Follow the money: Investigating gender disparity in industry payments among senior academics and leaders in plastic surgery

Ledibabari M. Ngaage; Chelsea Harris; Wilmina Landford; Brooks J. Knighton; Talia Stewart; Shealinna Ge; Ronald P. Silverman; Sheri Slezak; Yvonne M. Rasko

doi:10.1371/journal.pone.0235058

Peer Review History

Original SubmissionOctober 28, 2019
2 Apr 2020 Decision Letter - Hans-Peter Simmen, Editor PONE-D-19-30059 Follow the Money: Investigating Gender Disparity in Industry Payments Among Senior Academics and Leaders in Plastic Surgery PLOS ONE Dear Dr Rasko, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that your well written study has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please, consider especiailly the comments and proposals of reviewer 3. I am convinced that your manuscript will improve enormously. We would appreciate receiving your revised manuscript by May 17 2020 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Competing interests can arise in relationship to an organization or another person. Please follow this link to our website for more details on competing interests: http://journals.plos.org/plosone/s/competing-interests [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Thank you for your submission of this article. Your study is a database review and comes to reasonable conclusions using standardized measures. I would like you to point out in either your discussion or conclusions that more and more academic centers in the United States have prohibitions on certain types of industry sponsorships by academic faculty which results in disparities which may be confounding your results. For instance speaker honoraria for non-CME events are often prohibited and this results in certain institutions, most specifically those with the most significant federal research funding, and likely the most gender equality, having the least input into these results. Reviewer #2: The authors aim to characterise the relationship between industry sponsorship and senior leaders in academic plastic surgery andl evaluate the role of gender on in the nature and monetary value of industry payments. They conclude that ndustry payments were distributed equally to male and female senior plastic surgeons except for speakerships. Career lenght and H-index were positively associated with total industry payments. The study is clearly written and well performed. I have the following questions 1. How do the authors explain that only a small number of industry grants were included ? 2. Please specify "associated research" Reviewer #3: General comments: The study applied a quite strict inclusion and exclusion criteria therefore results in a very limited sample size, especially including only 38 females. It’s unclear how representative is this study sample (as % of academic faculties). The merits of inclusion and exclusion criteria is also questionable. Faculty with the rank of associate professor maybe included, if not those with the rank of assistant professor. Those who processed no payment data for 2018 may also be included as it enables the examination of research question: what are the characteristics of academics who received industry payments. Measurement of leadership position focuses only on departmental positions. This should be expanded to leadership position in professional societies as well as recipients of major rewards in plastic surgery. Abstracts 1) Add description of inclusion and exclusion criteria 2) In Results paragraph line 39, change to “for speakerships where women received smaller amounts compared to their male counterparts (median payments of $3,675 vs. $7,134 for women and men respectively, P<0.0001)”. 3) In Results paragraph line 40-42, “Multiple linear regression … (R=0.17, … and R=0.14, …)” - Explain what is the R value. Introduction 1) Lines 69-71, consider changing to “This paper aims to 1) characterize academics who received industry sponsorship; 2) examine relationship between industry sponsorship and gender, academic rank, leadership position, career length, and academic productivity”. Method 1) Line 86, consider to include faculty with the academic rank of professor or associate professor. 2) Line 110, consider faculty with the academic rank of professor or associate professor or a leadership position. 3) Lines 112-113, consider deleting “(iv) who possessed no payment data for 2018” from the exclusion criteria. Data analysis 1) Lines 124-125, explain the meaning of R statistic. Results 1) Line 133, 316 differs from the sum of 279 and 38 in table 1. 2) Line 140, p=0.0024; Line 141, p=0.0096. Both p-values differ from the p-values in table 1. 3) Lines 147 and 150, re-organize figures: put 1a) and 2a), 1b) and 2b) together. 4) Lines 149-150, “This was also true when the groups were stratified by academic rank (Figure 1b) or leadership position (Figure 2b)”, this interpretation seems to be wrong. Differences between men and women appears to be large, especially in figure 2b) stratified by leadership position. 5) Lines 173, “After adjusting for confounding variables”, explain the list of confounding variables. Tables Table 1: 1) Report one p-value from the chi-square test examining the relationship between academic rank and gender, or leadership position and gender. 2) Report statistical tests used to obtain p-values for median H-index and median career length in footnote. Table 2: 1) Report p-values comparing men and women on median dollar value for education and associated research. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Zubin J. Panthaki, MD, CM, FACS Reviewer #2: No Reviewer #3: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: Paper Review Comments WL.docx https://doi.org/10.1371/journal.pone.0235058.r001
Revision 1
23 May 2020 Author Response Dear Editor and Reviewers, Many thanks for your kind comments and feedback. We have edited the manuscript according to reviewer feedback and included an additional analysis of the cohort who did not receive any industry contributions. We have provided a detailed feedback to each query below. Many thanks, Yvonne Rasko ----------------------------- General comments: The study applied a quite strict inclusion and exclusion criteria therefore results in a very limited sample size, especially including only 38 females. It’s unclear how representative is this study sample (as % of academic faculties). The merits of inclusion and exclusion criteria is also questionable. Faculty with the rank of associate professor maybe included, if not those with the rank of assistant professor. Those who processed no payment data for 2018 may also be included as it enables the examination of research question: what are the characteristics of academics who received industry payments. Measurement of leadership position focuses only on departmental positions. This should be expanded to leadership position in professional societies as well as recipients of major rewards in plastic surgery. A: The authors would like to thank you for the review of our manuscript and insightful comments. There are 805 academic plastic surgeons in the US, therefore, our cohort represents 40% of the total population of academic plastic surgeons. Although 38 women is a small sample size, they constitute 12% of our study cohort which is similar to the percentage of female plastic surgeons in the US (16%). The small sample size results from the underrepresentation of women in this surgical specialty and emphasises the urgency and need for this work which highlights other gender disparities within the profession. We chose to focus our study on those in senior academic positions in plastic surgery. Earlier studies demonstrate gender disparities in industry payments and academic achievement in plastic surgery. Although the gendered differences in scholarly achievement narrow as one’s academic seniority increases, it is unknown whether the same gender parity exists in industry payments. The field of plastic surgery is relatively small with only four major US professional societies. The leaders of these societies are already included within the cohort as they are also departmental leaders. The database includes information on physicians who receive no payments from industry i.e. their names can still be found within the database. We have included those within our study and have included an additional section in the results to characterise their details. Those whose names cannot be located in the Open Payment Database are excluded because it is unknown whether they received any industry payments. --------------------- Abstracts 1) Add description of inclusion and exclusion criteria 2) In Results paragraph line 39, change to “for speakerships where women received smaller amounts compared to their male counterparts (median payments of $3,675 vs. $7,134 for women and men respectively, P<0.0001)”. 3) In Results paragraph line 40-42, “Multiple linear regression … (R=0.17, … and R=0.14, …)” - Explain what is the R value. A: Many thanks for your thoughtful feedback. We have included inclusion and exclusion criteria in the methods. The sentence in the results section has been altered as described. The explanation of the correlation coefficient, R, is included in the methods. --------------------- Introduction 1) Lines 69-71, consider changing to “This paper aims to 1) characterize academics who received industry sponsorship; 2) examine relationship between industry sponsorship and gender, academic rank, leadership position, career length, and academic productivity”. A: Many thanks for your comment. We have changed the sentence in the introduction. --------------------- Method 1) Line 86, consider to include faculty with the academic rank of professor or associate professor. 2) Line 110, consider faculty with the academic rank of professor or associate professor or a leadership position. 3) Lines 112-113, consider deleting “(iv) who possessed no payment data for 2018” from the exclusion criteria. A: Thank you for your thorough reviews and feedback. We have edited the sentence within the methods and further clarified our inclusion criteria. --------------------- Data analysis 1) Lines 124-125, explain the meaning of R statistic. A: Many thanks for your comment. The R statistic is Pearson’s correlation coefficient which is use to measure the relationship between variables in a linear regression analysis. We have added this explanation into the data analysis section. --------------------- Results 1) Line 133, 316 differs from the sum of 279 and 38 in table 1. 2) Line 140, p=0.0024; Line 141, p=0.0096. Both p-values differ from the p-values in table 1. 3) Lines 147 and 150, re-organize figures: put 1a) and 2a), 1b) and 2b) together. 4) Lines 149-150, “This was also true when the groups were stratified by academic rank (Figure 1b) or leadership position (Figure 2b)”, this interpretation seems to be wrong. Differences between men and women appears to be large, especially in figure 2b) stratified by leadership position. 5) Lines 173, “After adjusting for confounding variables”, explain the list of confounding variables. A: Many thanks for your thoughtful feedback on our manuscript. The sums in the table should be 278 and 38. This has been corrected. The p values in the text refer to the odds ratios, the p-values in the table refer to the chi-square test. We have added a footnote to the table to explain this. We have reorganised the figures as requested. We have rephrased the sentence within the methods so it now reads: “In contrast, the median dollar value of industry payments differed by academic rank and leadership position, with female associate professors and female subdivision heads receiving the highest total value payments (Figure 2a and 2b). However, no significance was found.” The variables included in the regression were gender, academic rank, possession of a departmental leadership position, career length, and H-index. We have clarified this within the text of the results. --------------------- Tables Table 1: 1) Report one p-value from the chi-square test examining the relationship between academic rank and gender, or leadership position and gender. 2) Report statistical tests used to obtain p-values for median H-index and median career length in footnote. Table 2: 1) Report p-values comparing men and women on median dollar value for education and associated research. A: Thank you for reviewing our manuscript and providing detailed feedback. We have reported the p-values from a chi-square test examining the relationship between academic rank and gender, and leadership position and gender in Table 1. We have also clarified the statistical test used in a footnote for Table 1. In Table 2 (now Table 3), the Mann Whitney U test is used to compare the median values amounts. The Mann Whitney U test can only be used if there are at least five samples within each group. Education and associated research have fewer than 5 values in one group which precludes statistical analysis. We have included this explanation within the data analysis section. --------------------- Attachments Attachment Submitted filename: prof and pay response (1).docx https://doi.org/10.1371/journal.pone.0235058.r002
9 Jun 2020 Decision Letter - Hans-Peter Simmen, Editor Follow the Money: Investigating Gender Disparity in Industry Payments Among Senior Academics and Leaders in Plastic Surgery PONE-D-19-30059R1 Dear Dr. Rasko, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Hans-Peter Simmen, M.D., Professor of Surgery Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0235058.r003
Formally Accepted
15 Dec 2020 Acceptance Letter - Hans-Peter Simmen, Editor PONE-D-19-30059R1 Follow the Money: Investigating Gender Disparity in Industry Payments Among Senior Academics and Leaders in Plastic Surgery Dear Dr. Rasko: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Hans-Peter Simmen Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0235058.r004

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