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Ozieranski P, Mulinari S. Broken beyond repair: self regulation of industry payments to clinicians and hospitals. BMJ 2024; 386:q1559. [PMID: 38997125 DOI: 10.1136/bmj.q1559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Affiliation(s)
- Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Bath, UK
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2
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Murayama A, Higuchi K, Senoo Y. Financial Relationships Between Pharmaceutical Companies and Internal Medicine Societies. JAMA Netw Open 2024; 7:e244777. [PMID: 38568694 PMCID: PMC10993069 DOI: 10.1001/jamanetworkopen.2024.4777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/02/2024] [Indexed: 04/05/2024] Open
Abstract
This cross-sectional study uses payment data publicly disclosed by pharmaceutical companies affiliated with the Japan Pharmaceutical Manufacturers Association to describe their financial relationships with the subspecialty societies of the Japanese Society of Internal Medicine.
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Affiliation(s)
- Anju Murayama
- Tohoku University School of Medicine, Sendai, Miyagi, Japan
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Yuki Senoo
- Higashi Totsuka Memorial Hospital, Yokohama, Kanagawa, Japan
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3
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Copp T, Pickles K, Smith J, Hersch J, Johansson M, Doust J, McKinn S, Sharma S, Hardiman L, Nickel B. Marketing empowerment: how corporations co-opt feminist narratives to promote non-evidence based health interventions. BMJ 2024; 384:e076710. [PMID: 38355160 DOI: 10.1136/bmj-2023-076710] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- Tessa Copp
- Sydney Health Literacy Lab, Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Wiser Healthcare, Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Kristen Pickles
- Sydney Health Literacy Lab, Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Wiser Healthcare, Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Jenna Smith
- Sydney Health Literacy Lab, Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Wiser Healthcare, Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Jolyn Hersch
- Sydney Health Literacy Lab, Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Wiser Healthcare, Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Minna Johansson
- Global Center for Sustainable Healthcare, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jenny Doust
- Australian Women and Girls' Health Research Centre, School of Public Health, University of Queensland, Brisbane, Australia
| | - Shannon McKinn
- Sydney Health Literacy Lab, Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Sweekriti Sharma
- Sydney Health Literacy Lab, Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Wiser Healthcare, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia
| | | | - Brooke Nickel
- Sydney Health Literacy Lab, Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia
- Wiser Healthcare, Sydney School of Public Health, University of Sydney, Sydney, Australia
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Murayama A. Industry-sponsored meal payments are associated with prescriptions and Medicare expenditures on brand-name colchicine in the United States. Int J Rheum Dis 2024; 27:e14962. [PMID: 37923570 DOI: 10.1111/1756-185x.14962] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/11/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
AIM To investigate the association between industry-sponsored meal payments and the prescribing patterns of brand-name colchicines, namely Colcrys and Mitigare, among Medicare beneficiaries in the United States from 2014 to 2021. METHODS This cross-sectional study utilized data from the Open Payments Database and Medicare Part D covering the years 2014 to 2021. The study included 54 836 physicians who submitted more than 10 colchicine claims. Exposure was defined as the receipt of one or more industry-sponsored meals from the manufacturers of Colcrys or Mitigare. The primary outcomes included the likelihood of prescribing Colcrys and Mitigare, as well as the associated number of claims and Medicare expenditures. RESULTS Among 54 836 eligible physicians, 44.9% received meal payments from the Colcrys manufacturer, and 8.0% from the Mitigare manufacturer, over the eight-year study period. The average meal payment value was $14.9 for Colcrys and $15.1 for Mitigare. The receipt of meal payments was significantly associated with an increased likelihood of prescribing Colcrys (odds ratio: 1.24 [95% CI: 1.21-1.27], p < .001) and Mitigare (odds ratio: 3.54 [95% CI: 2.98-4.20], p < .001). Each additional meal payment corresponded with a significant increase in Medicare expenditures: $55.4 (95% CI: $48.3-$62.5, p < .001) for Colcrys and $153.7 (95% CI: $17.7-$289.6, p = .03) for Mitigare. These associations remained consistent across different specialties and genders. CONCLUSION This study reveals that receipt of meal payments from manufacturers of brand-name colchicine was significantly associated with an increased rate of prescriptions for these brand-name drugs, leading to higher Medicare expenditures in the United States.
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Affiliation(s)
- Anju Murayama
- School of Medicine, Tohoku University, Sendai City, Japan
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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5
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Mulinari S, Ozieranski P. Unethical pharmaceutical marketing: a common problem requiring collective responsibility. BMJ 2023; 382:e076173. [PMID: 37726130 DOI: 10.1136/bmj-2023-076173] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Affiliation(s)
- Shai Mulinari
- Department of Sociology, Faculty of Social Sciences, Lund University, Lund, Sweden
| | - Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Bath, UK
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6
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Van de Vliet P, Sprenger T, Kampers LFC, Makalowski J, Schirrmacher V, Stücker W, Van Gool SW. The Application of Evidence-Based Medicine in Individualized Medicine. Biomedicines 2023; 11:1793. [PMID: 37509433 PMCID: PMC10376974 DOI: 10.3390/biomedicines11071793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
The fundamental aim of healthcare is to improve overall health of the population by providing state-of-the-art healthcare for individuals at an affordable cost. The foundation for this system is largely referred to as "evidence-based medicine". Too often, evidence-based medicine is based solely on so-called "best research evidence", collected through randomized controlled trials while disregarding clinical expertise and patient expectations. As healthcare gravitates towards personalized and individualized medicine, such external clinical (research) evidence can inform, but never replace, individual clinical expertise. This applies in particular to orphan diseases, for which clinical trials are methodologically particularly problematic, and evidence derived from them is often questionable. Evidence-based medicine constitutes a complex process to allow doctors and patients to select the best possible solutions for each individual based on rapidly developing new therapeutic directions. This requires a revisit of the foundations of evidence-based medicine. A proposition as to how to manage evidence-based data in individualized immune-oncology is presented here.
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Affiliation(s)
| | - Tobias Sprenger
- Immune-Oncological Centre Cologne (IOZK), D-50674 Cologne, Germany
| | | | | | | | - Wilfried Stücker
- Immune-Oncological Centre Cologne (IOZK), D-50674 Cologne, Germany
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7
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Murayama A, Kamamoto S, Saito H, Ozaki A. Pharmaceutical payments to Japanese board-certified dermatologists: a 4-year retrospective analysis of personal payments from pharmaceutical companies between 2016 and 2019. Sci Rep 2023; 13:7425. [PMID: 37156855 PMCID: PMC10167352 DOI: 10.1038/s41598-023-34705-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 05/05/2023] [Indexed: 05/10/2023] Open
Abstract
There are prevalent financial relationships between dermatologists and pharmaceutical companies in Japan. However, little was known about the extent of whole picture of the personal payments made to dermatologists by pharmaceutical companies. This study aimed to examine the personal payments to the board-certified dermatologists by the Japanese Dermatological Association from the pharmaceutical companies between 2016 and 2019. Using the publicly disclosed payments data by the pharmaceutical companies between 2016 and 2019, we evaluated the magnitude, prevalence, and trends in the personal payments made to all board-certified dermatologists for the lecturing, writing, and consulting compensations. The payments were descriptively analyzed overall and by dermatologist demographics. Additionally, the payment trends were assessed by generalized estimating equation models. Of 6883 active board-certified dermatologists, 3121 (45.3%) received a total of $33,223,806 personal payments between 2016 and 2019. The median per-physician payments and number of payments (interquartile range) were $1737 ($613-$5287) and 4.0 (2.0-10.0) over the 4 years, respectively. Only top 1%, 5%, 10% of dermatologists received 41.7% (95% confidence interval [CI] 38.2-45.1%), 76.9% (95% CI 74.7-79.1%), and 87.6% (95% CI 86.2-88.9%) of overall payments. The number of dermatologists receiving payments and per-dermatologist payments increased by 4.3% (95% CI 3.1‒5.5%, p < 0.001) and 16.4% (95% CI 13.5‒19.4%, p < 0.001) each year. The board-certification in dermatology-oncology, in cosmetic dermatology, and male sex were significantly associated with higher personal payments with relative monetary values of 2.29 (95% CI 1.65-3.19, p < 0.001), 3.16 (95% CI 1.89-5.26, p < 0.001), and 5.38 (95% CI 4.12-7.04, p < 0.001). Less than half of Japanese board-certified dermatologists received lower personal payments from the pharmaceutical companies than those to other specialists. However, these personal payments were increasingly more prevalent and greater over the 4 years.
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Affiliation(s)
- Anju Murayama
- Tohoku University School of Medicine, Sendai, Miyagi, Japan.
| | - Sae Kamamoto
- Faculty of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hiroaki Saito
- Medical Governance Research Institute, Minato-Ku, Tokyo, Japan
- Department of Internal Medicine, Soma Central Hospital, Soma, Fukushima, Japan
| | - Akihiko Ozaki
- Faculty of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
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Ozieranski P, Saito H, Rickard E, Mulinari S, Ozaki A. International comparison of pharmaceutical industry payment disclosures in the UK and Japan: implications for self-regulation, public regulation, and transparency. Global Health 2023; 19:14. [PMID: 36869318 PMCID: PMC9985252 DOI: 10.1186/s12992-022-00902-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 12/20/2022] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Self-regulation of payment disclosure by pharmaceutical industry trade groups is a major global approach to increasing transparency of financial relationships between drug companies and healthcare professionals and organisations. Nevertheless, little is known about the relative strengths and weaknesses of self-regulation across countries, especially beyond Europe. To address this gap in research and stimulate international policy learning, we compare the UK and Japan, the likely strongest cases of self-regulation of payment disclosure in Europe and Asia, across three dimensions of transparency: disclosure rules, practices, and data. RESULTS The UK and Japanese self-regulation of payment disclosure had shared as well unique strengths and weaknesses. The UK and Japanese pharmaceutical industry trade groups declared transparency as the primary goal of payment disclosure, without, however, explaining the link between the two. The rules of payment disclosure in each country provided more insight into some payments but not others. Both trade groups did not reveal the recipients of certain payments by default, and the UK trade group also made the disclosure of some payments conditional on recipient consent. Drug company disclosure practices were more transparent in the UK, allowing for greater availability and accessibility of payment data and insight into underreporting or misreporting of payments by companies. Nevertheless, the share of payments made to named recipients was three times higher in Japan than in the UK, indicating higher transparency of disclosure data. CONCLUSIONS The UK and Japan performed differently across the three dimensions of transparency, suggesting that any comprehensive analysis of self-regulation of payment disclosure must triangulate analysis of disclosure rules, practices, and data. We found limited evidence to support key claims regarding the strengths of self-regulation, while often finding it inferior to public regulation of payment disclosure. We suggest how the self-regulation of payment disclosure in each country can be enhanced and, in the long run, replaced by public regulation to strengthen the industry's accountability to the public.
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Affiliation(s)
- Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Emily Rickard
- Department of Social and Policy Sciences, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Shai Mulinari
- Department of Sociology, Lund University, Lund, Sweden
| | - Akihiko Ozaki
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
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Ozaki A, Harada K, Murayama A, Saito H, Sawano T, Tanimoto T, Shrestha S, Bhandari D, Crump A. Japan's valsartan clinical trials shambles; time for fundamental changes. Int J Health Plann Manage 2023; 38:557-568. [PMID: 36794862 DOI: 10.1002/hpm.3618] [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: 08/03/2021] [Revised: 09/27/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
Japan's Diovan® /valsartan 'scandal' has received sensational coverage in the nation's media since 2012. Publication of fraudulent research and their subsequent retraction boosted and then curtailed the use of what was a useful therapeutic drug. Some authors of the papers resigned, others disputed the retractions and resorted to legal counsel to protect themselves. One individual, an undeclared Novartis employee involved in the research, was arrested. A complex and virtually unwinnable case was brought against him and Novartis, claiming that data alteration amounted to false advertising, but lengthy criminal court cases resulted in the case failing. Unfortunately, key elements, including conflicts of interest, pharmaceutical company interference in trials of its product, and the role of the institutions involved, have been effectively ignored. The incident also emphasised the fact that Japan's unique society and approach to science does not conform well to international standards. Although the supposed impropriety caused the appearance of a new Clinical Trials Act in 2018, the law has been criticized for being ineffectual and simply increasing clinical trial bureaucracy. This article examines the 'scandal' and identifies where changes must be made to clinical research and the roles of the various stakeholders in Japan to increase public trust in clinical trials and biomedical publications.
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Affiliation(s)
- Akihiko Ozaki
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Fukushima, Iwaki, Japan
| | - Kayo Harada
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - Anju Murayama
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kosei Hospital, Sendai, Miyagi, Japan
| | - Toyoaki Sawano
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
| | | | - Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor Darul Ehsan, Malaysia
| | - Divya Bhandari
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - Andy Crump
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
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10
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Murayama A, Shigeta H, Kamamoto S, Yamashita E, Saito H, Sawano T, Bhandari D, Shrestha S, Kusumi E, Tanimoto T, Ozaki A. Pharmaceutical Payments to Japanese Board‐Certified Head and Neck Surgeons Between 2016 and 2019. OTO Open 2023; 7:e31. [PMID: 36998569 PMCID: PMC10046701 DOI: 10.1002/oto2.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/15/2022] [Accepted: 12/25/2022] [Indexed: 02/19/2023] Open
Abstract
Objective To evaluate the magnitude, prevalence, and trend of the financial relationship between Japanese head and neck surgeons and pharmaceutical companies between 2016 and 2019. Study Design Cross-sectional analysis. Setting Japan. Methods This study evaluated personal payments concerning lecturing, consulting, and writing paid by 92 major pharmaceutical companies to all Japanese head and neck surgeons board-certified by the Japan Society for Head and Neck Surgery between 2016 and 2019. The payments were descriptively analyzed and payment trend were assessed using population-averaged generalized estimating equations. Further, the payments to board executive board members with specialist certification were also evaluated separately. Results Of all 443 board-certified head and neck surgeons in Japan, 365 (82.4%) received an average of $6443 (standard deviation: $12,875), while median payments were $2002 (interquartile ranges [IQR] $792-$4802). Executive board specialists with a voting right received much higher personal payments (median $26,013, IQR $12,747-$35,750) than the non-executive specialists (median $1926, IQR $765‒$4134, p < .001) and the executive board specialists without a voting right (median $4411, IQR $963-$5623, p = .015). The payments per specialist and prevalence of specialists with payments annually increased by 11.4% (95% CI: 5.8%-17.2%; p < .001) and 7.3% (95% CI: 3.8%-11.0%; p < .001), respectively. Conclusion There were increasingly widespread and growing financial relationships with pharmaceutical companies among head and neck surgeons in Japan, alongside of introduction of novel drugs. The leading head and neck surgeons received much higher personal payments from pharmaceutical companies, and no sufficient regulation was implemented by the society in Japan.
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Affiliation(s)
- Anju Murayama
- Medical Governance Research Institute Minato‐ku Tokyo Japan
- School of Medicine Tohoku University Sendai city Miyagi Japan
| | - Haruki Shigeta
- Medical Governance Research Institute Minato‐ku Tokyo Japan
- School of Medicine Tohoku University Sendai city Miyagi Japan
| | - Sae Kamamoto
- Medical Governance Research Institute Minato‐ku Tokyo Japan
- Faculty of Medicine Hamamatsu University School of Medicine Hamamatsu Shizuoka Japan
| | | | - Hiroaki Saito
- Medical Governance Research Institute Minato‐ku Tokyo Japan
- Department of Internal Medicine Soma Central Hospital Soma City Fukushima Japan
| | - Toyoaki Sawano
- Department of Surgery Jyoban Hospital of Tokiwa Foundation Iwaki City Fukushima Japan
| | - Divya Bhandari
- Medical Governance Research Institute Minato‐ku Tokyo Japan
| | - Sunil Shrestha
- School of Pharmacy, Monash University Malaysia Jalan Lagoon Selatan Bandar Sunway Jalan Lagoon Selatan Malaysia
| | - Eiji Kusumi
- Medical Governance Research Institute Minato‐ku Tokyo Japan
- Department of Internal Medicine Navitas Clinic Shinjuku Shinjuku‐ku Tokyo Japan
| | - Tetsuya Tanimoto
- Medical Governance Research Institute Minato‐ku Tokyo Japan
- Department of Internal Medicine Navitas Clinic Tachikawa Tachikawa City Tokyo Japan
| | - Akihiko Ozaki
- Medical Governance Research Institute Minato‐ku Tokyo Japan
- Department of Breast and Thyroid Surgery Jyoban Hospital of Tokiwa Foundation Iwaki City Fukushima Japan
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11
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Murayama A, Kamamoto S, Murata N, Yamasaki R, Yamada K, Yamashita E, Saito H, Tanimoto T, Ozaki A. Evaluation of financial conflicts of interest and quality of evidence in Japanese gastroenterology clinical practice guidelines. J Gastroenterol Hepatol 2022; 38:565-573. [PMID: 36518089 DOI: 10.1111/jgh.16089] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/02/2022] [Accepted: 12/11/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Clinical practice guidelines assist healthcare professionals in providing evidence-based care. However, pharmaceutical companies' financial interests often influence guideline content. This study aimed to elucidate the magnitude of financial ties among Japanese gastroenterology guideline authors and the pharmaceutical industry. METHODS Using pharmaceutical company disclosed payment data, we evaluated financial conflicts of interest (COI) among Japanese Society of Gastroenterology guideline authors between 2016 and 2021. Additionally, we assessed the evidence quality supporting guideline recommendations and associations with financial COI. Finally, we evaluated author COI management during guideline development against global standards. RESULTS Overall, 88.2% (231/262) of guideline authors received a median of $12 968 (interquartile range [IQR]: $1839-$70 374) in payments between 2016 and 2019 for lectures, writings, and consulting. Chairpersons received significantly higher payments (median: $86 444 [IQR: $15 455-$165 679]). Notably, 41 (15.6%) authors had undeclared payments exceeding declaration requirements. Low or very low-quality evidence supported 41.0% of recommendations. There was a negative association between the median 4-year payment per author and the proportion of recommendations based on low-quality evidence (odds ratio: 0.966 [95% confidence interval [95% CI]: 0.945-0.987], P = 0.002) and positive association with moderate-quality evidence (odds ratio: 1.018 [95% CI: 1.011-1.025], P < 0.001). Still, the Japanese Society of Gastroenterology guideline development process remains less transparent, with insufficient COI policies relative to global standards. CONCLUSION There were extensive financial COI between pharmaceutical companies and guideline authors, and more than 40% of recommendations were based on low-quality evidence. More rigorous and transparent COI policies for guideline development adhering to global standards are warranted.
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Affiliation(s)
- Anju Murayama
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,School of Medicine, Tohoku University, Sendai, Miyagi, Japan
| | - Sae Kamamoto
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Faculty of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Nanami Murata
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Faculty of Medicine, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Ryota Yamasaki
- Faculty of Medicine, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Kohki Yamada
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Osaka University School of Medicine, Osaka, Japan
| | - Erika Yamashita
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - Hiroaki Saito
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Tetsuya Tanimoto
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Department of Internal Medicine, Navitas Clinic, Tachikawa, Tokyo, Japan
| | - Akihiko Ozaki
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
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12
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Gusmano MK, Chinitz D, Rodwin V. Pricing of Drugs With Evidence Development. JAMA 2022; 328:777-778. [PMID: 35997742 DOI: 10.1001/jama.2022.11232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - David Chinitz
- School of Public Health, Hebrew University and Hadassah in Jerusalem, Jerusalem, Israel
| | - Victor Rodwin
- Wagner School of Public Service, New York University, New York, New York
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13
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Verkerk EW, Van Dulmen SA, Born K, Gupta R, Westert GP, Kool RB. Key Factors that Promote Low-Value Care: Views of Experts From the United States, Canada, and the Netherlands. Int J Health Policy Manag 2022; 11:1514-1521. [PMID: 34273925 PMCID: PMC9808325 DOI: 10.34172/ijhpm.2021.53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 04/30/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Around the world, policies and interventions are used to encourage clinicians to reduce low-value care. In order to facilitate this, we need a better understanding of the factors that lead to low-value care. We aimed to identify the key factors affecting low-value care on a national level. In addition, we highlight differences and similarities in three countries. METHODS We performed 18 semi-structured interviews with experts on low-value care from three countries that are actively reducing low-value care: the United States, Canada, and the Netherlands. We interviewed 5 experts from Canada, 6 from the United States, and 7 from the Netherlands. Eight were organizational leaders or policy-makers, 6 as low-value care researchers or project leaders, and 4 were both. The transcribed interviews were analyzed using inductive thematic analysis. RESULTS The key factors that promote low-value care are the payment system, the pharmaceutical and medical device industry, fear of malpractice litigation, biased evidence and knowledge, medical education, and a 'more is better' culture. These factors are seen as the most important in the United States, Canada and the Netherlands, although there are several differences between these countries in their payment structure, and industry and malpractice policy. CONCLUSION Policy-makers and researchers that aim to reduce low-value care have experienced that clinicians face a mix of interdependent factors regarding the healthcare system and culture that lead them to provide low-value care. Better awareness and understanding of these factors can help policy-makers to facilitate clinicians and medical centers to deliver high-value care.
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Affiliation(s)
- Eva W. Verkerk
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Simone A. Van Dulmen
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Karen Born
- Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Reshma Gupta
- University of California Health, Sacramento, CA, USA
| | - Gert P. Westert
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rudolf B. Kool
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Murayama A, Kamamoto S, Saito H, Yamada K, Bhandari D, Shoji I, Mamada H, Kawashima M, Yamashita E, Kusumi E, Sawano T, Sapkota B, Tanimoto T, Ozaki A. Pharmaceutical Payments to Japanese Board-Certified Infectious Disease Specialists: A Four-Year Retrospective Analysis of Payments from 92 Pharmaceutical Companies between 2016 and 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127417. [PMID: 35742661 PMCID: PMC9223711 DOI: 10.3390/ijerph19127417] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/31/2022] [Accepted: 06/14/2022] [Indexed: 01/30/2023]
Abstract
Backgrounds: Conflict of interest with pharmaceutical companies is one of the most concerned issues in infectious diseases. However, there is a lack of whole picture of detailed payments in Japan. Methods: This retrospective study assessed financial relationships between pharmaceutical companies and all infectious disease specialists board-certified by the Japanese Association for Infectious Disease, using publicly disclosed payment data from 92 major pharmaceutical companies. Descriptive analyses were conducted for the payments. Payment trends were examined by the generalized estimating equations. Results: Of 1614 board-certified infection disease specialists, 1055 (65.4%) received a total of $17,784,070 payments, corresponding to 21,680 contracts between 2016 and 2019. The mean ± SD and median (interquartile range: IQR) were $16,857 ± $45,010 and $3183 ($938–$11,250) in payments. All board executive members of Japanese Association of Infectious Disease received higher payments averaging $163,792. There were no significant changes in payments per specialist (annual change rate: −1.4% [95% CI: −4.7–2.3%], p = 0.48) and prevalence of specialists with payments (annual change rate: −1.4% [95% CI: −3.1–0.2%], p = 0.093) over the four years. Conclusion: There were substantial financial relationships between pharmaceutical companies and board-certified infectious disease specialists in Japan. Furthermore, high ranked specialists such as those in the executive board had stronger financial ties with the companies.
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Affiliation(s)
- Anju Murayama
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
- School of Medicine, Tohoku University, Sendai City 980-8577, Miyagi, Japan
- Correspondence: ; Tel.: +81-90-6321-6996
| | - Sae Kamamoto
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
- School of Medicine, Hamamatsu University, Hamamatsu City 431-2102, Shizuoka, Japan
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kosei Hospital, Sendai City 980-0873, Miyagi, Japan;
| | - Kohki Yamada
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
| | - Divya Bhandari
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
| | - Iori Shoji
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
| | - Hanano Mamada
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
| | - Moe Kawashima
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
| | - Erika Yamashita
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
| | - Eiji Kusumi
- Navitas Clinic Shinjuku, Shinjuku-ku 160-0022, Tokyo, Japan;
| | - Toyoaki Sawano
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki City 972-8322, Fukushima, Japan;
| | - Binaya Sapkota
- Nobel College Faculty of Health Sciences, Pokhara University, Kathmandu 33700, Nepal;
| | - Tetsuya Tanimoto
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
- Department of Internal Medicine, Navitas Clinic, Tachikawa City 160-0022, Tokyo, Japan
| | - Akihiko Ozaki
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki City 972-8322, Fukushima, Japan
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15
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Trayer J, Rowbotham NJ, Boyle RJ, Smyth AR. Industry influence in healthcare harms patients: myth or maxim? Breathe (Sheff) 2022; 18:220010. [PMID: 36337122 PMCID: PMC9584590 DOI: 10.1183/20734735.0010-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/31/2022] [Indexed: 11/05/2022] Open
Abstract
Healthcare is a major global industry accounting for a significant proportion of government spending. Drug and medical device manufacturers are publicly traded companies with a responsibility to their shareholders to maximise profits by increasing sales. In order to achieve this, industry exerts influence over every part of healthcare including academic research, medical education, clinical guideline development, physician prescribing and through direct interactions with patients. In contrast, healthcare services seek to provide effective, safe and evidence-based treatments. This article examines interactions with industry across these domains and seeks to identify mutually beneficial relationships and potential conflict leading to patient harms. Case studies are used to illustrate these interactions. There is no single solution for improving healthcare's relationship with industry, although increased transparency has raised awareness of this issue. We briefly discuss some successful interventions that have been tried at national and regulatory level. While industry influence is widespread in healthcare and this has benefits for shareholders, healthcare practitioners have an ethical obligation to prioritise their patients' best interests. Industry interactions with healthcare professionals have a valid role in product development and distribution, but industry sponsorship of healthcare education and practice, guideline development or regulatory decision-making can have harmful consequences for patients. Healthcare practitioners need to carefully consider these issues when deciding whether to collaborate with industry. Educational aims To explore the many areas where industry influences healthcare and the subsequent effects on patient care. Case studies are used to illustrate examples of beneficial and harmful effects of this influence.To raise awareness of the effects of industry influence and for readers to consider their own potential conflicts of interest.To suggest potential ways to improve the current system with a focus on solutions which have successfully been trialled already.
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Affiliation(s)
- James Trayer
- Dept of Paediatric Allergy, Imperial College Healthcare NHS Trust, London, UK
| | - Nicola J. Rowbotham
- Evidence Based Child Health Group, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Robert J. Boyle
- Dept of Paediatric Allergy, Imperial College Healthcare NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Alan R. Smyth
- Evidence Based Child Health Group, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
- Dept of Paediatric Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
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16
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Brown RCH, de Barra M, Earp BD. Broad Medical Uncertainty and the ethical obligation for openness. SYNTHESE 2022; 200:121. [PMID: 35431349 PMCID: PMC8994926 DOI: 10.1007/s11229-022-03666-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 03/20/2022] [Indexed: 06/14/2023]
Abstract
This paper argues that there exists a collective epistemic state of 'Broad Medical Uncertainty' (BMU) regarding the effectiveness of many medical interventions. We outline the features of BMU, and describe some of the main contributing factors. These include flaws in medical research methodologies, bias in publication practices, financial and other conflicts of interest, and features of how evidence is translated into practice. These result in a significant degree of uncertainty regarding the effectiveness of many medical treatments and unduly optimistic beliefs about the benefit/harm profiles of such treatments. We argue for an ethical presumption in favour of openness regarding BMU as part of a 'Corrective Response'. We then consider some objections to this position (the 'Anti-Corrective Response'), including concerns that public honesty about flaws in medical research could undermine trust in healthcare institutions. We suggest that, as it stands, the Anti-Corrective Response is unconvincing.
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Affiliation(s)
| | - Mícheál de Barra
- Centre for Culture and Evolution, Brunel University London, London, UK
| | - Brian D. Earp
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
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17
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Stegenga J. Red herrings about relative measures: A response to Hoefer and Krauss. STUDIES IN HISTORY AND PHILOSOPHY OF SCIENCE 2022; 92:56-59. [PMID: 35134731 DOI: 10.1016/j.shpsa.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/18/2021] [Accepted: 01/11/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Jacob Stegenga
- Department of History and Philosophy of Science, University of Cambridge, Free School Lane, Cambridge, CB2 3RH, United Kingdom.
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18
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Wheelock A, Ives J. Vaccine confidence, public understanding and probity: time for a shift in focus? JOURNAL OF MEDICAL ETHICS 2022; 48:250-255. [PMID: 33687913 DOI: 10.1136/medethics-2020-106805] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/27/2021] [Accepted: 02/05/2021] [Indexed: 06/12/2023]
Abstract
Lack of vaccine confidence can contribute to drops in vaccination coverage and subsequent outbreaks of diseases like measles and polio. Low trust in vaccines is attributed to a combination of factors, including lack of understanding, vaccine scares, flawed policies, social media and mistrust of vaccine manufacturers, scientists and decision-makers. The COVID-19 crisis has laid bare societies' vulnerability to new pathogens and the critical role of vaccines (and their acceptability) in containing this and future pandemics. It has also put science at the forefront of the response, with several governments relying on academics to help shape policy and communicate with the public. Against this backdrop, protecting public trust in scientists and scientific output is arguably more important than ever. Yet, conflicts of interest (CoI) in biomedical research remain ubiquitous and harmful, and measures to curb them have had limited success. There is also evidence of bias in industry-sponsored vaccine studies and academics are voicing concerns about the risks of working in a CoI prevalent research area. Here, we set out to challenge established thinking with regard to vaccine confidence, by shifting the gaze from a deficit in public understanding towards probity in research relationships and suggesting an alternative and perhaps complementary strategy for addressing vaccine mistrust. We argue that a concerted effort needs to be made to revisit the norms that undergird contemporary vaccine research, coupled with a willingness of all stakeholders to reimagine those relationships with an emphasis on demonstrating trustworthiness and probity.
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Affiliation(s)
- Ana Wheelock
- Department of Surgery and Cancer, Imperial College London, London, UK
- Business School, Kingston University, Kingston-Upon-Thames, London, UK
| | - Jonathan Ives
- Centre for Ethics in Medicine, University of Bristol, Bristol, UK
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19
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Pokorny AMJ, Moynihan R, Fox P, Karikios DJ, Bero LA, Mintzes BJ. Australian Cancer Physicians and the Pharmaceutical Industry: A Survey of Attitudes and Interactions. JCO Oncol Pract 2022; 18:e1154-e1163. [PMID: 35316090 DOI: 10.1200/op.21.00767] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Interactions between cancer physicians and the pharmaceutical industry may create conflicts of interest that can adversely affect patient care. We aimed to survey cancer physicians regarding their attitudes toward and interactions with industry. METHODS We surveyed Australian cancer physicians between December 2020 and February 2021, questioning how often they interacted with industry and their attitudes toward this. We also assessed factors associated with accepting payments from industry and the amount received, and opinions on policies and industry influence. We used logistic and linear regression to examine links between attitudes and behaviors. RESULTS There were 116 responses (94 complete). Almost half (n = 53 of 115, 46.1%) felt that there was a positive relationship between cancer physicians and industry. Most (n = 79 of 104, 76.0%) interacted with industry at least once a month, and 67.7% (n = 63 of 93) had received nonresearch payments from industry previously, with a median value of 2,000 Australian dollars over 1 year. Most respondents believed that interactions could influence prescribing while simultaneously denying influence on their own prescribing (n = 66 of 94, 70.2%). Those who judged general sales representative interactions (odds ratio [OR] 9.37 [95% CI, 1.05 to 83.41], P = .045) or clinician sponsorship (OR 3.22 [95% CI, 1.01 to 10.30], P = .049) to be more acceptable also met with sales representatives more frequently. Physicians were more likely to accept industry payments when they deemed sponsorship of clinicians for conferences (OR 10.55 [95% CI, 2.33 to 47.89], P = .002) or honoraria for advisory board membership more acceptable (OR 3.91 [95% CI, 1.04 to 14.74], P = .04) or when they had higher belief in industry influence over own prescribing (OR 25.51 [95% CI, 2.70 to 241.45], P = .005). CONCLUSION Australian cancer physicians interact with industry frequently, and those who feel positive about these interactions are likely to do so more often. More research is needed to understand the motivations behind these interactions.
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Affiliation(s)
- Adrian M J Pokorny
- Alice Springs Hospital, Northern Territory, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ray Moynihan
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
| | - Peter Fox
- Central West Cancer Care Centre, Orange, New South Wales, Australia.,School of Medicine, Western Sydney University, New South Wales, Australia
| | - Deme J Karikios
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Nepean Cancer Care Centre, Kingswood, New South Wales, Australia
| | - Lisa A Bero
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Barbara J Mintzes
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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20
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Grundy Q, Parker L, Wong A, Fusire T, Dimancesco D, Tisocki K, Walkowiak H, Vian T, Kohler J. Disclosure, transparency, and accountability: a qualitative survey of public sector pharmaceutical committee conflict of interest policies in the World Health Organization South-East Asia Region. Global Health 2022; 18:33. [PMID: 35303902 PMCID: PMC8931570 DOI: 10.1186/s12992-022-00822-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Weak governance over public sector pharmaceutical policy and practice limits access to essential medicines, inflates pharmaceutical prices, and wastes scarce health system resources. Pharmaceutical systems are technically complex and involve extensive interactions between the private and public sectors. For members of public sector pharmaceutical committees, relationships with the private sector can result in conflicts of interest, which may introduce commercial biases into decision-making, potentially compromising public health objectives and health system sustainability. We conducted a descriptive, qualitative study of conflict of interest policies and practices in the public pharmaceutical sector in ten countries in the World Health Organization (WHO) South-East Asia Region (SEAR) (Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, and Timor-Leste) between September 2020 and March 2021. RESULTS We identified 45 policy and regulatory documents and triangulated documentary data with 21 expert interviews. Key informants articulated very different governance priorities and conflict of interest concerns depending on the features of their country's pharmaceutical industry, market size, and national economic objectives related to the domestic pharmaceutical industry. Public sector pharmaceutical policies and regulations consistently contained provisions for pharmaceutical committee members to disclose relevant interests, but contained little detail about what should be declared, when, and how often, nor whether disclosures are evaluated and by whom. Processes for preventing or managing conflicts of interest were less well developed than those for disclosure except for a few key procurement processes. Where processes for managing conflicts of interest were specified, the dominant strategy was to recuse committee members with a conflict of interest from relevant work. Policies rarely specified that committee members should divest or otherwise be free from conflicts of interest. CONCLUSIONS Robust processes for conflict of interest prevention and management could ensure the integrity of decision-making and build public trust in pharmaceutical processes to achieve public health objectives. Upstream approaches including supportive legislative frameworks, the creation of oversight bodies, and strengthening regulatory institutions can also contribute to building cultures of transparency, accountability, and trust.
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Affiliation(s)
- Quinn Grundy
- University of Toronto, Suite 130, 155 College Street, Toronto, M5T 1P8, Canada.
| | | | - Anna Wong
- University of Toronto, Suite 130, 155 College Street, Toronto, M5T 1P8, Canada
| | - Terence Fusire
- World Health Organization, South East Asia Region Office, New Delhi, India
| | | | | | - Helena Walkowiak
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, USA
| | - Taryn Vian
- University of San Francisco, San Francisco, USA
| | - Jillian Kohler
- University of Toronto, Suite 130, 155 College Street, Toronto, M5T 1P8, Canada
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21
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Murayama A, Senoo Y, Harada K, Kotera Y, Saito H, Sawano T, Suzuki Y, Tanimoto T, Ozaki A. Awareness and Perceptions among Members of a Japanese Cancer Patient Advocacy Group Concerning the Financial Relationships between the Pharmaceutical Industry and Physicians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063478. [PMID: 35329160 PMCID: PMC8952770 DOI: 10.3390/ijerph19063478] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/02/2022] [Accepted: 03/11/2022] [Indexed: 02/04/2023]
Abstract
Objectives: Awareness and perceptions of financial conflicts of interest (FCOI) between pharmaceutical companies (Pharma) and healthcare domains remain unclear in Japanese cancer patient communities. This study aimed to assess awareness (RQ1), the influence of FCOI on physician trustworthiness (RQ2), and their perception (RQ3) among the Japanese cancer patient advocacy group members. Methods: A cross-sectional study using a self-administered survey was conducted with a Japanese cancer patient advocacy group between January and February 2019. The main outcome measures included awareness and perceptions of physician–Pharma interactions, their impact on physician trustworthiness, and attitudes towards FCOI among medical and other professions. Furthermore, we performed thematic analyses on the comments which responders provided in the surveys. Results: Among the 524 contacted members, 96 (18.3%) completed the questionnaire, including 69 (77.5%) cancer patients. In RQ1, most of the respondents were aware of physician–Pharma interactions, although the extent differed based on the nature of the interaction. Furthermore, the respondents mainly considered these interactions influential on clinical practice (RQ2) and agreed to the need for further regulation of physician–Pharma interactions (QR3). In qualitative analyses (n = 56), we identified the 4 following themes: perception towards the FCOI (Theme 1), concerns about the respondent’s treatment (Theme 2), reason of physician–Pharma interactions (Theme 3), and possible solutions from the patient perspective (Theme 4). Conclusions: Most respondents were generally aware of physician–Pharma-associated FCOI and perceived them negatively. Additionally, participants appeared supportive of further FCOI regulation to protect patient-centred care. Abbreviations: FCOI—financial conflicts of interest; United States—US; Pharma—pharmaceutical companies; RQ—research question.
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Affiliation(s)
- Anju Murayama
- Medical Governance Research Institute, Minato-ku, Tokyo 108-0074, Japan; (Y.S.); (K.H.); (Y.S.); (T.T.); (A.O.)
- School of Medicine, Tohoku University, Sendai 980-8574, Japan
- Correspondence: ; Tel.: +81-90-6321-6996
| | - Yuki Senoo
- Medical Governance Research Institute, Minato-ku, Tokyo 108-0074, Japan; (Y.S.); (K.H.); (Y.S.); (T.T.); (A.O.)
| | - Kayo Harada
- Medical Governance Research Institute, Minato-ku, Tokyo 108-0074, Japan; (Y.S.); (K.H.); (Y.S.); (T.T.); (A.O.)
| | - Yasuhiro Kotera
- School of Health Sciences, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai 980-0873, Japan;
| | - Toyoaki Sawano
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki 972-8322, Japan;
| | - Yosuke Suzuki
- Medical Governance Research Institute, Minato-ku, Tokyo 108-0074, Japan; (Y.S.); (K.H.); (Y.S.); (T.T.); (A.O.)
| | - Tetsuya Tanimoto
- Medical Governance Research Institute, Minato-ku, Tokyo 108-0074, Japan; (Y.S.); (K.H.); (Y.S.); (T.T.); (A.O.)
- Department of Internal Medicine, Navitas Clinic Kawasaki, Tokyo 210-0007, Japan
| | - Akihiko Ozaki
- Medical Governance Research Institute, Minato-ku, Tokyo 108-0074, Japan; (Y.S.); (K.H.); (Y.S.); (T.T.); (A.O.)
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki 972-8322, Japan
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22
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Stegenga J. Viruses without borders and the medical research agenda. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2022; 33:217-221. [PMID: 35275561 DOI: 10.3233/jrs-227016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The COVID-19 pandemic has shown us that there are numerous research questions-empirical, political, and philosophical-that need addressing both prior to, during, and after a pandemic. The current organisation of medical research has hindered our ability to efficiently answer these questions. This in turn suggests that there ought to be changes to how the medical research agenda is set.
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Affiliation(s)
- Jacob Stegenga
- Department of History and Philosophy of Science, University of Cambridge, Cambridge,
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23
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Grundy Q, Millington A, Robinson A, Held F, Fabbri A. Exposure, access and interaction: A global analysis of sponsorship of nursing professional associations. J Adv Nurs 2022; 78:1140-1153. [DOI: 10.1111/jan.15158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Quinn Grundy
- University of Toronto, Lawrence S. Bloomberg Faculty of Nursing Toronto Canada
| | - Anna Millington
- University of Toronto, Lawrence S. Bloomberg Faculty of Nursing Toronto Canada
| | - Andrea Robinson
- University of Toronto, Lawrence S. Bloomberg Faculty of Nursing Toronto Canada
| | - Fabian Held
- The University of Sydney, Office of the Deputy Vice‐Chancellor (Education) Sydney Australia
| | - Alice Fabbri
- Tobacco Control Research Group, Department for Health University of Bath Bath UK
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24
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Clinckemaillie M, Scanff A, Naudet F, Barbaroux A. Sunshine on KOLs: assessment of the nature, extent and evolution of financial ties between the leaders of professional medical associations and the pharmaceutical industry in France from 2014 to 2019: a retrospective study. BMJ Open 2022; 12:e051042. [PMID: 35110312 PMCID: PMC8811544 DOI: 10.1136/bmjopen-2021-051042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To investigate the financial relationships between key opinion leader (KOL) or non-KOL physicians and pharmaceutical and device companies in France. DESIGN Retrospective and descriptive study. SETTING All doctors practising in France, with a focus on 548 KOLs (board members of the professional medical associations that published guidelines in 2018-2019, identified on the associations' websites between 2018 and 2020). Ties were collected from the 'Transparency in Healthcare' database. MAIN OUTCOME MEASURES The number and the value of gifts from 2014 to 2019, and of remunerations and contractual agreements from 2017 to 2019. RESULTS KOLs represented 0.24% of the total number of physicians in France. The total value of gifts declared in the French database for all physicians amounted to €818M (US$936M, £741M). At least one gift was declared for 83% of KOLs. KOLs' gifts represented 0.68% of the total number of gifts to physicians and 1.5% of the total value of gifts, with a mean of €3700 per capita per year.The total value of contractual agreements declared for all physicians amounted to €125M. Contractual agreements involving the KOLs represented 0.72% of the number of contractual agreements with physicians and 2.5% of the value of the agreements, with a mean of €1900 per capita per year.A total of €156M in remunerations were declared for all physicians. KOL remunerations represented 2.3% of the number of physician remunerations and 4.4% of the total value of the remunerations paid to physicians, with a mean of €4100 per capita per year.Almost all professional medical associations (99%) had at least one KOL in their board with a financial tie to the industry, but the amount varied widely among the associations. CONCLUSION Financial relationships between KOLs and the industry in France are extensive. KOLs have much more financial ties than non-KOL practitioners.
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Affiliation(s)
- Marie Clinckemaillie
- Département d'Enseignement et de Recherche en Médecine Générale, RETINES, HEALTHY, Université Côte d'Azur, Nice, France
| | - Alexandre Scanff
- CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Clinique de Rennes)], Université de Rennes, Rennes, France
| | - Florian Naudet
- Clinical Investigation Center (INSERM 1414) and Adult Psychiatry Department, Rennes University Hospital, Rennes 1 University, Rennes, Bretagne, France
| | - Adriaan Barbaroux
- Département d'Enseignement et de Recherche en Médecine Générale, RETINES, LAPCOS, HEALTHY, Université Côte d'Azur, Nice, France
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25
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Makhinson M, Seshia SS, Young GB, Smith PA, Stobart K, Guha IN. The iatrogenic opioid crisis: An example of 'institutional corruption of pharmaceuticals'? J Eval Clin Pract 2021; 27:1033-1043. [PMID: 33760335 DOI: 10.1111/jep.13566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 11/28/2022]
Abstract
RATIONALE Prescribed opioids are major contributors to the international public health opioid crisis. Such widespread iatrogenic harms usually result from collective decision failures of healthcare organizations rather than solely of individual organizations or professionals. Findings from a system-wide safety analysis of the iatrogenic opioid crisis that includes roles of pertinent healthcare organizations may help avoid or mitigate similar future iatrogenic consequences. In this retrospective exploratory study, we report such an analysis. METHODS The study population encompassed the entire age spectrum and included those in whom opioids prescribed for chronic pain (unrelated to malignancy) were associated with death or morbidity. Root cause analysis, incorporating recent suggestions for improvement, was used to identify possible contributory factors from the literature. Based on their mandated roles and potential influences to prevent or mitigate the iatrogenic crisis, relevant organizations were grouped and stratified from most to least influential. RESULTS The analysis identified a chain of multiple interrelated causal factors within and between organizations. The most influential organizations were pharmaceutical, political, and drug regulatory; next: experts and their related societies, and publications. Less influential: accreditation, professional licensing and regulatory, academic and healthcare funding bodies. Collectively, their views and decisions influenced prescribing practices of frontline healthcare professionals and advocacy groups. Financial associations between pharmaceutical and most other organizations/groups were common. Ultimately, patients were adversely affected. There was a complex association with psychosocial variables. LIMITATIONS The analysis suggests associations not causality. CONCLUSION The iatrogenic crisis has multiple intricately linked roots. The major catalyst: pervasive pharma-linked financial conflicts of interest (CoIs) involving most other healthcare organizations. These extensive financial CoIs were likely triggers for a cascade of erroneous decisions and actions that adversely affected patients. The actions and decisions of pharma ranged from unethical to illegal. The iatrogenic opioid crisis may exemplify 'institutional corruption of pharmaceuticals'.
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Affiliation(s)
- Michael Makhinson
- Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine at the University of California, Los Angeles, California, USA.,Department of Psychiatry, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Shashi S Seshia
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Gordon Bryan Young
- Clinical Neurological Sciences and Medicine (Critical Care), Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada.,Grey Bruce Health Services, Owen Sound, Ontario, Canada
| | - Preston A Smith
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kent Stobart
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Indra Neil Guha
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
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Ringborg U, Berns A, Celis JE, Heitor M, Tabernero J, Schüz J, Baumann M, Henrique R, Aapro M, Basu P, Beets‐Tan R, Besse B, Cardoso F, Carneiro F, van den Eede G, Eggermont A, Fröhling S, Galbraith S, Garralda E, Hanahan D, Hofmarcher T, Jönsson B, Kallioniemi O, Kásler M, Kondorosi E, Korbel J, Lacombe D, Carlos Machado J, Martin‐Moreno JM, Meunier F, Nagy P, Nuciforo P, Oberst S, Oliveiera J, Papatriantafyllou M, Ricciardi W, Roediger A, Ryll B, Schilsky R, Scocca G, Seruca R, Soares M, Steindorf K, Valentini V, Voest E, Weiderpass E, Wilking N, Wren A, Zitvogel L. The Porto European Cancer Research Summit 2021. Mol Oncol 2021; 15:2507-2543. [PMID: 34515408 PMCID: PMC8486569 DOI: 10.1002/1878-0261.13078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 01/22/2023] Open
Abstract
Key stakeholders from the cancer research continuum met in May 2021 at the European Cancer Research Summit in Porto to discuss priorities and specific action points required for the successful implementation of the European Cancer Mission and Europe's Beating Cancer Plan (EBCP). Speakers presented a unified view about the need to establish high-quality, networked infrastructures to decrease cancer incidence, increase the cure rate, improve patient's survival and quality of life, and deal with research and care inequalities across the European Union (EU). These infrastructures, featuring Comprehensive Cancer Centres (CCCs) as key components, will integrate care, prevention and research across the entire cancer continuum to support the development of personalized/precision cancer medicine in Europe. The three pillars of the recommended European infrastructures - namely translational research, clinical/prevention trials and outcomes research - were pondered at length. Speakers addressing the future needs of translational research focused on the prospects of multiomics assisted preclinical research, progress in Molecular and Digital Pathology, immunotherapy, liquid biopsy and science data. The clinical/prevention trial session presented the requirements for next-generation, multicentric trials entailing unified strategies for patient stratification, imaging, and biospecimen acquisition and storage. The third session highlighted the need for establishing outcomes research infrastructures to cover primary prevention, early detection, clinical effectiveness of innovations, health-related quality-of-life assessment, survivorship research and health economics. An important outcome of the Summit was the presentation of the Porto Declaration, which called for a collective and committed action throughout Europe to develop the cancer research infrastructures indispensable for fostering innovation and decreasing inequalities within and between member states. Moreover, the Summit guidelines will assist decision making in the context of a unique EU-wide cancer initiative that, if expertly implemented, will decrease the cancer death toll and improve the quality of life of those confronted with cancer, and this is carried out at an affordable cost.
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Murayama A, Kida F, Ozaki A, Saito H, Sawano T, Tanimoto T. Financial and Intellectual Conflicts of Interest Among Japanese Clinical Practice Guidelines Authors for Allergic Rhinitis. Otolaryngol Head Neck Surg 2021; 166:869-876. [PMID: 34399654 DOI: 10.1177/01945998211034724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To elucidate financial and intellectual conflicts of interest (COIs) among clinical practice guideline (CPG) authors of allergic rhinitis in Japan and to evaluate the extent of transparency and accuracy in COIs by CPG authors of allergic rhinitis. STUDY DESIGN A cross-sectional analysis of the payment data from all 79 pharmaceutical companies in Japan between 2016 and 2017. SETTING Japan. METHODS We considered all 27 CPG authors from 2 different versions of the most prominent CPGs for allergic rhinitis in Japan. Using payment data disclosed by 79 major pharmaceutical companies between 2016 and 2017, we assessed the magnitude and characteristics of financial COIs of CPG authors. We also evaluated the intellectual COIs of the CPG authors by counting self-citations of research articles related to CPG statements and recommendations. RESULTS Of 27 CPG authors, 26 authors (96.3%) received at least 1 payment from a combined total of $1,333,552 between 2016 and 2017. The 2-year combined average and median monetary values per author were $49,391 (SD, $67,438) and $18,400 (interquartile range: $6,216-$72,494), respectively. Pharmaceutical companies with novel drugs predominantly made these payments. The percentage of citations with at least 1 CPG author relative to total citations was 47.6% in 2016 and 27.9% in 2020. There were no formal COI disclosure statements in either version. CONCLUSION This study found that allergic rhinitis CPG authors had significant financial relationships with pharmaceutical companies, particularly those marketing novel drugs. In addition, CPG authors had relatively high self-citation rates, a potential marker of intellectual COIs. More rigorous and comprehensive COI management strategies are needed.
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Affiliation(s)
- Anju Murayama
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - Futa Kida
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - Akihiko Ozaki
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Toyoaki Sawano
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
| | - Tetsuya Tanimoto
- Department of Internal Medicine, Navitas Clinic, Tachikawa, Tokyo, Japan
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Diong J, Kroeger CM, Reynolds KJ, Barnett A, Bero LA. Strengthening the incentives for responsible research practices in Australian health and medical research funding. Res Integr Peer Rev 2021; 6:11. [PMID: 34340719 PMCID: PMC8328133 DOI: 10.1186/s41073-021-00113-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/16/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Australian health and medical research funders support substantial research efforts, and incentives within grant funding schemes influence researcher behaviour. We aimed to determine to what extent Australian health and medical funders incentivise responsible research practices. METHODS We conducted an audit of instructions from research grant and fellowship schemes. Eight national research grants and fellowships were purposively sampled to select schemes that awarded the largest amount of funds. The funding scheme instructions were assessed against 9 criteria to determine to what extent they incentivised these responsible research and reporting practices: (1) publicly register study protocols before starting data collection, (2) register analysis protocols before starting data analysis, (3) make study data openly available, (4) make analysis code openly available, (5) make research materials openly available, (6) discourage use of publication metrics, (7) conduct quality research (e.g. adhere to reporting guidelines), (8) collaborate with a statistician, and (9) adhere to other responsible research practices. Each criterion was answered using one of the following responses: "Instructed", "Encouraged", or "No mention". RESULTS Across the 8 schemes from 5 funders, applicants were instructed or encouraged to address a median of 4 (range 0 to 5) of the 9 criteria. Three criteria received no mention in any scheme (register analysis protocols, make analysis code open, collaborate with a statistician). Importantly, most incentives did not seem strong as applicants were only instructed to register study protocols, discourage use of publication metrics and conduct quality research. Other criteria were encouraged but were not required. CONCLUSIONS Funders could strengthen the incentives for responsible research practices by requiring grant and fellowship applicants to implement these practices in their proposals. Administering institutions could be required to implement these practices to be eligible for funding. Strongly rewarding researchers for implementing robust research practices could lead to sustained improvements in the quality of health and medical research.
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Affiliation(s)
- Joanna Diong
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Cynthia M Kroeger
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Katherine J Reynolds
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Adrian Barnett
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, QLD, Brisbane, 4000, Australia
| | - Lisa A Bero
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
- Centre for Bioethics and Humanities, University of Colorado, Boulder, CO, 80309-0552, USA
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Collin J, Wright A, Hill S, Smith K. Conflicted and confused? Health harming industries and research funding in leading UK universities. BMJ 2021; 374:n1657. [PMID: 34315731 PMCID: PMC8428257 DOI: 10.1136/bmj.n1657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Jeff Collin and colleagues review how the UK’s leading universities deal with research funding from health harming industries and call for more effective governance of conflicts of interest
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Affiliation(s)
- Jeff Collin
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), UK
| | - Alex Wright
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Sarah Hill
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), UK
| | - Kat Smith
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), UK
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
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Legg T, Hatchard J, Gilmore AB. The Science for Profit Model-How and why corporations influence science and the use of science in policy and practice. PLoS One 2021; 16:e0253272. [PMID: 34161371 PMCID: PMC8221522 DOI: 10.1371/journal.pone.0253272] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 06/01/2021] [Indexed: 12/15/2022] Open
Abstract
Science has been at the centre of attempts by major industries, including tobacco, chemical, and pharmaceutical, to delay progress in tackling threats to human and planetary health by, inter alia, obscuring industry harms, and opposing regulation. Some aspects of this influence are well documented, others remain poorly understood, and similarities between industries remain underexplored. This study, therefore, aims to synthesise the literature to develop an evidence-based typology and model of corporate influence on science in order to provide an overview of this multi-faceted phenomenon. We obtained literature examining corporate attempts to influence science and the use of science in policy and practice from: database searches, bibliographies, expert recommendations, and web alerts; using a modified scoping review methodology (n = 68). Through interpretive analysis we developed the Science for Profit Typology and Model. We identified eight corporate sectors repeatedly engaging in activities to influence science, including: manipulation of scientific methods; reshaping of criteria for establishing scientific "proof"; threats against scientists; and clandestine promotion of policy reforms that increase reliance on industry evidence. The typology identifies five macro-level strategies used consistently across the eight industries, comprising 19 meso-level strategies. The model shows how these strategies work to maximise the volume, credibility, reach, and use of industry-favourable science, while minimising these same aspects of industry-unfavourable science. This creates doubt about harms of industry products/practices or efficacy of policies affecting industry; promotes industry-favoured policy responses and industry products as solutions; and legitimises industry's role as scientific stakeholder. These efforts ultimately serve to weaken policy, prevent litigation, and maximise use of industry products/practices-maximising corporate profitability. We provide an accessible way to understand how and why corporations influence science, demonstrate the need for collective solutions, and discuss changes needed to ensure science works in the public interest.
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Affiliation(s)
- Tess Legg
- Department for Health, Tobacco Control Research Group, University of Bath, Bath, United Kingdom
| | - Jenny Hatchard
- Department for Health, Tobacco Control Research Group, University of Bath, Bath, United Kingdom
| | - Anna B. Gilmore
- Department for Health, Tobacco Control Research Group, University of Bath, Bath, United Kingdom
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31
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Affiliation(s)
- Lisa A Bero
- Schools of Medicine and Public Health, University of Colorado, USA
| | - Lisa Parker
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine and Health University of Sydney
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32
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Morton WJ. Feasibility of effectiveness trials in pediatric anesthesia. Paediatr Anaesth 2021; 31:390-396. [PMID: 33434376 DOI: 10.1111/pan.14129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Effectiveness studies aim to investigate whether an intervention does more good than harm in normal clinical practice. DISCUSSION Historically, research in pediatric anesthesia has appropriately concentrated on efficacy studies which even if of excellent design, tell us little about how generalizable or applicable the findings are to routine clinical practice. Simultaneously effectiveness and cost-effectiveness research has been limited due to systematic and cultural factors. To understand the challenges of effectiveness research in children, it is necessary to examine the overlapping relationship between efficacy, effectiveness, and cost-effectiveness studies. This can be illuminated with Cochrane´s hierarchy of investigation and the disease, illness, and sickness modelfrom the philosophy of science. Effectiveness (illness perspective) studies form the middle rung of Cochrane´s research hierarchy, between efficacy (disease perspective) and cost-effectiveness (sickness perspective) research. Effectiveness studies aim to be generalizable and determine whether interventions work in routine clinical practice. Since outcomes that reflect patient priorities offer the most generalizability these are encouraged in effectiveness studies. Due to developing consciousness and communication in young children, identifying and measuring patient-centered outcomes has challenges. These challenges are not insurmountable and with appropriate communication and research techniques the subjective nature of the experience of illness in the young may be elucidated and should direct research goals where possible. Sickness perspective research, in terms of cost-effectiveness, remains underdeveloped in pediatric anesthesia. SUMMARY Pediatric anesthesia has a strong base in efficacy research, but the need to expand research to include effectiveness and eventually cost-effectiveness studies should not be ignored.
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Affiliation(s)
- William J Morton
- Akershus University Hospital, Lørenskog, Norway.,University of Oslo, Oslo, Norway
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33
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VAN Schalkwyk MC, Maani N, Cohen J, McKee M, Petticrew M. Our Postpandemic World: What Will It Take to Build a Better Future for People and Planet? Milbank Q 2021; 99:467-502. [PMID: 33783865 PMCID: PMC8241272 DOI: 10.1111/1468-0009.12508] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Policy Points Despite the pandemic's ongoing devastating impacts, it also offers the opportunity and lessons for building a better, fairer, and sustainable world. Transformational change will require new ways of working, challenging powerful individuals and industries who worsened the crisis, will act to exploit it for personal gain, and will work to ensure that the future aligns with their interests. A flourishing world needs strong and equitable structures and systems, including strengthened democratic, research, and educational institutions, supported by ideas and discourses that are free of opaque and conflicted influence and that challenge the status quo and inequitable distribution of power.
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Affiliation(s)
- May Ci VAN Schalkwyk
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine
| | - Nason Maani
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine.,School of Public Health, Boston University
| | | | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine
| | - Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine
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Hengartner MP, Amendola S, Kaminski JA, Kindler S, Bschor T, Plöderl M. Suicide risk with selective serotonin reuptake inhibitors and other new-generation antidepressants in adults: a systematic review and meta-analysis of observational studies. J Epidemiol Community Health 2021; 75:jech-2020-214611. [PMID: 33685964 DOI: 10.1136/jech-2020-214611] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 11/25/2020] [Accepted: 02/20/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is ongoing controversy whether antidepressant use alters suicide risk in adults with depression and other treatment indications. METHODS Systematic review of observational studies, searching MEDLINE, PsycINFO, Web of Science, PsycARTICLES and SCOPUS for case-control and cohort studies. We included studies on depression and various indications unspecified (including off-label use) reporting risk of suicide and/or suicide attempt for adult patients using selective serotonin reuptake inhibitors (SSRI) and other new-generation antidepressants relative to non-users. Effects were meta-analytically aggregated with random-effects models, reporting relative risk (RR) estimates with 95% CIs. Publication bias was assessed via funnel-plot asymmetry and trim-and-fill method. Financial conflict of interest (fCOI) was defined present when lead authors' professorship was industry-sponsored, they received industry-payments, or when the study was industry-sponsored. RESULTS We included 27 studies, 19 on depression and 8 on various indications unspecified (n=1.45 million subjects). SSRI were not definitely related to suicide risk (suicide and suicide attempt combined) in depression (RR=1.03, 0.70-1.51) and all indications (RR=1.19, 0.88-1.60). Any new-generation antidepressant was associated with higher suicide risk in depression (RR=1.29, 1.06-1.57) and all indications (RR=1.45, 1.23-1.70). Studies with fCOI reported significantly lower risk estimates than studies without fCOI. Funnel-plots were asymmetrical and imputation of missing studies with trim-and-fill method produced considerably higher risk estimates. CONCLUSIONS Exposure to new-generation antidepressants is associated with higher suicide risk in adult routine-care patients with depression and other treatment indications. Publication bias and fCOI likely contribute to systematic underestimation of risk in the published literature. REGISTRATION Open Science Framework, https://osf.io/eaqwn/.
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Affiliation(s)
- Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Simone Amendola
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Roma, Italy
| | - Jakob A Kaminski
- Department of Psychiatry and Psychotherapy, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Simone Kindler
- Psychotherapist in Private Practice, Winterthur, Switzerland
| | - Tom Bschor
- Department of Psychiatry and Psychotherapy, University Hospital, Technical University of Dresden, Dresden, Germany
| | - Martin Plöderl
- Department of Crisis Intervention and Suicide Prevention, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria
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Tarras ES, Marshall DC, Rosenzweig K, Korenstein D, Chimonas S. Trends in Industry Payments to Medical Oncologists in the United States Since the Inception of the Open Payments Program, 2014 to 2019. JAMA Oncol 2021; 7:440-444. [PMID: 33377904 DOI: 10.1001/jamaoncol.2020.6591] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Given the potential for undue influence of industry-physician payments on oncology care, it is important to understand how a national transparency program may be associated with financial interactions between industry and medical oncologists. Objective To identify trends in industry payments to medical oncologists from 2014 to 2019 and determine if the implementation of the Open Payments program is associated with changes in the frequency or value of payments or any shift in the nature of industry-oncologist financial interactions. Design, Setting, and Participants This retrospective, population-based, observational cohort study analyzed Open Payments reports of industry payments made in 2014 to 2019 to a cohort of licensed medical oncologists practicing in the US in 2014, using data from the National Plan and Provider Enumeration System. Exposures Receipt of an industry payment from January 1, 2014, to December 31, 2019. Main Outcomes and Measures General industry payments to medical oncologists, including the proportion receiving payments, total annual value and number of payments, and average annual trends over time, by aggregate value and by nature-of-payment category. Trends over time were analyzed using linear regression and generalized estimating equations. Results In 2014 to 2019, there were 15 585 medical oncologists who received a total of 2.2 million industry payments with a total value of $509 million. The absolute number of oncologists receiving payments decreased from 10 498 in 2014 to 8918 in 2019 (-15.1%). The annual per-physician payment value decreased among those receiving less than $10 000 in aggregate by -3.2% yearly (95% CI, -4.1% to -2.3%; P < .001), but increased for those receiving more than $10 000. Payments increased for consulting (13.7%; 95% CI, 12.4%-15.0%; P < .001) and for entertainment, meals, travel or lodging, and gifts (0.8%; 95% CI, 0.1%-1.5%; P = .03). Conclusions and Relevance The number of medical oncologists accepting industry payments has decreased; however, high-value industry payments have been consolidated in a relatively small number of medical oncologists accepting higher payment values over time. The nature of payments has shifted toward consulting. These findings highlight the limitations of transparency without accountability.
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Affiliation(s)
| | - Deborah C Marshall
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kenneth Rosenzweig
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Susan Chimonas
- Memorial Sloan Kettering Cancer Center, New York, New York
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36
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Simon C. Introduction: How evident is the evidence? Fertil Steril 2021; 113:1091-1092. [PMID: 32482243 DOI: 10.1016/j.fertnstert.2020.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 11/28/2022]
Abstract
Randomized-controlled trials (RCTs) and meta-analyses are the pinnacle of evidence-based medicine, enabling identification of the best available diagnostic, interventional, and therapeutic options. These tools help clinicians and policy-makers to set clinical guidelines, but they also represent a double-edged sword: the meaningfulness of RCTs and meta-analyses relies on their quality, performance, and integrity. The present Views and Reviews collection prepared by 18 renowned experts and coordinated by Ben Mol aims to inform and educate our readers about RCTs and meta-analyses in reproductive medicine. The collection begins with the basic features that guarantee the quality of a trial, including protocols, registrations and monitoring, study design and analysis, and reporting standards. Next are discussed the status of planning and coordination of RCTs in different global settings, current unmet needs, and how future studies can better meet these needs, as well as methodologic issues facing different types of RCTs. Finally, insight is provided into the issue of data fabrication and falsification, offering possible solutions to ensure the integrity of RCTs. The challenges and benefits of these crucial evidence-generating tools deserve our attention and education because the findings of RCTs and meta-analyses can directly affect the health of our patients, and when performance and integrity problems exist, the "magic" of these tools disappears-with harmful consequences.
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Affiliation(s)
- Carlos Simon
- Department of Pediatrics, Obstetrics, and Gynecology, University of Valencia, Valencia, Spain; Igenomix Foundation-Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts.
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Coordination and planning of clinical research on a national and global level. Fertil Steril 2021; 113:1100-1106. [PMID: 32482245 DOI: 10.1016/j.fertnstert.2020.04.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 12/11/2022]
Abstract
In reproductive medicine, the needs and desires of infertility patients drive future research, with the most important outcome being live birth of a baby. Large, multicenter, randomized clinical trials are considered the best research tool to evaluate the effectiveness of medical interventions, but they can often take a long time to find definitive answers. Advances in individual participant data (IPD) and network meta-analysis have enabled research questions to be answered more quickly, but better planning could streamline this process further. To harmonize research findings that are taking place globally in this way, it is crucial that the same outcomes are collected in clinical trials conducted in reproductive medicine. Furthermore, the conduct of clinical trials often requires collaboration on an international scale; however, individual countries have their own processes for research prioritization and delivery. We describe the perspective of high- and low-resourced settings and industry as well as the mechanisms of prioritization and coordination that are in place in different settings. In addition, we discuss the importance of the patient perspective, which can help shape the research question, clinical trial design, and the logistical operations of trial delivery. The need for increased global collaboration and coalitions within and between stakeholders is evident for the research community to accelerate advances and maximize benefits in reproductive medicine.
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Elder K, Turner KA, Cosgrove L, Lexchin J, Shnier A, Moore A, Straus S, Thombs BD. Reporting of financial conflicts of interest by Canadian clinical practice guideline producers: a descriptive study. CMAJ 2021; 192:E617-E625. [PMID: 32538799 DOI: 10.1503/cmaj.191737] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The producers of clinical practice guidelines (CPGs) may not disclose industry funding in their CPGs. We reviewed Canadian national CPGs to examine the existence and disclosure of industry-related organizational funding in the CPGs, financial conflicts of interest of committee members and organizational procedures for managing financial conflicts of interest. METHODS For this descriptive study, we searched the asset map of the Strategy for Patient-Oriented Research Evidence Alliance and the CPG Infobase for CPGs published between Jan. 1, 2016, and Nov. 30, 2018. Eligible guidelines had to have a national focus and either a first-line drug recommendation or a screening recommendation leading to drug treatment. One investigator reviewed all CPG titles to exclude those that were clearly ineligible. Two reviewers independently reviewed all remaining guidelines and extracted data. We analyzed the data descriptively. RESULTS We included 21 CPGs: 3 from government-sponsored organizations, 9 from disease or condition interest groups and 9 from medical professional societies. None of the 3 government-sponsored organizations reported industry funding, and none of their committee members disclosed financial conflicts of interest. Among the 18 disease or condition interest groups and medical professional societies, 14 (93%) of the 15 that disclosed funding sources on websites (3 did not disclose) reported organizational funding from industry, but none disclosed this information in the CPGs; 12 (86%) of the 14 with conflict-of-interest disclosure statements in the CPG (4 did not include disclosures) had at least 1 committee member with a financial conflict (mean proportion of committee members with a conflict 56%); and for all 8 CPGs with identifiable chairs or cochairs (chairs or cochairs not reported for 10) at least 1 of these people had a financial conflict of interest. None of the guidelines described a plan to manage organizational financial conflicts of interest. INTERPRETATION Canadian CPGs are vulnerable to industry influence through funding of producers of guidelines and through the financial conflicts of interest of committee members. The CPG producers that receive industry funding should disclose organizational financial conflicts in the CPGs, should engage independent oversight committees and should restrict voting on recommendations to guideline panelists who have no financial conflicts.
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Affiliation(s)
- Katharine Elder
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Kimberly A Turner
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Lisa Cosgrove
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Joel Lexchin
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Adrienne Shnier
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Ainsley Moore
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Sharon Straus
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Brett D Thombs
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.
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Ohnesorge M. The Limits of Conventional Justification: Inductive Risk and Industry Bias Beyond Conventionalism. Front Res Metr Anal 2020; 5:599506. [PMID: 33870060 PMCID: PMC8025966 DOI: 10.3389/frma.2020.599506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/23/2020] [Indexed: 11/13/2022] Open
Abstract
This article develops a constructive criticism of methodological conventionalism. Methodological conventionalism asserts that standards of inductive risk ought to be justified in virtue of their ability to facilitate coordination in a research community. On that view, industry bias occurs when conventional methodological standards are violated to foster industry preferences. The underlying account of scientific conventionality, however, is insufficient for theoretical and practical reasons. Conventions may be justified in virtue of their coordinative functions, but often qualify for posterior empirical criticism as research advances. Accordingly, industry bias does not only threaten existing conventions but may impede their empirically warranted improvement if they align with industry preferences. My empiricist account of standards of inductive risk avoids such a problem by asserting that conventional justification can be pragmatically warranted but has, in principle, only a provisional status. Methodological conventions, therefore, should not only be defended from preference-based infringements of their coordinative function but ought to be subjected to empirical criticism.
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Affiliation(s)
- Miguel Ohnesorge
- Department of History and Philosophy of Science, University of Cambridge, Cambridge, United Kingdom
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Abstract
Food corporations have exploited the dominant model in nutrition science to shape the way their ultra-processed products are defended, promoted, and regulated. Gyorgy Scrinis examines their scientific strategies and suggests ways to reframe the debate
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Affiliation(s)
- Gyorgy Scrinis
- School of Agriculture and Food, University of Melbourne, Melbourne, Australia
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42
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James JE. Disclosing conflict of interest does not mitigate healthcare bias and harm: It is time to sever industry ties. Eur J Clin Invest 2020; 50:e13344. [PMID: 32654125 DOI: 10.1111/eci.13344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 11/28/2022]
Abstract
Disclosing conflict of interest is widely believed to mitigate bias and harm from industry entanglement in healthcare research, education and practice. However, evidence is lacking of disclosure-related mitigation. Radical and extensive severing of industry ties to health care is necessary to curtail industry-related bias and harm.
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Ooi K. The Pitfalls of Overtreatment: Why More Care is not Necessarily Beneficial. Asian Bioeth Rev 2020; 12:399-417. [PMID: 33717342 PMCID: PMC7747436 DOI: 10.1007/s41649-020-00145-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 12/22/2022] Open
Abstract
Overtreatment refers to interventions that do not benefit the patient, or where the risk of harm from the intervention is likely to outweigh any benefit the patient will receive. It can account for up to 30% of health care costs, and is increasingly recognised as a widespread problem across nations and within clinical and scientific communities. There are a number of inter-related factors that drive overtreatment including the expanding definition of diseases, advertising and the influence of the pharmaceutical industry, how doctors are trained and remunerated, demands from patients (and their families) and the fear of complaints leading doctors to practise defensively. This paper discusses a number of ethical and practical issues arising from overtreatment that doctors and patients should be aware of. It also considers the flow-on effects of overtreatment such as the increased cost of care, increase in work load for health professionals, and wastage as resources are diverted from more genuine and pressing needs. In addition, there are references to a number of Medical Council of New Zealand statements about what good medical practice means in an environment of resource limitation. The paper concludes with a few measures that doctors and patients could take to reduce overtreatment but acknowledges that health care is extremely complex so it would be unrealistic to eliminate overtreatment entirely.
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Affiliation(s)
- Kanny Ooi
- Medical Council of New Zealand, Wellington, New Zealand
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45
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Haddaway NR, Akl EA, Page MJ, Welch VA, Keenan C, Lotfi T. Open synthesis and the coronavirus pandemic in 2020. J Clin Epidemiol 2020; 126:184-191. [PMID: 32621854 PMCID: PMC7328560 DOI: 10.1016/j.jclinepi.2020.06.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/10/2020] [Accepted: 06/28/2020] [Indexed: 12/30/2022]
Abstract
•Open Science principles are vital for ensuring reproducibility, trust, and legacy. •Evidence synthesis is a vital means of summarizing research for decision-making. •Open Synthesis is the application of Open Science principles to evidence synthesis. •Open approaches to planning, conducting, and reporting synthesis have many benefits. •We call on the evidence synthesis community to embrace Open Synthesis.
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Affiliation(s)
- Neal R Haddaway
- Stockholm Environment Institute, Linnégatan 87D, Stockholm, Sweden; African Centre for Evidence, University of Johannesburg, Johannesburg, South Africa; The SEI Centre of the Collaboration for Environmental Evidence, Stockholm, Sweden; Mercator Research Institute on Global Commons and Climate Change, Berlin, Germany.
| | - Elie A Akl
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Department of Health Research Methods, Evidence, and Impact (HE&I), McMaster University, Hamilton, Ontario, Canada; The Global Evidence Synthesis Initiative (GESI) Secretariat, American University of Beirut, Beirut, Lebanon
| | - Matthew J Page
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Vivian A Welch
- Bruyere Research Institute, Ottawa, Canada; Campbell Collaboration, Oslo, Norway; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa
| | - Ciara Keenan
- Campbell UK and Ireland, Belfast, UK; Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | - Tamara Lotfi
- Department of Health Research Methods, Evidence, and Impact (HE&I), McMaster University, Hamilton, Ontario, Canada; The Global Evidence Synthesis Initiative (GESI) Secretariat, American University of Beirut, Beirut, Lebanon
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Bavli I, Steel D. Inductive Risk and OxyContin: The Ethics of Evidence and Post-Market Surveillance of Pharmaceuticals in Canada. Public Health Ethics 2020. [DOI: 10.1093/phe/phaa031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
The argument from inductive risk claims that judgments about the moral severity of errors are relevant to decisions about what should count as sufficient evidence for accepting claims. While this idea has been explored in connection with evidence required for the approval of pharmaceuticals, the role of inductive risk in the post-approval process has been largely neglected. In this article, we examine the ethics of inductive risk in connection with revisions to the product monograph for OxyContin in Canada, which understates the risks of addiction and abuse associated with this drug. Using the concept of inductive risk, we consider what evidence should have been sufficient for Health Canada (HC) to revise the product monograph for OxyContin. Given the stakes involved, we argue that a less strict standard of evidence would have been appropriate, yet HC in fact took the opposite course, insisting upon a higher standard of evidence than it normally requires. In addition to providing a novel perspective on the opioid crisis in Canada, this article contributes to existing philosophical work by demonstrating that inductive risks in the post-approval stage are important and linked to pre-approval inductive risks.
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Affiliation(s)
- Itai Bavli
- Interdisciplinary Studies Graduate Program and the W. Maurice Young Centre for Applied Ethics (School of Population and Public Health), the University of British Columbia and Harvard Department of the History of Science
| | - Daniel Steel
- W. Maurice Young Centre for Applied Ethics (School of Population and Public Health), The University of British Columbia
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Affiliation(s)
- Reinhard Griebenow
- European Cardiology Section Foundation, European Cardiology Section Foundation (ECSF), Cologne, Germany
- European Cardiology Section Foundation (ECSF), Cologne, Germany
| | - Peter Mills
- European Cardiology Section Foundation, European Cardiology Section Foundation (ECSF), Cologne, Germany
- European Cardiology Section Foundation (ECSF), Cologne, Germany
| | - Joerg Stein
- European Cardiology Section Foundation, European Cardiology Section Foundation (ECSF), Cologne, Germany
- European Cardiology Section Foundation (ECSF), Cologne, Germany
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Hollak CEM, Sirrs S, van den Berg S, van der Wel V, Langeveld M, Dekker H, Lachmann R, de Visser SJ. Registries for orphan drugs: generating evidence or marketing tools? Orphanet J Rare Dis 2020; 15:235. [PMID: 32883346 PMCID: PMC7469301 DOI: 10.1186/s13023-020-01519-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/24/2020] [Indexed: 02/06/2023] Open
Abstract
Independent disease registries for pre-and post-approval of novel treatments for rare diseases are increasingly important for healthcare professionals, patients, regulators and the pharmaceutical industry. Current registries for rare diseases to evaluate orphan drugs are mainly set up and owned by the pharmaceutical industry which leads to unacceptable conflicts of interest. To ensure independence from commercial interests, disease registries should be set up and maintained by healthcare professionals and patients. Public funding should be directed towards an early establishment of international registries for orphan diseases, ideally well before novel treatments are introduced. Regulatory bodies should insist on the use of data from independent disease registries rather than company driven, drug-oriented registries.
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Affiliation(s)
- Carla E M Hollak
- Department of Endocrinology and Metabolism, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, F5-170, P.O. Box 22660, 1100, DD, Amsterdam, The Netherlands. .,Platform Medicine for Society at Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Sandra Sirrs
- Division of Endocrinology and Metabolism, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sibren van den Berg
- Platform Medicine for Society at Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Vincent van der Wel
- Platform Medicine for Society at Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mirjam Langeveld
- Department of Endocrinology and Metabolism, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, F5-170, P.O. Box 22660, 1100, DD, Amsterdam, The Netherlands
| | - Hanka Dekker
- VKS, The Dutch patient association for Inherited Metabolic Diseases, Zwolle, Netherlands
| | - Robin Lachmann
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - Saco J de Visser
- Platform Medicine for Society at Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Afnan MAM, Khan KS, Mol BW. Generating translatable evidence to improve patient care: the contribution of human factors. Reprod Biomed Online 2020; 41:353-356. [PMID: 32553553 PMCID: PMC7207140 DOI: 10.1016/j.rbmo.2020.04.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/15/2020] [Accepted: 04/25/2020] [Indexed: 12/27/2022]
Abstract
Generating translatable evidence to improve patient care has proved challenging in reproductive medicine, with many 'add-on' treatments in routine assisted conception clinical practice that have not been reliably tested. This has consequences for patient care; specifically, IVF pregnancy rates have not improved. A change of culture is required in our profession, from indiscriminately applying the latest 'add-on' to large-scale participation in generating reliable translatable evidence.
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Affiliation(s)
- Masoud A M Afnan
- Department of Obstetrics and Gynaecology, Qingdao United Family Hospital, Qingdao, People's Republic of China.
| | - Khalid Saeed Khan
- Distinguished Investigator in Preventive Medicine and Public Health at the University of Granada funded by the Beatriz Galindo Program (Senior Modality) of the Spanish Ministry of Science, Innovation and Universities, Universidad de Granada, Granada, Spain
| | - Ben Willem Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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Nakkash R, Ali A, Alaouie H, Asmar K, Hirschhorn N, Mugharbil S, Nuwayhid I, London L, Saban A, Rashid SF, Ahmed MK, Knai C, Bigland C, Afifi RA. Attitudes and practices of public health academics towards research funding from for-profit organizations: cross-sectional survey. Int J Public Health 2020; 65:1133-1145. [PMID: 32840634 PMCID: PMC7497330 DOI: 10.1007/s00038-020-01416-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives The growing trend of for-profit organization (FPO)-funded university research is concerning because resultant potential conflicts of interest might lead to biases in methods, results, and interpretation. For public health academic programmes, receiving funds from FPOs whose products have negative health implications may be particularly problematic. Methods A cross-sectional survey assessed attitudes and practices of public health academics towards accepting funding from FPOs. The sampling frame included universities in five world regions offering a graduate degree in public health; 166 academics responded. Descriptive, bivariate, and logistic regression analyses were conducted. Results Over half of respondents were in favour of accepting funding from FPOs; attitudes differed by world region and gender but not by rank, contract status, % salary offset required, primary identity, or exposure to an ethics course. In the last 5 years, almost 20% of respondents had received funding from a FPO. Sixty per cent of respondents agreed that there was potential for bias in seven aspects of the research process, when funds were from FPOs. Conclusions Globally, public health academics should increase dialogue around the potential harms of research and practice funded by FPOs. Electronic supplementary material The online version of this article (10.1007/s00038-020-01416-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rima Nakkash
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ahmed Ali
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hala Alaouie
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Khalil Asmar
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | | | - Sanaa Mugharbil
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Iman Nuwayhid
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Leslie London
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Amina Saban
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Sabina Faiz Rashid
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md Koushik Ahmed
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Cecile Knai
- London School of Hygiene and Tropical Medicine, London, UK
| | - Charlotte Bigland
- UK Specialty Registrar, Severn Postgraduate Medical Education School of Public Health, Health Education England, London, UK
| | - Rima A Afifi
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N Riverside Drive, Iowa City, IA, USA.
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