Spine Studies Fuel Millions in Revenue, and Controversy

In a response letter to the publication, Zdeblick wrote that The Spine Journal's criticisms were "Inappropriate and irresponsible."

 "Although interesting, a single publication in the medical literature does not constitute a 'truth," Zdeblick wrote.

Referring to Carragee's overseas stint in the military, he described his "18-month" hiatus as impacting his style as a surgeon. "I am concerned not only with the validity of the conclusions drawn but also with the tone of the commentary chosen to accompany the article," Zdeblick added.

Carragee and his colleagues responded to Zdeblick in a letter, writing that the physician made "unwarranted personal and professional attacks."

''The old saying is 'follow the money' and in this case, there is plenty to follow," Carragee and his co-authors wrote. Carragee wrote that Zdeblick had a "$23 million financial relationship" with Medtronic that has been the "subject of a publicly documented investigation by Sen. Charles Grassley (R-IA)." Zdeblick also receives "millions of royalty dollars" from a tapered fusion device product sold separate from the Infuse Bone Graft, but must be used together with the product, they wrote.

 "If a guy has done good work and discovered great things and gets royalties for it, he should get paid for whatever the market bears," Carragee says. "The question is: should he be writing the basic seminal paper on it as well. Or maybe he should be writing a white paper for the company."

"I think we have to separate advertising copy from scientific articles," he adds. "If you want to write advertising copy, plenty of people will have a section for it."

Carragee criticized the lack of proper procedures in documenting disclosures and other areas that could reveal potential conflicts of interest. The Spine Journal also is changing its disclosure requirements for its top staff, he says.

The journal has taken steps to restructure its editorial process ensuring divestiture and disclosure of potential conflicts.

"If we want people to be transparent, we ought to be transparent," he says.