Hello, my name is Ilya Frid. I am a third year medical student at Geisinger Commonwealth School of Medicine, and I will be presenting my topic on conflict of interest disclosures in neurostimulation device studies. I and the other authors of this study have no conflicts to declare. In this presentation, we will cover a brief introduction on conflict of interests and the history of the issues surrounding conflict of interest disclosures. We will cover the purpose and study design behind our research, then we will talk about the results and provide recommendations for your future publishing needs. A conflict of interest is when a participant's private interests compete with his or her responsibilities to the scientific community, readers, and society. If we take a look at some of these headlines in the New York Times in the recent years, we can see that this is a growing problem in the scientific industry. Now this is only four of the headlines, but if you do a brief search on your own in any of the major news publishers around the country, you will see that this is a growing problem and deserves our attention as scientific members of the community. That being said, having a conflict of interest is not in itself a wrongdoing, but it can undermine the credibility of one's research if improperly disclosed. Now part of the problem is that neurosurgery is driven by rapid technological and industrial advancement. We're not alone in this, however. Orthopedic surgery and plastic surgery are other fields that are also driven similarly by industrial advancement. Therefore, commercially funded research is vital to the neurosurgical field and to improving outcomes of patient care. It's not difficult to understand as a surgical field depends on the tools of its trade, and therefore the manufacturer of those tools need to fund its researchers in order to provide advancement in that field. However, commercial biases do exist and they do muddy our knowledge base and create challenges in objective assessment of patient outcomes. The problem doesn't stop there, though. We have to take a look at the conflict of interest policies and the journal guidelines, as they're not always explicit and standardized across different publishers. An example of this problem is shown here, where a previously published study showed that 65% of the top 20 highest impact factor journals in neurosurgery required conflict of interest disclosures from all authors. More shockingly was that 53% required disclosures from all non-financial conflicts. Lastly, only 10% designated a specific time frame for those conflict of interest disclosures. It was found in that study that the higher the impact factor, the more comprehensive the conflict of interest policy. However, some of these policies are directed by the publishers and not directly by the journals. On the right, we see a different study that shows why it's important to disclose financial conflicts of interest properly. In this quote, it says, any financial conflict of interest significantly influences whether studies report findings favorable to industry. In our study, we used ProRepublica's Dollars for Docs database to compile a list of the top earners in four neurostimulation device categories that included deep brain stimulators, spinal cord stimulators, reactive neurostimulators, and vagus nerve stimulators. We then compiled the demographic information for these authors and used PubMed to search for the publications of these authors for a limited time frame from 2015 to 2016. We then recorded the disclosure of each publication and recorded which journals they were found in. We also recorded some additional information as per this chart on this slide. Our goal was to see whether or not there was a correlation between how much an author earned and whether or not they were likely to provide a disclosure statement in their publication. In our results, we see that 23.4% of the authors were in the neurosurgical field, while the majority were in neurology. Of those authors, 89% were male and 85% held an MD degree. When taking a look at the cumulative payment distribution for these authors, we see that the top two payment categories were for being a speaker at a venue other than a continuing education program and for royalty and licenses. These values added up to $7,813,000 for being a speaker and $7,795,000 for royalties and licenses. If we break this data down even further, we can see that the majority of funds came for spinal cord stimulators, in which a combined amount of $12,962,000 was paid out over a two-year time frame for these top-earning authors. The next device was vagus nerve stimulators that paid out $6,909,000 to authors. The categories varied amongst devices as well. For instance, for spinal cord stimulators and deep brain stimulator devices, the highest contribution category was for being a speaker at a venue other than a continuing education program. However, for vagus nerve stimulators, that category was royalty and license payments, and for reactive nerve stimulators, it was honoraria. Now, if we take a look at our author data, we can see that between the years of 2015 and 2016, the majority of authors did provide a disclosure statement. That being said, approximately 60 publications each year either did not contain a statement or the author did not disclose their financial conflict of interest. If we take a look at the graph on the right, we can see that on average, authors that had more compensation from these device manufacturing companies were more likely to disclose their conflict of interest than authors that made less money from these device manufacturing companies. In fact, we saw that on average, the authors that did not have a disclosure statement or that didn't disclose their conflict of interest were compensated $320,000 less than authors that did disclose their financial compensation. In conclusion, payments from pharmaceutical and device manufacturing companies can create biases in reporting findings and physician practice. Therefore, disclosing of such fundings allows for transparency and trust in the author's responsibility to maintain objectivity in their studies. Our particular study found that authors who are known to receive large payments for medical devices occasionally do not include disclosure statements in a significant portion of their publications. Additionally, authors are more likely to disclose a conflict of interest with an increasing amount of contribution that they receive from device manufacturers. Lastly, authors are more likely to disclose a conflict of interest in journals with higher impact factors. Our recommendation is that you provide consideration for the following types of conflicts. Financial ties, academic commitments, personal relationships, political and religious beliefs, and institutional affiliations are all important in this consideration. And while we consider financial ties to be self-explanatory, we don't always give thought to the remaining four categories. And additionally, we recommend that you thoroughly read the publisher's conflict of interest reporting guidelines and consult all authors of your study to report potential conflict of interest. Lastly, it's always better to over-report potential conflict of interest rather than under-report essential conflicts. Please take a look at these chosen works cited for further information. Thank you for listening to our presentation.

conflict of interest disclosures

neurostimulation device studies

scientific industry

research credibility

financial conflicts of interest