To the Editor Sullivan and colleagues 1 showed that male physicians received far larger medical industry compensations than female physicians possibly due to the so-called glass ceiling effect. We have 3 comments.First, we are interested in how the COVID-19 pandemic affected the male-female disparity of industry compensations. Sullivan and colleagues 1 analyzed data from the Open Payments Database only through 2019, but it is already possible to obtain data through 2021 as we did. 2 Notably, during the pandemic, academic performance has been more devastating among women than men, and to analyze whether similar disproportionate impacts exist in the medical industry compensations is of interest after 2020.Second, it would be meaningful to reveal the breakdown of the industry compensations in this study. While a malefemale disparity of the compensation was increasingly exacerbated as the position got higher and as the year progressed, the factors that affected such a difference were not well investigated. A detailed breakdown of industry compensations may shed some light on this matter. For example, it has been pointed out that consulting, traveling, and lodging may be received more by those with higher positions. 3 Furthermore, speaking engagements have been noted to be related to promotion and have been shown to be lower among female physicians. 4 Third, it is unfortunate that there was a lack of discussion regarding a negative impact of financial relationships with pharmaceutical companies on practice and research. Not only Sullivan and colleagues 1 but also the accompanying Invited Commentary discussed that a disproportionately low acceptance of the compensations among women should be justified. However, industry compensations are the primary source of financial conflict of interest in medical society, and the fact that female physicians received fewer compensations should not always be considered negative. Namely, it is possible that
To the Editor Wan and colleagues 1 found that there was little to no differences in the long-term outcomes between minimal access breast surgery (MABS) and conventional breast surgery in their institution. We have 3 questions about this research.First, we are interested about the infrastructure and chronological changes in the authors' institution. Given that the study period ranged 13 years, the type of equipment they used and their changes may have influenced the study results over time. Furthermore, we would also like to ask if they may have encountered any hardships due to the use of certain novel equipment. 2 In recent years, the field of robotic-assisted surgery has been vastly changing, and the same results may not be reproduced in other institutions without the same or more updated technology. 3 Second, we are interested in whether the surgeons' experience may have affected the outcomes of the surgery. MABS is not a common surgery in many places of the world. Thus, both in laparoscopic surgeries and in robot-assisted surgery, the experience of the surgeon is considered to be extremely important. 4 Since the experience of the surgeon can be an influential factor for the outcomes, it would be useful to take into account the factor of each operator according to their years of practice and number of MABS completed.The third is about the cost of the surgery, which can be one of the biggest drawback of MABS. Several recent studies indicated that the cost for surgery is significantly different between conventional and robot-assisted surgery. 5 Furthermore, it is plausible that patients who could receive the more expensive surgery are financially privileged and have more resources, resulting in a selection bias between these operations.
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