Evidence-Based Medicine and Conflict of Interest

  • Eric Swanson


Conflict of interest represents a major obstacle to advancement in our specialty. About half of US physicians receive payments from pharmaceutical or medical device companies. Publications in our scientific journals are important marketing tools for manufacturers. New transparency laws make it easier to check for large payments to physicians. However, there are many other indirect ways that companies can reimburse investigators.

Conflicts are not just financial. Physicians may have an intellectual conflict if they become outspoken advocates. Our journals and societies are vulnerable when companies become partners and support society functions and journal publications. Expert witnesses have a medicolegal conflict once they testify regarding the standard of practice.

Randomized studies are rarely practical in surgery. Meta-analyses suffer from confounding variables. Fortunately, prospective observational studies can provide reliable information, particularly when the method includes consecutive patients, a high inclusion rate, defined eligibility criteria, and a reliable measurement device. Patient satisfaction is the determinant of success in cosmetic surgery and may be assessed with patient-reported outcome studies.

No discipline can benefit more from critical thinking than cosmetic surgery, which is often (unfortunately) regarded as an art rather than a science. Evidence-based medicine sets aside conventional wisdom, first principles, and clinical impressions. Eventually, strongly held beliefs give way to the facts.


Evidence-based Conflict Interest Financial Disclosure Transparency Measurements Body contouring 


  1. 1.
    Swanson E. The plastic surgeon: artist or scientist? Plast Reconstr Surg. 2013;131:182–4.CrossRefPubMedGoogle Scholar
  2. 2.
    Swanson E. Evidence-based cosmetic breast surgery. New York: Springer; 2017.CrossRefGoogle Scholar
  3. 3.
    Lopez J, Lopez S, Means J, et al. Financial conflicts of interest: an association between funding and findings in plastic surgery. Plast Reconstr Surg. 2015;136:690e–7e.CrossRefPubMedGoogle Scholar
  4. 4.
    Luce EA. Financial conflicts of interest in plastic surgery: background, potential for bias, disclosure, and transparency. Plast Reconstr Surg. 2015;135:1149–55.CrossRefPubMedGoogle Scholar
  5. 5.
    Hall-Findlay EJ. Breast implant complication review: double capsules and late seromas. Plast Reconstr Surg. 2011;127:56–66.CrossRefPubMedGoogle Scholar
  6. 6.
    Hidalgo D, Weinstein A. Intraoperative comparison of anatomical versus round implants in breast augmentation: a randomized controlled trial. Plast Reconstr Surg. 2017;139:587–96.CrossRefPubMedGoogle Scholar
  7. 7.
    Dollars for docs website. Accessed 4 Sept 2017.
  8. 8.
    Tringale KR, Marshall D, Mackey TK, Connor M, Murphy JD, Hattangadi-gluth JA. Types and distribution of payments from industry to physicians in 2015. JAMA. 2017;317(17):1774–84.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Larkin I, Ang D, Steinhart J, et al. Association between academic medical center pharmaceutical detailing policies and physician prescribing. JAMA. 2017;317(17):1785–95.CrossRefPubMedGoogle Scholar
  10. 10.
    Adams WP Jr, Culbertson EJ, Deva AK, et al. Macrotextured breast implants with defined steps to minimize bacterial contamination around the device: experience in 42,000 implants. Plast Reconstr Surg. 2017;140:427–31.CrossRefPubMedGoogle Scholar
  11. 11.
    Swanson E. Textured breast implants, anaplastic large-cell lymphoma (ALCL), and conflict of interest. Plast Reconstr Surg. 2017;139:558e–9e.Google Scholar
  12. 12.
    Hall-Findlay E. Textured vs. smooth implants in breast augmentation. Paper presented at: American society of plastic surgeons breast and body contouring symposium, San Diego, CA, 10–12 Aug 2017.Google Scholar
  13. 13.
    Hidalgo D, Weinstein A. Reply: discussion on “Intraoperative comparison of anatomical versus round implants in breast augmentation: a randomized trial.” Plast Reconstr Surg 2017;140:828e.Google Scholar
  14. 14.
    Lim AF, Weintraub J, Kaplan EN, et al. The embrace device significantly decreases scarring following scar revision surgery in a randomized controlled trial. Plast Reconstr Surg. 2014;133:398–405.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Swanson E. Tension shielding with the embrace device: does it really improve scars? Plast Reconstr Surg. 2014;134:662e–4e.CrossRefPubMedGoogle Scholar
  16. 16.
    Stevens WG, Bachelor EP. Cryolipolysis conformable-surface applicator for nonsurgical fat reduction in lateral thighs. Aesthet Surg J. 2015;35:66–71.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Stevens WG. Cryolipolysis conformable-surface applicator for nonsurgical fat reduction in lateral thighs (reply to Dr. Swanson). Plast Reconstr Surg. 2016;138:153e–5e.CrossRefPubMedGoogle Scholar
  18. 18.
    Stevens WG. Nonsurgical body contouring. Presented at The American Society for Aesthetic Plastic Surgery, The Aesthetic Cruise, 25 July 2017.Google Scholar
  19. 19.
    Allergan will buy Zeltiq for $2.48 billion. Accessed 4 Sept 2017.
  20. 20.
    Swanson E. Cryolipolysis: the importance of scientific evaluation of a new technique. Aesthet Surg J. 2015;35:NP116–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Swanson E. Levels of evidence in cosmetic surgery: analysis and recommendations using a new CLEAR classification. Plast Reconstr Surg Glob Open. 2013;1:e66.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Quote by W. Edwards Deming. Accessed 4 Sept 2017.
  23. 23.
    Swanson E. Venous thromboembolism risk stratification and chemoprophylaxis: a meta-analysis finds no benefit, more risk. Plast Reconstr Surg Glob Open. 2017;5:e1356.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Swanson E. Comparison of limited and full dissection abdominoplasty using laser fluorescence imaging to evaluate perfusion of the abdominal skin. Plast Reconstr Surg. 2015;136:31e–43e.CrossRefPubMedGoogle Scholar
  25. 25.
    Tourani SS, Taylor GI, Ashton MW. Scarpa fascia preservation in abdominoplasty: does it preserve the lymphatics? Plast Reconstr Surg. 2015;136:258–62.CrossRefPubMedGoogle Scholar
  26. 26.
    Rohrich RJ, Wills A, Mulligan JR, Clark V, Sullivan D, Tynan E, Stuzin JM. To have some friends: a tribute to Robert Goldwyn, M.D., 1930 to 2010 – plastic and reconstructive surgery editor emeritus dies at age 79. Plast Reconstr Surg. 2010;126:691–5.CrossRefPubMedGoogle Scholar
  27. 27.
    Goldwyn RM. Wanted: real clinical results. Plast Reconstr Surg. 2004;114:1000–1.CrossRefGoogle Scholar
  28. 28.
    Lista F. Discussion: comparing round and anatomically shaped implants in augmentation mammaplasty: the experts’ ability to differentiate the type of implant. Plast Reconstr Surg. 2017;139:65–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Ardehali B, Fiorentino F. A meta-analysis of the effects of abdominoplasty modifications on the incidence of postoperative seroma. Aesthet Surg J. 2017;37:1136–43.CrossRefPubMedGoogle Scholar
  30. 30.
    Seretis K, Goulis D, Demiri EC, Lykoudis EG. Prevention of seroma formation following abdominoplasty: a systematic review and meta-analysis. Aesthet Surg J. 2017;37:316–23.CrossRefPubMedGoogle Scholar
  31. 31.
    Jabbour S, Awaida C, Mhawej R, Habre SB, Nasr M. Does the addition of progressive tension sutures to drains reduce seroma incidence after abdominoplasty? A systematic review and meta-analysis. Aesthet Surg J. 2017;37:440–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Rousseau P, Vincent H, Potier B, et al. Diathermocoagulation in cutting mode and large flap dissection. Plast Reconstr Surg. 2011;127:2093–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Valença-Filipe R, Martins A, Silva Á, et al. A prospective study on scalpel versus diathermocoagulation (coagulation mode). Plast Reconstr Surg Glob Open. 2015;3:e299.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Klassen A, Cano SJ, Alderman A, et al. The BODY-Q: a patient-reported outcome instrument for weight loss and body contouring treatments. Plast Reconstr Surg Glob Open. 2016;4:e679.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Winston Churchill quote. Accessed 4 Sept 2017.

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Eric Swanson
    • 1
  1. 1.Swanson CenterLeawoodUSA

Personalised recommendations