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Dargahi H, Kooshkebaghi M, Isazadeh N. Explaining the concepts and examples of conflict of interest and its management in the medical laboratory system of Iran: A scoping review. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:238. [PMID: 39297106 PMCID: PMC11410285 DOI: 10.4103/jehp.jehp_1672_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/27/2023] [Indexed: 09/21/2024]
Abstract
The occurrence of conflict of interest (CoI) is assumed to be a big challenge facing all healthcare sectors, including the medical laboratory system (MLS). Therefore, this study aimed to explain the concepts and examples of CoI and its management within this system. This scoping review was fulfilled in 2023 in Iran. To this end, the Persian and English keywords of this study were searched on the Persian and English databases based on the Medical Subject Headings (MeSH) and the Arksey and O'Malley methodological framework. All retrieved articles were then imported into EndNote X8, and their quality was evaluated via the Mixed Methods Appraisal Tool (MMAT). In total, 104 articles, of 6875 sources extracted, published from 2000 to 2023, were recruited following the identification and screening stages. Most articles had reported the maximum number of CoI examples in the MLS in diverse nations, including Iran, particularly in terms of structural, financial, objective, and subjective issues and primary and secondary interests among policymakers and higher-ranking managers of the healthcare system. Currently, CoI in healthcare systems, including the MLS, is unavoidable, but the best strategy, in preference to removing this situation, is to manage it under potential conditions before its occurrence and conversion into corruption. In view of that, it is recommended to provide effective training programs, increase transparency at work, facilitate compliance with professional guidelines, reform organizational structures and processes in the public sector, and establish policies best suited to manage CoI in the MLS of Iran.
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Affiliation(s)
- Hossein Dargahi
- Department of Health Management, Policy and Economics, School of Public Health, Health Information Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Kooshkebaghi
- Department of Health Management, Policy and Economics, School of Public Health, Health Information Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nikzad Isazadeh
- Department of Spritual Health, Quran, Hadis and Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Wiersma M, Kerridge IH, Lipworth W. Perspectives on non-financial conflicts of interest in health-related journals: A scoping review. Account Res 2024:1-37. [PMID: 38602335 DOI: 10.1080/08989621.2024.2337046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/26/2024] [Indexed: 04/12/2024]
Abstract
The objective of this scoping review was to systematically review the literature on how non-financial conflicts of interest (nfCOI) are defined and evaluated, and the strategies suggested for their management in health-related and biomedical journals. PubMed, Embase, Scopus and Web of Science were searched for peer reviewed studies published in English between 1970 and December 2023 that addressed at least one of the following: the definition, evaluation, or management of non-financial conflicts of interest. From 658 studies, 190 studies were included in the review. nfCOI were discussed most commonly in empirical (22%; 42/190), theoretical (15%; 29/190) and "other" studies (18%; 34/190) - including commentary, perspective, and opinion articles. nfCOI were addressed frequently in the research domain (36%; 68/190), publication domain (29%; 55/190) and clinical practice domain (17%; 32/190). Attitudes toward nfCOI and their management were divided into two distinct groups. The first larger group claimed that nfCOI were problematic and required some form of management, whereas the second group argued that nfCOI were not problematic, and therefore, did not require management. Despite ongoing debates about the nature, definition, and management of nfCOI, many articles included in this review agreed that serious consideration needs to be given to the prevalence, impact and optimal mitigation of non-financial COI.
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Affiliation(s)
- Miriam Wiersma
- Sydney Health Ethics, The University of Sydney, Sydney, Australia
| | - Ian H Kerridge
- Haematology Department, Royal North Shore Hospital, St Leonards, Australia
| | - Wendy Lipworth
- Philosophy Department, Ethics and Agency Research Centre, Macquarie University, Sydney, Australia
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Schäffer A, Groh KJ, Sigmund G, Azoulay D, Backhaus T, Bertram MG, Carney Almroth B, Cousins IT, Ford AT, Grimalt JO, Guida Y, Hansson MC, Jeong Y, Lohmann R, Michaels D, Mueller L, Muncke J, Öberg G, Orellana MA, Sanganyado E, Schäfer RB, Sheriff I, Sullivan RC, Suzuki N, Vandenberg LN, Venier M, Vlahos P, Wagner M, Wang F, Wang M, Soehl A, Ågerstrand M, Diamond ML, Scheringer M. Conflicts of Interest in the Assessment of Chemicals, Waste, and Pollution. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:19066-19077. [PMID: 37943968 DOI: 10.1021/acs.est.3c04213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Pollution by chemicals and waste impacts human and ecosystem health on regional, national, and global scales, resulting, together with climate change and biodiversity loss, in a triple planetary crisis. Consequently, in 2022, countries agreed to establish an intergovernmental science-policy panel (SPP) on chemicals, waste, and pollution prevention, complementary to the existing intergovernmental science-policy bodies on climate change and biodiversity. To ensure the SPP's success, it is imperative to protect it from conflicts of interest (COI). Here, we (i) define and review the implications of COI, and its relevance for the management of chemicals, waste, and pollution; (ii) summarize established tactics to manufacture doubt in favor of vested interests, i.e., to counter scientific evidence and/or to promote misleading narratives favorable to financial interests; and (iii) illustrate these with selected examples. This analysis leads to a review of arguments for and against chemical industry representation in the SPP's work. We further (iv) rebut an assertion voiced by some that the chemical industry should be directly involved in the panel's work because it possesses data on chemicals essential for the panel's activities. Finally, (v) we present steps that should be taken to prevent the detrimental impacts of COI in the work of the SPP. In particular, we propose to include an independent auditor's role in the SPP to ensure that participation and processes follow clear COI rules. Among others, the auditor should evaluate the content of the assessments produced to ensure unbiased representation of information that underpins the SPP's activities.
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Affiliation(s)
- Andreas Schäffer
- Institute for Environmental Research, RWTH Aachen University, 52074 Aachen, Germany
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, 210023 Nanjing, China
- Key Laboratory of the Three Gorges Reservoir Region's Eco-Environment, Chongqing University, 400045 Chongqing, China
| | - Ksenia J Groh
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, 8600 Dübendorf, Switzerland
| | - Gabriel Sigmund
- Environmental Technology, Wageningen University and Research, 6700 AA Wageningen, The Netherlands
| | - David Azoulay
- Center for International Environmental Law (CIEL), Washington, D.C. 20005, United States
| | - Thomas Backhaus
- Institute for Environmental Research, RWTH Aachen University, 52074 Aachen, Germany
- Department of Biological and Environmental Sciences, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Michael G Bertram
- Department of Wildlife, Fish, and Environmental Studies, Swedish University of Agricultural Sciences, Umeå 907 36, Sweden
- Department of Zoology, Stockholm University, Stockholm 114 18, Sweden
- School of Biological Sciences, Monash University, Melbourne 3800, Australia
| | - Bethanie Carney Almroth
- Department of Biological and Environmental Sciences, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Ian T Cousins
- Department of Environmental Science, Stockholm University, 10691 Stockholm, Sweden
| | - Alex T Ford
- Institute of Marine Sciences, University of Portsmouth, Portsmouth PO4 9LY, United Kingdom
| | - Joan O Grimalt
- Department of Environmental Chemistry, IDAEA-CSIC, 08034 Barcelona, Catalonia, Spain
| | - Yago Guida
- National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba 305-8506, Ibaraki, Japan
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, 21941-902 Rio de Janeiro, RJ, Brazil
| | - Maria C Hansson
- The Centre for Environmental and Climate Science (CEC), Lund University, 22362 Lund, Sweden
| | - Yunsun Jeong
- Division of Environmental Health, Korea Environment Institute (KEI), 30147 Sejong, Republic of Korea
| | - Rainer Lohmann
- Graduate School of Oceanography, University of Rhode Island, Narragansett, Rhode Island 02881, United States
| | - David Michaels
- Department of Environmental & Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, D.C. 20052, United States
| | - Leonie Mueller
- Institute for Environmental Research, RWTH Aachen University, 52074 Aachen, Germany
| | - Jane Muncke
- Food Packaging Forum Foundation, 8045 Zurich, Switzerland
| | - Gunilla Öberg
- University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Marcos A Orellana
- Global Toxics and Human Rights Project, American University Washington College of Law, Washington, D.C. 20016, United States
| | - Edmond Sanganyado
- Department of Applied Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, United Kingdom
| | - Ralf Bernhard Schäfer
- Institute for Environmental Sciences Landau, RPTU Kaiserslautern-Landau, 76829 Landau, Germany
| | - Ishmail Sheriff
- School of Civil Engineering, Universiti Sains Malaysia, 14300 Nibong Tebal, Penang, Malaysia
| | - Ryan C Sullivan
- Department of Chemistry and Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania 15217, United States
| | - Noriyuki Suzuki
- National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba 305-8506, Ibaraki, Japan
| | - Laura N Vandenberg
- Department of Environmental Health Sciences, School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts 01003, United States
| | - Marta Venier
- Indiana University, Bloomington, Indiana 47405, United States
| | - Penny Vlahos
- Marine Sciences, University of Connecticut, Groton, Connecticut 06340, United States
| | - Martin Wagner
- Department of Biology, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Fang Wang
- State Key Laboratory of Soil and Sustainable Agriculture, Institute of Soil Science, Chinese Academy of Sciences, Nanjing 210008, China
| | - Mengjiao Wang
- Greenpeace Research Laboratories, Department of Biosciences, University of Exeter, Exeter EX4 4RN, United Kingdom
| | - Anna Soehl
- International Panel on Chemical Pollution, 8044 Zürich, Switzerland
| | - Marlene Ågerstrand
- Department of Environmental Science, Stockholm University, 10691 Stockholm, Sweden
| | - Miriam L Diamond
- Department of Earth Sciences and School of the Environment, University of Toronto, Toronto M5S 3B1, Canada
| | - Martin Scheringer
- Institute of Biogeochemistry and Pollutant Dynamics, ETH Zürich, 8092 Zürich, Switzerland
- RECETOX, Masaryk University, 625 00 Brno, Czech Republic
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Nunn JS, Shafee T, Chang S, Stephens R, Elliott J, Oliver S, John D, Smith M, Orr N, Preston J, Borthwick J, van Vlijmen T, Ansell J, Houyez F, de Sousa MSA, Plotz RD, Oliver JL, Golumbic Y, Macniven R, Wines S, Borda A, da Silva Hyldmo H, Hsing PY, Denis L, Thompson C. Standardised data on initiatives-STARDIT: Beta version. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:31. [PMID: 35854364 PMCID: PMC9294764 DOI: 10.1186/s40900-022-00363-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE There is currently no standardised way to share information across disciplines about initiatives, including fields such as health, environment, basic science, manufacturing, media and international development. All problems, including complex global problems such as air pollution and pandemics require reliable data sharing between disciplines in order to respond effectively. Current reporting methods also lack information about the ways in which different people and organisations are involved in initiatives, making it difficult to collate and appraise data about the most effective ways to involve different people. The objective of STARDIT (Standardised Data on Initiatives) is to address current limitations and inconsistencies in sharing data about initiatives. The STARDIT system features standardised data reporting about initiatives, including who has been involved, what tasks they did, and any impacts observed. STARDIT was created to help everyone in the world find and understand information about collective human actions, which are referred to as 'initiatives'. STARDIT enables multiple categories of data to be reported in a standardised way across disciplines, facilitating appraisal of initiatives and aiding synthesis of evidence for the most effective ways for people to be involved in initiatives. This article outlines progress to date on STARDIT; current usage; information about submitting reports; planned next steps and how anyone can become involved. METHOD STARDIT development is guided by participatory action research paradigms, and has been co-created with people from multiple disciplines and countries. Co-authors include cancer patients, people affected by rare diseases, health researchers, environmental researchers, economists, librarians and academic publishers. The co-authors also worked with Indigenous peoples from multiple countries and in partnership with an organisation working with Indigenous Australians. RESULTS AND DISCUSSION Over 100 people from multiple disciplines and countries have been involved in co-designing STARDIT since 2019. STARDIT is the first open access web-based data-sharing system which standardises the way that information about initiatives is reported across diverse fields and disciplines, including information about which tasks were done by which stakeholders. STARDIT is designed to work with existing data standards. STARDIT data will be released into the public domain (CC0) and integrated into Wikidata; it works across multiple languages and is both human and machine readable. Reports can be updated throughout the lifetime of an initiative, from planning to evaluation, allowing anyone to be involved in reporting impacts and outcomes. STARDIT is the first system that enables sharing of standardised data about initiatives across disciplines. A working Beta version was publicly released in February 2021 (ScienceforAll.World/STARDIT). Subsequently, STARDIT reports have been created for peer-reviewed research in multiple journals and multiple research projects, demonstrating the usability. In addition, organisations including Cochrane and Australian Genomics have created prospective reports outlining planned initiatives. CONCLUSIONS STARDIT can help create high-quality standardised information on initiatives trying to solve complex multidisciplinary global problems.
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Affiliation(s)
- Jack S Nunn
- Director of Science for All (Education Charity Registered in Australia), Melbourne, Australia.
- School of Public Health, La Trobe University, Melbourne, VIC, Australia.
| | - Thomas Shafee
- School of Life Sciences, La Trobe University, Melbourne, VIC, Australia
| | | | - Richard Stephens
- Patient Advocate, Co-Editor-in-Chief, 'Research Involvement and Engagement', London, UK
| | - Jim Elliott
- Public Involvement Lead at Health Research Authority (England), London, UK
| | - Sandy Oliver
- Professor of Public Policy at UCL Social Research Institute, London, UK
- University of Johannesburg, Johannesburg, South Africa
| | - Denny John
- Adjunct Professor, Ramaiah University of Applied Sciences, Bengaluru, India
- Chair, Campbell and Cochrane Economic Methods Group, London, UK
| | | | - Neil Orr
- Department of Linguistics, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
- Poche Centre Indigenous Health, The University of Sydney, Sydney, Australia
| | - Jennifer Preston
- National Institute for Health and Care Research, Alder Hey Clinical Research Facility, Liverpool, UK
| | | | | | - James Ansell
- Consumers Health Forum of Australia, Deakin, Australia
| | | | - Maria Sharmila Alina de Sousa
- Independent Impact Intelligence Design & Strategy Consultant, Research Impact Academy Brazil Ambassador, Sao Paulo, Brazil
| | - Roan D Plotz
- Applied Ecology and Environmental Change Research Group, Institute for Sustainable Industries and Liveable Cities, Victoria University, Melbourne, Australia
| | | | | | - Rona Macniven
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Sydney, 2052, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, 2109, Australia
| | | | - Ann Borda
- University of Melbourne, Melbourne, Australia
- University College London, London, UK
| | - Håkon da Silva Hyldmo
- Department of Geography, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pen-Yuan Hsing
- University of Bath, Bath, UK
- MammalWeb Project, London, UK
| | - Lena Denis
- Johns Hopkins University, Baltimore, USA
| | - Carolyn Thompson
- University College London, London, UK
- Institute of Zoology, Zoological Society of London, London, UK
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Borow M, Levi B, Avissar B, Wapner L. The Physician on a Board of Directors: Bane or Benefit? J Healthc Leadersh 2022; 14:17-23. [PMID: 35241943 PMCID: PMC8886151 DOI: 10.2147/jhl.s344510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/08/2022] [Indexed: 11/23/2022] Open
Abstract
With the accelerated development of innovative domains such as artificial intelligence, big data, and personalized healthcare, the continuing growth of health-tech and bio-tech industries is to be expected. Concurrently, the question of the extent and nature of physicians’ involvement in these rapidly evolving industries arises, especially in management and leadership capacities such as directors or chief executive officers of such companies. Against this backdrop, the Israeli Medical Association recently launched a first-of-its-kind course designed to train senior physicians as directors in health-tech companies by providing them with vast relevant financial, legislative, and professional proficiencies. Due to their medical knowledge and clinical experience, physicians bring a substantial added value to these industries. However, considering the inherent tensions and potential conflicts between adhering to the logic of a profit-making, competitive market on one hand and maintaining the doctor’s oath on the other, it is inevitable that dilemmas and difficulties will emerge. Much has been written about the roles and responsibilities of boards of directors, but to date, little has focused on the unique position of physicians who serve in these roles. This article aims to examine the ways in which conflicts or dualities of interest manifest themselves for physicians who assume roles as directors and whether effective remedial strategies are available, based on the authors’ own experience in the initiation of the IMA physician-directors course.
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Affiliation(s)
- Malke Borow
- Israeli Medical Association, Ramat Gan, Israel
| | - Baruch Levi
- Israeli Medical Association, Ramat Gan, Israel
- Department of Health Policy and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Correspondence: Baruch Levi, Division of Law and Public Policy, Israeli Medical Association, 35 Jabotinsky St., Ramat Gan, Israel, Tel +972-54-6330935, Email
| | | | - Leah Wapner
- Israeli Medical Association, Ramat Gan, Israel
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Jia Q, Lei Y, Guo Y, Li X. Leveraging enterprise social network technology: understanding the roles of compatibility and intrinsic motivation. JOURNAL OF ENTERPRISE INFORMATION MANAGEMENT 2021. [DOI: 10.1108/jeim-05-2021-0225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This study explores the factors influencing the value of enterprise social media (ESM) from the perspective of compatibility. Establishing a theoretical model based on compatibility theory, the authors examine the effects of two dimensions of compatibility and the mediating effects of employees' intrinsic motivations. ESM is an important tool that helps companies to enhance knowledge sharing and cross-department collaboration. Thus, it is important to understand factors that can facilitate the role of ESM in improving enterprise operating performance.
Design/methodology/approach
The authors conducted a survey among 353 users of a leading ESM platform and empirically investigated how compatibility influences ESM value through employees' intrinsic motivations. Structural equation modeling (SEM) was applied to study the relationship among compatibility, employees' intrinsic motivations and ESM value.
Findings
The empirical research results indicate that compatibility of self-interest with group interest influences the value of ESM, and intrinsic motivations toward collaboration and toward knowledge management partially mediate the effects of the two dimensions of compatibility on ESM value.
Research limitations/implications
First, the empirical analysis relies on data from surveying employees of Chinese companies. Therefore, one direction for future research is to reexamine the model using data from other countries. Second, the effects of compatibility identified in the study may vary among different ESM platforms. In addition, the findings may change for organizations having different sizes.
Practical implications
This finding suggests that managers should pay close attention to potential conflicts of interest when implementing ESM to enhance group communication and collaboration. This study also highlights the importance of compatibility of new working processes with experience in practice. In addition, intrinsic motivations towards both cooperation and knowledge management in ESM are important factors influencing the value creation of ESM. Therefore, to cultivate employees' intrinsic motivation, managers and organizations need to facilitate the formation of a collaborative atmosphere and habits of cooperative adoption.
Originality/value
Although previous studies show that compatibility is a strong belief salient to technology acceptance and continuance usage behavior, the operational definition of compatibility developed by prior studies has generally been limited to the technology perspective and the individual level. However, the primary benefit of ESM is enabling online team collaboration and knowledge sharing across various departments. Thus, the level of compatibility between employees' self-interests and group interests may influence their intrinsic motivations toward ESM usage. From this perspective of individual–group interest conflicts, the authors propose a conceptual research model based on the theory of compatibility in innovation diffusion.
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Hardy JR, Philip J. Interests and conflicts when writing, reviewing and editing papers on voluntary assisted dying. Intern Med J 2021; 51:1563-1566. [PMID: 34664375 DOI: 10.1111/imj.15522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Janet R Hardy
- Mater Health, South East Queensland, Mater Research - University of Queensland, Brisbane, Queensland, Australia
| | - Jennifer Philip
- Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Ethical considerations and statistical analysis of industry involvement in machine learning research. AI & SOCIETY 2021. [DOI: 10.1007/s00146-021-01284-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractIndustry involvement in the machine learning (ML) community seems to be increasing. However, the quantitative scale and ethical implications of this influence are rather unknown. For this purpose, we have not only carried out an informed ethical analysis of the field, but have inspected all papers of the main ML conferences NeurIPS, CVPR, and ICML of the last 5 years—almost 11,000 papers in total. Our statistical approach focuses on conflicts of interest, innovation, and gender equality. We have obtained four main findings. (1) Academic–corporate collaborations are growing in numbers. At the same time, we found that conflicts of interest are rarely disclosed. (2) Industry papers amply mention terms that relate to particular trending machine learning topics earlier than academia does. (3) Industry papers are not lagging behind academic papers with regard to how often they mention keywords that are proxies for social impact considerations. (4) Finally, we demonstrate that industry papers fall short of their academic counterparts with respect to the ratio of gender diversity. We believe that this work is a starting point for an informed debate within and outside of the ML community.
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Zicari RV, Brusseau J, Blomberg SN, Christensen HC, Coffee M, Ganapini MB, Gerke S, Gilbert TK, Hickman E, Hildt E, Holm S, Kühne U, Madai VI, Osika W, Spezzatti A, Schnebel E, Tithi JJ, Vetter D, Westerlund M, Wurth R, Amann J, Antun V, Beretta V, Bruneault F, Campano E, Düdder B, Gallucci A, Goffi E, Haase CB, Hagendorff T, Kringen P, Möslein F, Ottenheimer D, Ozols M, Palazzani L, Petrin M, Tafur K, Tørresen J, Volland H, Kararigas G. On Assessing Trustworthy AI in Healthcare. Machine Learning as a Supportive Tool to Recognize Cardiac Arrest in Emergency Calls. FRONTIERS IN HUMAN DYNAMICS 2021. [DOI: 10.3389/fhumd.2021.673104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Artificial Intelligence (AI) has the potential to greatly improve the delivery of healthcare and other services that advance population health and wellbeing. However, the use of AI in healthcare also brings potential risks that may cause unintended harm. To guide future developments in AI, the High-Level Expert Group on AI set up by the European Commission (EC), recently published ethics guidelines for what it terms “trustworthy” AI. These guidelines are aimed at a variety of stakeholders, especially guiding practitioners toward more ethical and more robust applications of AI. In line with efforts of the EC, AI ethics scholarship focuses increasingly on converting abstract principles into actionable recommendations. However, the interpretation, relevance, and implementation of trustworthy AI depend on the domain and the context in which the AI system is used. The main contribution of this paper is to demonstrate how to use the general AI HLEG trustworthy AI guidelines in practice in the healthcare domain. To this end, we present a best practice of assessing the use of machine learning as a supportive tool to recognize cardiac arrest in emergency calls. The AI system under assessment is currently in use in the city of Copenhagen in Denmark. The assessment is accomplished by an independent team composed of philosophers, policy makers, social scientists, technical, legal, and medical experts. By leveraging an interdisciplinary team, we aim to expose the complex trade-offs and the necessity for such thorough human review when tackling socio-technical applications of AI in healthcare. For the assessment, we use a process to assess trustworthy AI, called 1Z-Inspection® to identify specific challenges and potential ethical trade-offs when we consider AI in practice.
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Abstract
BACKGROUND There is a lack of a comprehensive evaluation for pediatric clinical practice guidelines (CPGs) published in recent years. Here, we assessed the quality of pediatric CPGs, considering factors that might affect their quality. The aim of the study is to promote a more coherent development and application of CPGs. METHODS Pediatric CPGs published in PubMed, MedLive, Guidelines International Network, National Institute for Health and Care Excellence, and World Health Organization between 2017 and 2019 were searched and collected. Paired researchers conducted screening, data extraction, and quality assessment using the Appraisal of Guidelines for Research and Evaluation II (AGREE II). Linear regression analysis determined the factors affecting CPGs' quality. RESULTS The study included a total of 216 CPGs, which achieved a mean score of 4.26 out of 7 points (60.86%) in the AGREE II assessment. Only 6.48% of the CPGs reached the "recommend" level. The remaining 69.91% should have been modified before recommendation, while the other 23.61% did not reach the recommended level at all. The overall quality of recent pediatric CPGs was higher than previously, and the proportion of CPGs with low-quality decreased over time. However, there were still too few CPGs that reached a high-quality level. The "applicability" and "rigor of development" domains had generally low scores. CPGs formulated by developing countries or regions, those that are not under an organizations or groups responsibility, and those that used non-evidence-based methods were found to be associated with poorer quality in different domains as independent or combinational factors. CONCLUSIONS The quality of pediatric CPGs still needs to be improved. Specifically, a quality control before applying new CPGs should be essential to ensure their quality and applicability.
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Lipworth W. Beyond Duty: Medical "Heroes" and the COVID-19 Pandemic. JOURNAL OF BIOETHICAL INQUIRY 2020; 17:723-730. [PMID: 33169270 PMCID: PMC7651815 DOI: 10.1007/s11673-020-10065-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
When infectious disease outbreaks strike, health facilities acquire labels such as "war zones" and "battlefields" and healthcare professionals become "heroes" on the "front line." But unlike soldiers, healthcare professionals often take on these dangerous roles without any prior intention or explicit expectation that their work will place them in grave personal danger. This inevitably raises questions about their role-related obligations and whether they should be free to choose not to endanger themselves. In this article, I argue that it is helpful to view this situation not only through the lens of "professional duty" but also through the lens of "role-related conflicts." Doing so has the advantage of avoiding exceptionalism and allowing us to draw lessons not only from previous epidemics but also from a wide range of far more common role-related dilemmas in healthcare.
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Affiliation(s)
- Wendy Lipworth
- Sydney Health Ethics, University of Sydney, Medical Foundation Building (K25), Sydney, NSW, 2006, Australia.
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12
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Conflicts of interest in the context of end of life care for potential organ donors in Australia. J Crit Care 2020; 59:166-171. [DOI: 10.1016/j.jcrc.2020.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/01/2020] [Accepted: 06/22/2020] [Indexed: 12/17/2022]
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Wiersma M, Lipworth W, Komesaroff P, Kerridge I. Symposium Lead Essay-Conflict of Interest: Opening Up New Territories. JOURNAL OF BIOETHICAL INQUIRY 2020; 17:169-172. [PMID: 32542419 DOI: 10.1007/s11673-020-09987-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Miriam Wiersma
- The University of Sydney, Sydney Health Ethics, Level 1, Medical Foundation Building, K25, Sydney, NSW, 2006, Australia.
| | - Wendy Lipworth
- The University of Sydney, Sydney Health Ethics, Level 1, Medical Foundation Building, K25, Sydney, NSW, 2006, Australia
| | - Paul Komesaroff
- Centre for Ethics in Medicine and Society, Alfred Hospital, Monash University, Commercial Road, Prahran, Victoria, Australia
| | - Ian Kerridge
- The University of Sydney, Sydney Health Ethics, Level 1, Medical Foundation Building, K25, Sydney, NSW, 2006, Australia
- Haematology Department, Royal North Shore Hospital, Reserve Rd, St Leonards, NSW, 2065, Australia
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Mayes C. After Conflicts of Interest: From Procedural Short-Cut to Ethico-Political Debate. JOURNAL OF BIOETHICAL INQUIRY 2020; 17:245-255. [PMID: 32162157 DOI: 10.1007/s11673-020-09971-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 02/26/2020] [Indexed: 06/10/2023]
Abstract
This paper critically examines the proliferation of conflicts of interest (COI) discourse and how the most common conceptions of COI presuppose a hierarchy of primary and secondary interests. I show that a form of professional virtue or duty is commonly employed to give the primary interest normative force. However, I argue that in the context of increasingly commercialized healthcare neither virtue nor duty can do the normative work expected of them. Furthermore, I suggest that COI discourse is symptom of rather than solution to the problems of market forces in contemporary medicine. I contend that COI, as it is commonly conceived, is an inadequate concept through which to attend to these problems. It is used as a procedural short-cut to address ethico-political problems. That is, it is an economic and policy concept expected to do significant moral and political work. Like most short-cuts, this one also leads to entanglements and winding roads that fail to reach the destination. As such, I suggest that we need a different set of ethico-political tools to address normative fluidity of medical practice in the absence on a primary interest.
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Affiliation(s)
- Christopher Mayes
- Research Fellow (DECRA) Alfred Deakin Institute, Faculty of Arts and Education Waurn Ponds Campus, Locked Bag 20000, Geelong, VIC, 3220, Australia.
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