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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.

In fact, it is reported that Dr Anderson’s financial ties to Medtronic are so extensive that the University of Wisconsin–Madison has set up special oversight procedures for him, including annual meetings with his department chairman to review his relationship with Medtronic and its potential influence on his university activities. Unfortunately, such conflicts (and failures to disclose them) are rampant in the orthopedic surgery community—recent investigations have shown that nearly half of orthopedic surgeons who received more than $1 million per year in consulting fees failed to disclose any conflicts in their subsequent publications.3 We remind all our authors and readers of the importance of supporting their views with the highest-quality scientific evidence, free from bias, so that we can rely on the best published data in caring for our patients.

Meissner  K, Fässler  M, Rücker  G,  et al.  Differential effectiveness of placebo treatments: a systematic review of migraine prophylaxis. JAMA Intern Med. 2013;173(21):1941-1951.PubMedArticle
Anderson  PA, Froyshteter  AB, Tontz  WL  Jr.  Meta-analysis of vertebral augmentation compared with conservative treatment for osteoporotic spinal fractures. J Bone Miner Res. 2013;28(2):372-382.PubMedArticle
Chimonas  S, Frosch  Z, Rothman  DJ.  From disclosure to transparency: the use of company payment data. Arch Intern Med. 2011;171(1):81-86.PubMedArticle