Evidence-Based Medicine and Conflict of Interest

Abstract

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.