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Conflicts of interest and neurointerventional surgery
  1. Jackson P Midtlien1,
  2. Ankitha M Iyer1,
  3. Brie S Jones1,
  4. Carol Kittel2,
  5. Joshua A Hirsch3,
  6. Kyle M Fargen1
  1. 1 Neurological Surgery and Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
  2. 2 Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  3. 3 Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Jackson P Midtlien, Neurological Surgery and Radiology, Wake Forest School of Medicine, Winston-Salem NC 27101, North Carolina, USA; jmidtlie{at}

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Conflicts of interest (COI) in physician-industry relations have existed in medical practice, research, and education for many decades. A national survey in 2007 showed that 94% of physicians reported being involved in some type of relationship with pharmaceutical and/or medical device companies.1 More recently, there has been a push to increase transparency of these relationships so as to enhance patient confidence and trust. While recent federal policy developments have furthered efforts at transparency, the impact of these efforts remains uncertain.

Industry involvement in medicine has helped drive the development of many groundbreaking drugs and devices.2 Bearing that in mind, financial relationships have been shown to put patients at potential risk. In a systematic review of the financial transfers between pharmaceutical companies and physicians, Spurling et al found that the majority of these transfers led to higher prescribing rates, higher costs, and lower prescribing quality.3 In 2013, two physicians were found guilty of implanting defibrillators and pacemakers into their patients without disclosing that they were being paid an additional $400 to $1250 by the company to train and certify their sales representatives.4

Physician–industry relations involving medical devices are naturally more prevalent in surgical specialties.2 Neurointerventional surgery is heavily dependent on device innovation. A study in 2011 acknowledged that physician–industry relationships are essential to the advancement and innovation of practice while stressing the need for openness and strict ethical standards among COI development.2 Regardless, developmental progression and incorporation into practice of each device relies on its ability to demonstrate safe practice and improved outcomes through research and clinical trials.

Analysis of the impact of financial COI has not previously been performed in neurointerventional surgery. Additionally, the relationships between COI, bibliometric markers, and individual academic productivity have not been examined. Given the seemingly vital nature of industry …

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  • Contributors Study design: KF. Data collection: JM, AI, BJ. Statistical analysis: CK. Manuscript composition: JM, JH, CK, KF. Final approval of manuscript: all authors. Guarantor: KF.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests KF and JH serve on the editorial board of JNIS.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.