May 20, 2019
3 min read

Maintain integrity from the podium

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Conflicts of interest are abundant throughout orthopedics. Many orthopedic surgeons are well-recognized by the orthopedic community as the innovators, researchers and inventors of medical devices and techniques we use to improve patient care. Patients and practice skills benefit from the many advances industry partnership have created for our everyday patient care and surgical procedures.

Despite efforts by all involved parties, Jonathan D. Hughes, MD, and colleagues found, in a study that cross-referenced the Open Payment database with the mandatory declaration of conflict of interest, more than 40% of surgeons who receive compensation from industry fail to report the relationship to the American Academy of Orthopaedic Surgeons. Another significant concern is the hidden conflict of interest of speakers at educational courses. While it is not presumed that openly declared conflicts negate a presentation’s value, there is an inherent assumption the audience needs to be critical of conclusions that favor the intentions and goals of industry or other third parties. Critical analysis is paramount to identify valuable information that can lead to a positive change in methods used for patient care, while avoiding biased recommendations that may negatively influence patient care.

Conflicts of interest

There has been an overwhelming effort from meeting organizers and supporters to ensure all faculty follow the mandatory policies and declare all potential conflicts. However, the declaration of conflicts may be an incomplete representation of the actual presence of conflicts in many presentations. Frederick A. Matsen III, MD, and colleagues found in their analysis of the 2011 AAOS Annual Meeting that speakers disclosed their conflicts of interest for 100% of symposia, 80% of scientific exhibits, 76% of podium presentations and 75% of posters. They also found 7% of orthopedic companies were responsible for 67% of the conflicts of interest payments. A study by Michael Tanzer, MD, FRCSC, and colleagues showed more than 40% of a sample of AAOS members did not report conflicts despite their conflicts listed on orthopedic company websites.

Anthony A. Romeo

While the influence of hidden conflicts of interest remains a challenge to the integrity of the content, conflict of ego may be more serious. Listening carefully to presentations can indicate when a speaker deviates from the scientific process. Understanding the components of the scientific investigation tells the listener the speaker has abandoned the rigor needed to provide reproducible results and recommendations. There should be an inherent, self-directed responsibility for the speaker to define the problem, identify criteria for materials and methods, state unbiased results based on accepted means of measurement and statistical analysis and then clearly identify in the discussion opinion vs. supported research. Opinions are valuable but should be recognized as an area with the highest risk of conflicts of interest.


Conflict of ego

With conflict of ego, a speaker desires recognition for original ideas and recommendations, even if unsupported by their current work. When a speaker presents information on patients that only he or she has the insight and pridefully shares data collected in an unreproducible way, which can change the fine details of presumed objective data collection, the audience should be alerted to a serious conflict of ego. They should also recognize that in the unlikely event the study passes the peer-review process, the final publication will be different than the presentation. When conflict of ego occurs by a thought leader, the audience may be influenced to adapt unscientific practices which can be detrimental to patient care.

Conflicts of interest and conflicts of ego should be taken into consideration when evaluating the applicability of study results to a surgeon’s practice. Currently, the mandatory reporting program and the less formalized efforts from meeting organizers fails to provide a transparent representation of conflicts, which may falsely influence decision-making. Policies related to disclosing conflicts of interest need to be revisited and improved.

Disclosure: Romeo reports he receives royalties, is on the speakers bureau, is a consultant and does contracted research for Arthrex; receives institutional grants from MLB; and receives institutional research support from Arthrex, Ossur, Smith & Nephew, ConMed Linvatec, Athletico and Wright Medical.