Conflict of Interest in Sports Medicine: Does it Affect Our Judgement?

OBJECTIVES: The American Academy of Orthopaedic Surgeons (AAOS) and other orthopaedic societies require members who present original research to disclose conflicts so that audiences can make informed decisions when interpreting data. To what degree members use this information when interpreting studies has never been investigated. The purpose of our study was to evaluate how a reported conflict of interest by the primary research team can influence the perceived value of data presented in original research. METHODS: We devised a hypothetical prospective study (https://www.surveymonkey.com/s/MPCCLCX) and asked orthopaedic surgeons and non operative sports medicine specialists to rate the perceived clinical value of the data that was obtained based upon variations of study design, statistical significance of outcomes between treatment groups, and characteristics of the research setting (academic v. private institution). The research team in question was disclosed to have the following conflict of interest: the project was funded by a pharmaceutical company and that all authors received compensation for consulting services. RESULTS: 750 sports medicine physicians were sent a survey request to participate in this IRB approved study. 522 responses were obtained for an overall response rate of 70%. 99% of respondents were orthopaedic surgeons. The majority of respondents were from the Northeastern U.S. (32%) and male (96%). Most have been in practice for over 20 years (40%) and were from private practice single specialty groups (58%). 80% of respondents strongly agreed with the statement that conflict disclosure is important when interpreting study results. 62% of respondents reported always reading the disclosure slide during academy or other meeting presentations. 41% of respondents reported always using this information when deciding how to interpret scientific data. Using a case series design with significant positive results at an academic center, 24% reported that the study was likely trustworthy. When the setting of the study was changed to a community hospital, this number decreased to 5%. When no significant difference was found between the groups, 42% believed the study to be trustworthy. When the study design was Level I evidence (RCT trial) and at an academic center, 57% believed the study to be trustworthy. With the same criteria but at a community hospital, this number decreased to 39%. When the results of this design showed no difference among groups, the majority of respondents believed the study to be trustworthy (62%). CONCLUSION: Although the majority of orthopaedic surgeons in our analysis believed that disclosure of conflict of interest is important, less than half used this information when interpreting studies. Changing the study design from a case series to a randomized controlled trial improved the perceived reliability of the data, but was not as important as the reporting of “negative” results.