In this “Age of Transparency,” Consulting to Industry Does Not Necessarily Equal Bias

Dear Bariatric Times Editor:
Thank you for the opportunity to ask my question on financial transparency to exiting ASMBS President Dr. Scott Shikora in this month’s issue of Bariatric Times (Please see Dr. Shikora’s exit interview).

I asked Dr. Shikora the following question:
In this age of “transparency,” as we continue to grow exponentially, and profits from bariatric surgical support materials can be very lucrative, many are attracted to our field for other than altruistic reasons. Therefore, rather than ask the generic question about “disclosures,” do we have the right to ask to what degree and how much authors and researchers are actually paid by a commercial entity for their research and opinion about same?

Dr. Shikora responded saying:
I think that most of the current disclosure forms cover this issue and also allow the reader to make their own conclusions on the potential for conflict of interest. Many journals require the clinician to list income above $10,000.00 per year and also to disclose stock ownership.

I appreciate Dr. Shikora’s forthright, concise, although very brief, answer to my question about financial disclosures and transparency. Although many journals may require the clinician to list income greater than $10,000 a year, we rarely see this in print. There is no doubt that bariatric surgery has increased in interest exponentially with the move to minimally invasive techniques. Among other things, this has led to markedly increased profits for our suppliers, as well as for many of us who assist in research and development and product promotion. The vague, brief disclosure statements in the journals Surgery for Obesity and Related Diseases (SOARD) and Obesity Surgery fail to inform the reader of the degree of influence the commercial entity has on the author(s).

In a recent international consensus report on one of our newer procedures, the lead author acknowledged possible conflicts of interest, as he had financial support from 11 different suppliers via 24 separate channels, such as speaker forums, consultant fees, education and research support, and travel. Surely this is greater than $10,000 a year. Our suppliers have been and continue to be our lifeblood in the continued development of bariatric medicine, but we are the heart and soul, with the controlling stock.

The above being said, a true entrepreneur in our field deserves adequate compensation, but how does the average bariatric surgeon in the trenches know if an author (or presenter) is writing (or speaking) from the heart or the pocketbook? Answer: Attend the American Society for Metabolic and Bariatric Surgery, International Federation for the Surgery of Obesity, and Society of American Gastrointestinal and Endoscopic Surgeons meetings regularly and get to know these authors and speakers. Listen to the post-paper discussions and ask questions. Also, the authors and presenters are always available by snail- or e-mail. Utilize these tools and then decide on the validity of the article and what effect this knowledge should have on your patients. If you are still in doubt, check Dr. Pories’s concise explanation of the problem in SOARD 2009;5:521.

Sincerely,
Kenneth B. Jones Jr, MD, FACS
Past President, ASMBS; Medical Director, Bariatric Surgery Center of Excellence, Christus Schumpert Health Systems, North Louisiana, Shreveport

Category: Letters to the Editor, Past Articles