Reply: Financial Conflicts of Interest

Sir: We would like to thank Dr. Pan and colleagues for their thoughtful comments regarding our article.1 There are several key issues that need to be fully explored before we can determine the full impact of conflicts of interest in plastic surgery research. As Pan et al. describe, industry support of basic and clinical research is becoming more common due to decreasing governmental support.2 Accordinkg to Moses and Dorsey, more than 62 percent of all research funding now stems from industry.3 Unlike in the past, large multicenter trials that would otherwise be supported by government entities are now only supported through industry financing. We agree that industry support for plastic surgery research is not only important but essential. However, our findings highlight that changes at the funding level may be placing undue pressure on researchers to publish only positive results. Future studies should explore the potential drivers behind this sensitive association. We agree with Pan et al. that there may exist an inherent bias in the editorial process for the publication of positive results. Although this is a well-known phenomenon in other specialties,4–6 this has not been explored in plastic surgery. This type of publication bias would require an analysis of all manuscripts accepted and rejected by plastic surgery journals, and therefore was beyond the scope of our analysis. If such a publication bias exists in plastic surgery, a concerted effort by the plastic surgery scientific community may be needed to facilitate the publication of research findings with negative results. Lastly, when grouping each article by study outcome, as Pan et al. suggested, we did group all articles that were not positive (i.e., “negative” and “not applicable” articles) and compared them with articles that presented positive findings. When comparing these two groups, we found that studies that disclosed conflicts of interest were statistically less likely to publish negative results (unpublished data), providing further evidence that disclosing a conflict of interest is an independent predictor for publication of positive results. Our study provides strong evidence that an association exists between industry funding and publication of positive results. Although the drivers behind this strong association are unclear, future efforts should focus on elucidating these drivers and ensuring that the potential deleterious influences of industry funding on plastic surgery research are eliminated. DISCLOSURE Dr. May is a consultant for TEI Biosciences and an educational consultant for Johnson-Johnson–Mentor. Dr. Dorafshar receives indirect research support and is entitled to royalties from KLS Martin. Dr. Dorafshar also receives research support from De Puy Synthes. The remaining authors have no financial interests to disclose. Joseph Lopez, M.D., M.B.A.Department of Plastic and Reconstructive SurgeryJohns Hopkins HospitalBaltimore, Md. Sandra Lopez, B.S.Department of Plastic and Reconstructive SurgeryJohns Hopkins HospitalBaltimore, Md. Jessica Means, B.A.Columbia University College of Physicians and SurgeonsNew York, N.Y. Raja Mohan, M.D.Department of Plastic and Reconstructive SurgeryJohns Hopkins HospitalBaltimore, Md. Ashwin Soni, M.D.Division of Plastic SurgeryUniversity of Washington Medical CenterSeattle, Wash. Jacqueline Milton, Ph.D.Department of BiostatisticsBoston University School of Public HealthBoston, Mass. Anthony P. Tufaro, D.D.S., M.D.Department of Plastic and Reconstructive SurgeryJohns Hopkins HospitalBaltimore, Md. James W. May, Jr, M.D.Division of Plastic and Reconstructive SurgeryMassachusetts General HospitalBoston, Mass. Amir Dorafshar, M.B.Ch.B.Department of Plastic and Reconstructive SurgeryJohns Hopkins HospitalBaltimore, Md.