Thread by @andrewswright

Our paper on Conflict of Interest (COI) in invited talks at a surgical meeting was just published in @SurgEndosc - This thread is a quick Twitter summary rdcu.be/bOv1D @AlexLoisMD @saurabh_khand @Chenbariatrics1 @pugel
@OhJinsol

There is a lot of great evidence that COI is frequently underreported, with almost every study showing >25% unreported or underreported COI. For example, Olavarria et al showed that of 100 papers in hernia surgery 27% of authors underreported COI. ncbi.nlm.nih.gov/pubmed/28167228

There is also good evidence that papers with underreported COI are consistently more favorable to industry. For example, Patel et al showed that studies with undisclosed payments from Intuitive were 4.3X more likely to be recommend robotic surgery ncbi.nlm.nih.gov/pmc/articles/P…

These studies all use the Open Payments Database (OPD) to look at disclosures of COI in the surgical literature. The OPD is a great resource, and includes all industry-reported payments to US physicians. For example, here is a link to my personal report: openpaymentsdata.cms.gov/physician/1618…

It's important to note that the OPD may miss some COI that isn't in the form of direct payment, like research support, institutional support, personal relationships, stock ownership, etc

While the data is pretty clear that COI is underdisclosed in the literature, we didn't know (but we suspected) if the same would be true for speakers at Surgical Meetings.

The potential for COI at big national surgical meetings to influence recommendations is high, as surgeons attend these meetings to hear what experts recommend about common clinical issues.

The @SAGES_Updates meeting is unique, in that all invited talks are recorded and posted for free to Youtube, which allowed us to watch all invited talks, record COI disclosures, and then compare to the OPD.

As a shameless plug, and as an example, here is my talk on COI in the hernia literature from the #SAGES2018 meeting:

So what did we find after watching 479 invited talks? Most (86%) were compliant with having a disclosure statement at the beginning of the talk, but that means 13% didn't have any disclosure at all.

Almost 40% of speakers under-disclosed industry relationships, while some disclosed industry relationships relationships that weren't present in the OPD. Among a total of 315 speakers, 106 had no COI and 86 fully disclosed. This left 123 with incompletely disclosed COI.

A total of $6,389,097 was paid to presenters with individual financial relationships ranging from $0 to $374,502 (median $992). Speakers failed to disclose $2,049,535 worth of industry payments with a median undisclosed payment of $5058 (range $525–$361,073)

The highest payments were made to speakers in robotics and hernia with spending of $2,593,925 (40.6%) and $2,591,671 (40.5%), respectively, and the smallest amount was to speakers presenting in educational sessions at $93,363 (1.46%)

The majority of payments were for royalties and research.

To summarize: under-reporting of COI by invited speakers at a major national surgical meeting is common (39%). While most unreported COI is small, a large number of speakers have major undisclosed COI (>$10,000).

I don't want to pick on @SAGES_Updates about this, and SAGES has actually been very upfront and transparent. It's only because of this transparency that we were even able to look at this issue. We don't have data for other medical meetings, but I suspect we would find similar.

So what should we do about this? My personal recommendations: 1) Meetings should enforce COI disclosure rules, and the OPD should be used to double check

2) COI disclosure as it is done now isn't sufficient, as it doesn't characterize the nature of a relationship or the amount of financial interest.

In my mind there is a big difference between someone who gets 2K to reimburse travel to a training session on a new technology and someone who gets >100K for being a paid speaker/consultant. Both currently reported the same on a standard COI disclosure slide.

Full disclosure should include the name of the company, the amount of the payment, and the nature of that payment (consulting, education, etc)

Also, here is a debate in @gensurgnews on COI that I was part of, with some more thoughts including that not all COI is actually bad and that interaction with industry is needed to drive our specialty forward: generalsurgerynews.com/The-Great-Deba…