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Editor's Note
February 2014

VertebroplastyChanging Levels of Evidence and Conflict of Interest

JAMA Intern Med. 2014;174(2):308. doi:10.1001/jamainternmed.2013.13025

At JAMA Internal Medicine we take scientific rigor, high quality of evidence, and objective data very seriously. Drs Levy and Beall suggest that Dr Bauer overlooked or ignored studies that show reduction in pain with vertebroplasty. As Dr Bauer explains in his letter in reply, however, his statements are based on randomized, blinded clinical trials, which are considered the highest-quality evidence. Drs Levy and Beall fail to appreciate the greater reliability of randomization and blinding, which are particularly important for trials that have a powerful placebo effect.1 They assert that 2 randomized trials of vertebroplasty cited by Dr Bauer (both of which included blinding and sham controls) were “recently downgraded” in an article by Anderson and colleagues.2 Dr Bauer explains why the analysis by Anderson and colleagues is flawed. Moreover, Drs Levy and Beall, who acknowledge their own financial ties to the manufacturers of vertebroplasty devices, fail to mention that Dr Anderson receives hundreds of thousands of dollars from Medtronic, a major manufacturer of such products.

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