Letters to the Editor: Balancing the Scales while "Making a Difference"

Dear Editor,

   Regarding "Small Details Make A Difference: Tail Closures" (Ostomy/Wound Management. 2004;50[1]:12), the article criticized Velcro® because it catches on clothing, tends to become soiled, and is difficult to clean. In our worldwide experience with EasiClose (Coloplast Corporation, Marietta, Ga.), this has not been the case. Since 2000 when our company launched the original clampless pouch, thousands of users have reported extremely positive experiences. Moreover, we have clinical data showing more than 80% of users preferred our product's type of outlet to traditional drainable pouch closures.* If Velcro were as problematic as the author suggests, this would not be the case.

   Even more important than the materials used to close the outlet is the overall design of an integrated outlet, which was not addressed in the article. Whether Velcro or some other "interlocking material" is used, construction is a priority. Leakage and odor are two primary concerns for people with ostomies - constructing an outlet that ensures resistance to both is vitally important. A lower flap that can be folded over the bottom (to completely close the outlet and prevent soiled areas of the outlet from coming in contact with the outside environment) is the only way to ensure the pouch is completely hygienic. Our product's outlet is the only integrated closure constructed in that manner.

   Lastly, in previous issues of O/WM, "The Ostomy Files" included the disclosure that this section is supported by a grant from ConvaTec. This disclosure wasn't printed in the January 2004 issue. While we fully trust the author to be objective (and applaud her for her insights in "The Ostomy Files" and her service to people with ostomies over many years), we feel this "undisclosed" commercial support could ultimately make readers question the objectivity of this column.

   * Data on file.
Brad Selman, Director of Marketing; Ostomy and Continence Care, Coloplast Corp.

Reply

   I completely agree with Mr. Selman regarding the importance of having "open, objective, non-commercial and evidence-based discussions." I also agree with him about the importance of including a disclosure statement on any grant-funded columns appearing in a journal. Its omission in the January 2004 issue was simply a space-related oversight, as the publishers and editors of O/WM constantly strive to maintain the highest level of integrity and professionalism in this journal. Moreover, under an unrestricted grant, I am given free reign by the sponsor of "The Ostomy Files" to write about any ostomy-related topic I deem appropriate for clinicians who provide ostomy care, whether or not ostomy products are discussed.

   Mr. Selman's letter brings to light a long-standing problem. Due to the paucity of published research on ostomy care and rehabilitation, conducting evidence-based discussions on ostomy care, quality of life issues, or ostomy products (regardless of the manufacturer) is exceedingly difficult. Because I have written and lectured about ostomy care for more than 20 years, I know that 1) published research on ostomy is scant in the literature, and 2) editors of ostomy-related journals are constantly clamoring for additional ostomy submissions. Had the study mentioned by Mr. Selman been published in a peer-reviewed journal, not only would it have been welcomed by the editors and audience of an ostomy-related publication, but also I would have been able to include it as part of an evidence-based discussion on tail closures.

   I share Mr. Selman's desire to improve the quality of life for persons with an ostomy and to educate the professionals who care for them. I encourage him and others to submit their clinical data for publication so the quantity and caliber of ostomy-related evidence-based literature available can be improved.

   Gwen Turnbull, RN, BS