====== Trust ======

The state of being responsible for someone or something.

Developmental [[incentive]]s are fundamental to surgical [[progress]], yet financial and professional incentives inherently create [[conflicts of interest]] (COI). Understanding how to manage COI held by [[neurosurgeon]]s, [[industry]], [[hospital]]s, and journal [[editor]]s, without thwarting [[progress]] and [[innovation]] is critical.

A [[review]] of the [[literature]] was performed to assess [[conflicts of interest]] that affect neurosurgical [[innovation]], and [[review]] ways to manage COI of various parties while adhering to  [[ethical standards]].

COI are inherent to [[collaboration]] and [[innovation]], and are therefore an [[unavoidable]] component of neurosurgery. The lack of a clear distinction between clinical [[practice]] and [[innovation]], ability to use [[device]]s off-label, and unstandardized [[disclosure]] requirements create inconsistencies in the way that conflicts of interest are handled. Additionally, lack of requirements to compare innovation to the [[standard of care]] and inherent [[bias]] that affects [[study design]] and [[interpretation]] can have profound effects on the medical [[literature]]. Conflicts of interest can have both direct and downstream effects on neurosurgical practice, and it is possible to manage them while improving the [[quality]] of [[research]] and [[innovation]].

Conflicts of interest are inherent to surgical [[innovation]], and can be handled in an ethically sound manner. [[Neurosurgeon]]s, device [[companies]], [[hospital]]s, and medical [[journal]]s can take steps to proactively confront [[bias]] and ensure [[patient autonomy]] and [[safety]]. These steps can preserve public [[trust]] and ultimately improve [[evidence]]-based neurosurgical practice
((DiRisio AC, Muskens IS, Cote DJ, Babu M, Gormley WB, Smith TR, Moojen WA,
Broekman ML. Oversight and Ethical Regulation of Conflicts of Interest in
Neurosurgery in the United States. Neurosurgery. 2019 Feb 1;84(2):305-312. doi:
10.1093/neuros/nyy227. PubMed PMID: 29850841.
)).