academic presentations and publications should be considered on their merits, and the professional audience should be allowed to weigh the value of the material against presumption of bias based on disclosures. Ultimately, reproducibility and utility of a work will establish the work's value. Disclosure should not evolve into a basis for censorship, especially because the future demands of disclosure and definitions of bias and conflict of interest may become extraordinary. As for disclosures, I am an employee of a fee for service private practice; a journal editor paid from royalties; a contracted consultant to TEI Biosciences; and a recipient of speaker fees from the MiMedx Group. As drenched as I may appear with conflicts of interest, I still feel entitled to present original work and commentaries to my profession. DOI: 10.1097/01.prs.0000475810.20166.56
Plastic and reconstructive surgery