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Pereira MMA, Dini C, Souza JGS, Barão VAR, de Avila ED. Industry support for dental implant research: A metatrend study of industry partnership in the development of new technologies. J Prosthet Dent 2024; 132:72-80. [PMID: 35811163 DOI: 10.1016/j.prosdent.2022.05.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 10/17/2022]
Abstract
STATEMENT OF PROBLEM Industry needs scientific knowledge to develop new products and services, and their financial support to dental implant researchers translates into commercial products. Therefore, identifying the relevant factors for a successful industry partnership is important. PURPOSE The purpose of this study was to provide a 20-year bibliometric overview of industry-sponsored studies in implant dentistry to identify possible factors involved in industry partnership motivations. MATERIAL AND METHODS A hand search of 6 of the most established journals in the implant dentistry field was performed for articles published in 1999, 2004, 2009, 2014, and 2019. Information regarding the continent of origin of the corresponding author, interinstitute collaboration, type and topic of research, and the h-index of the corresponding author was recorded for each included article. Bivariate and multivariate logistic regression was used to determine statistical relationship between industry support and exploratory factors (α=.05). RESULTS A 6% increase in the chance of industry investment was observed over the years (odds ratio [OD]=1.06; P<.001). Studies from North America (OD=4.87; P<.001) and Europe (OD=3.13; P<.001) were more likely to receive industry funding. Data also revealed a direct relationship between the increasing number of institutions involved in the study and the probability of industry funding (OD=1.21; P<.001). Animal studies (OD=2.26; P<.001) about surgical procedures and prosthodontic topics (OD=1.40; P=.044) stood out for having greater industry support. Researchers with an h-index between 31 and 40 were more likely to receive industry financial support (OD=2.46; P=.001). CONCLUSIONS Industry support for dental implant research was closely aligned with the continent of origin, interinstitute collaboration, type and topic of research, and the h-index of the corresponding author.
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Affiliation(s)
- Marta M A Pereira
- PhD student, Department of Dental Materials and Prosthodontics, School of Dentistry at Araraquara, Sao Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Caroline Dini
- PhD student, Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - João G S Souza
- Professor, Dental Research Division, Guarulhos University (UNG), Guarulhos, São Paulo, Brazil; Dental Science School (Faculdade de Ciências Odontológicas - FCO), Montes Claros, Minas Gerais, Brazil
| | - Valentim A R Barão
- Associate Professor, Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Erica D de Avila
- Professor, Dental Research Division, Guarulhos University (UNG), Guarulhos, São Paulo, Brazil; Graduate Program Professor, Department of Dental Materials and Prosthodontics, School of Dentistry at Araraquara, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil.
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2
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Guo XM, Barber EL. The Invisible Hand of Industry. Clin Obstet Gynecol 2022; 65:260-267. [PMID: 35476619 PMCID: PMC9060382 DOI: 10.1097/grf.0000000000000697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Over the last decades, federal funding for medical research has decreased, while industry funding has increased. The majority of clinical trials are now industry funded. Involvement of industry raises documented concerns of reporting and publication bias, data suppression, and conclusions that may more favorably align with funder motivations rather than study results. However, industry involvement may also lead to scientific innovation, efficiency, and a more rapid timeline to bring new developments to patients. Through a careful review of a manuscript, the reader can understand the nature of industry involvement and interpret the results in this context.
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Affiliation(s)
- X Mona Guo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - Emma L Barber
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology
- Robert H Lurie Comprehensive Cancer Center, Northwestern University
- Surgical Outcomes and Quality Improvement Center, Institute for Public Health in Medicine, Chicago, Illinois
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3
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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: 2] [Impact Index Per Article: 1.0] [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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4
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Focosi D, Casadevall A, Maggi F, Antonelli G. Reflections after 2 years of COVID-19 pandemic. Rev Med Virol 2022; 32:e2351. [PMID: 35384110 PMCID: PMC9111062 DOI: 10.1002/rmv.2351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | - Arturo Casadevall
- Department of Medicine, Johns Hopkins School of Public Health and School of Medicine, Baltimore, Maryland, USA
| | | | - Guido Antonelli
- Department of Molecular Medicine, Sapienza University of Rome, and Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
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5
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Boesen K, Simonsen AL, Jørgensen KJ, Gøtzsche PC. Cross-sectional study of medical advertisements in a national general medical journal: evidence, cost, and safe use of advertised versus comparative drugs. Res Integr Peer Rev 2021; 6:8. [PMID: 33971984 PMCID: PMC8108346 DOI: 10.1186/s41073-021-00111-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 04/11/2021] [Indexed: 01/15/2023] Open
Abstract
Background Healthcare professionals are exposed to advertisements for prescription drugs in medical journals. Such advertisements may increase prescriptions of new drugs at the expense of older treatments even when they have no added benefits, are more harmful, and are more expensive. The publication of medical advertisements therefore raises ethical questions related to editorial integrity. Methods We conducted a descriptive cross-sectional study of all medical advertisements published in the Journal of the Danish Medical Association in 2015. Drugs advertised 6 times or more were compared with older comparators: (1) comparative evidence of added benefit; (2) Defined Daily Dose cost; (3) regulatory safety announcements; and (4) completed and ongoing post-marketing studies 3 years after advertising. Results We found 158 medical advertisements for 35 prescription drugs published in 24 issues during 2015, with a median of 7 advertisements per issue (range 0 to 11). Four drug groups and 5 single drugs were advertised 6 times or more, for a total of 10 indications, and we made 14 comparisons with older treatments. We found: (1) ‘no added benefit’ in 4 (29%) of 14 comparisons, ‘uncertain benefits’ in 7 (50%), and ‘no evidence’ in 3 (21%) comparisons. In no comparison did we find evidence of ‘substantial added benefit’ for the new drug; (2) advertised drugs were 2 to 196 times (median 6) more expensive per Defined Daily Dose; (3) 11 safety announcements for five advertised drugs were issued compared to one announcement for one comparator drug; (4) 20 post-marketing studies (7 completed, 13 ongoing) were requested for the advertised drugs versus 10 studies (4 completed, 6 ongoing) for the comparator drugs, and 7 studies (2 completed, 5 ongoing) assessed both an advertised and a comparator drug at 3 year follow-up. Conclusions and relevance In this cross-sectional study of medical advertisements published in the Journal of the Danish Medical Association during 2015, the most advertised drugs did not have documented substantial added benefits over older treatments, whereas they were substantially more expensive. From January 2021, the Journal of the Danish Medical Association no longer publishes medical advertisements. Supplementary Information The online version contains supplementary material available at 10.1186/s41073-021-00111-9.
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Affiliation(s)
- Kim Boesen
- Nordic Cochrane Centre, Rigshospitalet Dept. 7811, 2100 Copenhagen, Denmark. .,Current address: Meta Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Charité Universitätsmedizin, QUEST Center for Transforming Biomedical Research, Berlin, Germany.
| | | | - Karsten Juhl Jørgensen
- Nordic Cochrane Centre, Rigshospitalet Dept. 7811, 2100 Copenhagen, Denmark.,Centre for Evidence-Based Medicine (CEBMO) and Cochrane Denmark, Dept. Clinical Research, University of Southern Denmark, Odense, Denmark.,Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
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6
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Lexchin J, Bero LA, Davis C, Gagnon MA. Achieving greater independence from commercial influence in research. BMJ 2021; 372:n370. [PMID: 33687982 DOI: 10.1136/bmj.n370] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Joel Lexchin
- School of Health Policy and Management, York University, Toronto, ON, Canada
- Department of Family and Community Medicine University of Toronto, Toronto, Canada
- University Health Network, Toronto, Canada
| | - Lisa A Bero
- Center for Bioethics and Humanities, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Courtney Davis
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Marc-Andre Gagnon
- School of Public Policy and Administration, Carleton University, Ottawa, ON, Canada
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7
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McClymont E, Brophy J, Dubey V, Kwong J, Meyer S, Crowcroft N, Halperin S, MacDonald S, Simmons K, Top K, Ward B, Sadarangani M. Is 'conflict of interest' a Misnomer? Managing interests in immunization research and evaluation. Hum Vaccin Immunother 2021; 18:1879580. [PMID: 33651972 PMCID: PMC8920130 DOI: 10.1080/21645515.2021.1879580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Potential conflicts of interest in vaccine research can lead to negative consequences that undermine public trust and thereby put communities at risk. However, collaborations that may give rise to potential conflicts between interests can also greatly facilitate appropriate, scientifically robust, and timely vaccine development, implementation, and evaluation. At present, policies regarding the management of potential conflicts between interests are not ideal. To optimally manage interests in vaccine research, we recommend acknowledging all forms of interests and treating them all as relevant, developing appropriate collaborations, referring to all “conflicts of interest” simply as “interests” or “declarations,” and promoting transparency through developing consistent reporting mechanisms.
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Affiliation(s)
- Elisabeth McClymont
- Department of Obstetrics and Gynecology, Université de Montréal, Montréal, Quebec, Canada
| | - Jason Brophy
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Jeff Kwong
- Clinical Public Health Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Samantha Meyer
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Natasha Crowcroft
- Clinical Public Health Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Scott Halperin
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shannon MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Karen Simmons
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Karina Top
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Brian Ward
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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8
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Yu J, Su G, Hirst A, Yang Z, Zhang Y, Li Y. Identifying competing interest disclosures in systematic reviews of surgical interventions and devices: a cross-sectional survey. BMC Med Res Methodol 2020; 20:260. [PMID: 33076823 PMCID: PMC7574563 DOI: 10.1186/s12874-020-01144-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/09/2020] [Indexed: 02/08/2023] Open
Abstract
Background A competing interest is an important source of bias in research and disclosure is frequently employed as a strategy to manage it. Considering the importance of systematic reviews (SRs) and the varying prevalence of competing interests in different research fields, we conducted a survey to identify the range of competing interests in SRs assessing surgical interventions or devices and explored the association between the competing interest disclosures and authors’ conclusions. Methods We retrieved SRs of surgical interventions and devices published in 2017 via PubMed. Information regarding general characteristics, funding sources, and competing interest disclosures were extracted. We conducted a descriptive analysis of the studies’ characteristics and compared them between Cochrane SRs (CSRs) and non-Cochrane SRs using the Chi-square test. Results were expressed as odds ratio and their 95% confidence interval. Results One hundred fifty-five SRs published in 2017 were included in the study. More than half of the SRs (58.7%) reported their funding sources and 94.2% reported authors’ competing interest disclosures. Among 146 SRs that stated competing interest disclosures, only 35 (22.6%) SRs declared at least one author had a competing interest. More than 40 terms were used to describe competing interests. Cochrane SRs (CSRs) were more likely to provide a detailed description of competing interests compared to those in non-CSRs (48.0% versus 25.4%, P = 0.023). No association between positive conclusions and competing interest disclosures was found (P = 0.484, OR = 0.43, 95%CI: 0.08, 2.16). In the subgroup analyses, SRs stating no competing interest disclosure were more likely to report positive conclusions than those stating at least one type of competing interest, but the difference is not significantly different (P = 0.406, OR = 1.38, 95%CI: 0.64, 2.98). Conclusion In surgical SRs, there is a high percentage of competing interest disclosures but without detailed information. The identification and statement of competing interests with a detailed description, particularly the non-financial ones, needs improvement. Some efficient and effective methods/tools for identifying, quantifying, and minimizing potential competing interests in systematic reviews remains valuable.
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Affiliation(s)
- Jiajie Yu
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Guanyue Su
- School of Preclinical and Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Allison Hirst
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Zhengyue Yang
- School of Medicine, PanZhiHua University, Panzhihua, 617000, China
| | - You Zhang
- School of Medicine, PanZhiHua University, Panzhihua, 617000, China
| | - Youping Li
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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9
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Dal-Ré R, Bouter LM, Moher D, Marušić A. Mandatory disclosure of financial interests of journals and editors. BMJ 2020; 370:m2872. [PMID: 32967915 DOI: 10.1136/bmj.m2872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Rafael Dal-Ré
- Epidemiology Unit, Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Lex M Bouter
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, and Department of Philosophy, Vrije Universiteit Amsterdam, Netherlands
| | - David Moher
- Centre of Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Ana Marušić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
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10
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Industry compensation and self-reported financial conflicts of interest among authors of highly cited peripheral artery disease studies. J Vasc Surg 2020; 72:673-684. [DOI: 10.1016/j.jvs.2019.09.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 09/07/2019] [Indexed: 12/20/2022]
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11
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Relationships among commercial practices and author conflicts of interest in biomedical publishing. PLoS One 2020; 15:e0236166. [PMID: 32706798 PMCID: PMC7380625 DOI: 10.1371/journal.pone.0236166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/30/2020] [Indexed: 11/29/2022] Open
Abstract
Recently, concerns have been raised over the potential impacts of commercial relationships on editorial practices in biomedical publishing. Specifically, it has been suggested that certain commercial relationships may make editors more open to publishing articles with author conflicts of interest (aCOI). Using a data set of 128,781 articles published in 159 journals, we evaluated the relationships among commercial publishing practices and reported author conflicts of interest. The 159 journals were grouped according to commercial biases (reprint services, advertising revenue, and ownership by a large commercial publishing firm). 30.6% (39,440) of articles were published in journals showing no evidence of evaluated commercial publishing relationships. 33.9% (43,630) were published in journals accepting advertising and reprint fees; 31.7% (40,887) in journals owned by large publishing firms; 1.2% (1,589) in journals accepting reprint fees only; and 2.5% (3,235) in journals accepting only advertising fees. Journals with commercial relationships were more likely to publish articles with aCOI (9.2% (92/1000) vs. 6.4% (64/1000), p = 0.024). In the multivariate analysis, only a journal’s acceptance of reprint fees served as a significant predictor (OR = 2.81 at 95% CI, 1.5 to 8.6). Shared control estimation was used to evaluate the relationships between commercial publishing practices and aCOI frequency in total and by type. BCa-corrected mean difference effect sizes ranged from -1.0 to 6.1, and confirm findings indicating that accepting reprint fees may constitute the most significant commercial bias. The findings indicate that concerns over the influence of industry advertising in medical journals may be overstated, and that accepting fees for reprints may constitute the largest risk of bias for editorial decision-making.
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Gomes WJ, Albuquerque LC, Jatene FB, Leal JCF, Rocha EAV, Almeida RMS. The transfiguration of the EXCEL trial: exceeding ethical and moral boundaries. Eur J Cardiothorac Surg 2020; 58:30-34. [DOI: 10.1093/ejcts/ezaa121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Walter J Gomes
- Cardiovascular Surgery Discipline, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Luciano C Albuquerque
- Sao Lucas Hospital of the Pontifical Catholic University of Porto Alegre, Porto Alegre, RS, Brazil
| | - Fabio B Jatene
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Joao Carlos F Leal
- Faculty of Medicine of São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil
| | - Eduardo A V Rocha
- Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Rui M S Almeida
- Faculty of Medicine of the University Center Assis Gurgacz, Cascavel, PR, Brazil
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13
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Satalkar P, Perneger T, Shaw D. Accommodating an Uninvited Guest: Perspectives of Researchers in Switzerland on 'Honorary' Authorship. SCIENCE AND ENGINEERING ETHICS 2020; 26:947-967. [PMID: 31784940 DOI: 10.1007/s11948-019-00162-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 11/26/2019] [Indexed: 06/10/2023]
Abstract
The aim of this paper is to analyze the attitudes and reactions of researchers towards an authorship claim made by a researcher in a position of authority who has not made any scientific contribution to a manuscript or helped to write it. This paper draws on semi-structured interviews conducted with 33 researchers at three seniority levels working in biomedicine and the life sciences in Switzerland. This manuscript focuses on the analysis of participants' responses when presented with a vignette describing an authorship assignment dilemma within a research group. The analysis indicates that researchers use a variety of explanations and arguments to justify inclusion of what guidelines would describe as honorary or guest authorship. Fuzzy parameters such as "substantial contribution" lead to varied interpretation and consequently convenient application of authorship guidelines in practice. Factors such as the culture of the research group, the values and practice shaped by the research leaders, the hierarchy and relative (perceived) positions of power within research institutions, and the importance given to publications as the currency for academic success and growth tend to have a strong influence on authorship practice. Unjustified authorship assignment practices can be reduced to some extent by creating empowering research cultures where each researcher irrespective of his/her career stage feels empowered to confidently raise concerns without fearing adverse impact on their professional lives. However, individual researchers and research institutions currently have limited influence on established methods for evaluating academic success, which is primarily based on the number of high impact publications.
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Affiliation(s)
- Priya Satalkar
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
| | - Thomas Perneger
- Division of Clinical Epidemiology, University Hospital Geneva, Geneva, Switzerland
| | - David Shaw
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
- Department of Health, Ethics and Society, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Lundh A, Rasmussen K, Østengaard L, Boutron I, Stewart LA, Hróbjartsson A. Systematic review finds that appraisal tools for medical research studies address conflicts of interest superficially. J Clin Epidemiol 2019; 120:104-115. [PMID: 31809849 DOI: 10.1016/j.jclinepi.2019.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/19/2019] [Accepted: 12/02/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The objective of this study was to identify and summarize 1) appraisal tools and other guides which address conflicts of interest in medical research studies; and 2) top journals with policies on managing conflicts of interest in journal papers. STUDY DESIGN AND SETTING We searched bibliographic databases, other sources, and websites of 30 top medical journals. Two authors selected documents and extracted data. RESULTS We included 27 appraisal tools. None were designed specifically for addressing conflicts of interest and they included only 1-2 short items on conflicts of interest. We also included eight other types of guides. Of 27 appraisal tools, 23 addressed study funding, and 19 authors' conflicts of interest. Nine tools addressed availability of conflicts of interest information, 13 reported conflicts of interest, and five influence from conflicts of interest. Twelve of 30 top journals had conflicts of interest managing policies (beyond disclosure). One journal restricted nonresearch papers (e.g., editorials) to authors without financial conflicts of interest and ten only restricted under certain circumstances. CONCLUSION Appraisal tools that address conflicts of interest typically do so superficially and rarely address how conflicts of interest may influence studies. Less than half of top medical journals have explicit policies on managing conflicts of interest.
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Affiliation(s)
- Andreas Lundh
- Centre for Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, Odense, Denmark; Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Infectious Diseases, Hvidovre Hospital, Hvidovre, Denmark.
| | | | - Lasse Østengaard
- Centre for Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, Odense, Denmark; Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; University Library of Southern Denmark, Odense, Denmark
| | - Isabelle Boutron
- Centre of Research in Epidemiology and StatisticS (CRESS), Inserm, INRA, Université de Paris, Paris, France
| | - Lesley A Stewart
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Asbjørn Hróbjartsson
- Centre for Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, Odense, Denmark; Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Jerčić Martinić-Cezar I, Marušić A. Completeness of reporting in abstracts of randomized controlled trials in subscription and open access journals: cross-sectional study. Trials 2019; 20:669. [PMID: 31791393 PMCID: PMC6889688 DOI: 10.1186/s13063-019-3781-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 10/09/2019] [Indexed: 12/11/2022] Open
Abstract
Background Open access (OA) journals are becoming a publication standard for health research, but it is not clear how they differ from traditional subscription journals in the quality of research reporting. We assessed the completeness of results reporting in abstracts of randomized controlled trials (RCTs) published in these journals. Methods We used the Consolidated Standards of Reporting Trials Checklist for Abstracts (CONSORT-A) to assess the completeness of reporting in abstracts of parallel-design RCTs published in subscription journals (n = 149; New England Journal of Medicine, Journal of the American Medical Association, Annals of Internal Medicine, and Lancet) and OA journals (n = 119; BioMedCentral series, PLoS journals) in 2016 and 2017. Results Abstracts in subscription journals completely reported 79% (95% confidence interval [CI], 77–81%) of 16 CONSORT-A items, compared with 65% (95% CI, 63–67%) of these items in abstracts from OA journals (P < 0.001, chi-square test). The median number of completely reported CONSORT-A items was 13 (95% CI, 12–13) in subscription journal articles and 11 (95% CI, 10–11) in OA journal articles. Subscription journal articles had significantly more complete reporting than OA journal articles for nine CONSORT-A items and did not differ in reporting for items trial design, outcome, randomization, blinding (masking), recruitment, and conclusions. OA journals were better than subscription journals in reporting randomized study design in the title. Conclusion Abstracts of randomized controlled trials published in subscription medical journals have greater completeness of reporting than abstracts published in OA journals. OA journals should take appropriate measures to ensure that published articles contain adequate detail to facilitate understanding and quality appraisal of research reports about RCTs.
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Affiliation(s)
| | - Ana Marušić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia.
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de Lotbiniere-Bassett MP, Riva-Cambrin J, McDonald PJ. Conflict of interest policies and disclosure requirements in neurosurgical journals. J Neurosurg 2019; 131:264-270. [PMID: 30117775 DOI: 10.3171/2018.4.jns172751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 04/02/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE An increasing amount of funding in neurosurgery research comes from industry, which may create a conflict of interest (COI) and the potential to bias results. The reporting and handling of COIs have become difficult, particularly as explicit policies themselves and definitions thereof continue to vary between medical journals. In this study, the authors sought to evaluate the prevalence and comprehensiveness of COI policies among leading neurosurgical journals. METHODS The authors conducted a cross-sectional study of publicly available online disclosure policies in the 20 highest-ranking neurosurgical journals, as determined by Google Scholar Metrics, in July 2016. RESULTS Overall, 89.5% of the highest-impact neurosurgical journals included COI policy statements. Ten (53%) journals requested declaration of nonfinancial conflicts, while 2 journals specifically set a time period for COIs. Sixteen journals required declaration from the corresponding author, 13 from all authors, 6 from reviewers, and 5 from editors. Four journals were included in the International Committee of Medical Journal Editors (ICMJE) list of publications that follow the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (currently known as Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals). Five journal policies included COI declaration verification, management, or enforcement. The neurosurgery journals with more comprehensive COI policies were significantly more likely to have higher h5-indices (p = 0.003) and higher impact factors (p = 0.01). CONCLUSIONS In 2016, the majority of, but not all, high-impact neurosurgical journals had publically available COI disclosure policies. Policy inclusiveness and comprehensiveness varied substantially across neurosurgical journals, but COI comprehensiveness was associated with other established markers of individual journals' favorability and influence, such as impact factor and h5-index.
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Affiliation(s)
| | - Jay Riva-Cambrin
- 5Division of Neurosurgery, Department of Clinical Neurosciences, and
- 6Alberta Children's Hospital, University of Calgary, Alberta, Canada
| | - Patrick J McDonald
- 1Faculty of Medicine and
- 1Faculty of Medicine and
- 1Faculty of Medicine and
- 4Department of Surgery, University of British Columbia, Vancouver, British Columbia; and
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Ellison TS, Koder T, Schmidt L, Williams A, Winchester CC. Open access policies of leading medical journals: a cross-sectional study. BMJ Open 2019; 9:e028655. [PMID: 31227538 PMCID: PMC6596940 DOI: 10.1136/bmjopen-2018-028655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/14/2019] [Accepted: 05/10/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES Academical and not-for-profit research funders are increasingly requiring that the research they fund must be published open access, with some insisting on publishing with a Creative Commons Attribution (CC BY) licence to allow the broadest possible use. We aimed to clarify the open access variants provided by leading medical journals and record the availability of the CC BY licence for commercially funded research. METHODS We identified medical journals with a 2015 impact factor of ≥15.0 on 24 May 2017, then excluded from the analysis journals that only publish review articles. Between 29 June 2017 and 26 July 2017, we collected information about each journal's open access policies from their websites and/or by email contact. We contacted the journals by email again between 6 December 2017 and 2 January 2018 to confirm our findings. RESULTS Thirty-five medical journals publishing original research from 13 publishers were included in the analysis. All 35 journals offered some form of open access allowing articles to be free-to-read, either immediately on publication or after a delay of up to 12 months. Of these journals, 21 (60%) provided immediate open access with a CC BY licence under certain circumstances (eg, to specific research funders). Of these 21, 20 only offered a CC BY licence to authors funded by non-commercial organisations and one offered this option to any funder who required it. CONCLUSIONS Most leading medical journals do not offer to authors reporting commercially funded research an open access licence that allows unrestricted sharing and adaptation of the published material. The journals' policies are therefore not aligned with open access declarations and guidelines. Commercial research funders lag behind academical funders in the development of mandatory open access policies, and it is time for them to work with publishers to advance the dissemination of the research they fund.
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Affiliation(s)
| | - Tim Koder
- Oxford PharmaGenesis Ltd, Oxford, UK
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Grey P, Grey A, Bolland MJ. Outcomes, Interventions and Funding in Randomised Research Published in High-Impact Journals. Trials 2018; 19:592. [PMID: 30373636 PMCID: PMC6206943 DOI: 10.1186/s13063-018-2978-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 10/12/2018] [Indexed: 11/16/2022] Open
Abstract
Background Randomised clinical trials are pivotal in guiding clinical practice. Trials with surrogate outcomes and industry sponsorship might be less reliable than those with hard outcomes and independent sponsorship. The types of interventions evaluated in randomised clinical trials might not reflect the diversity of those employed in clinical practice. Methods We assessed the types of primary outcome, types of intervention and sponsorship of 360 randomised clinical trials evaluating 416 interventions, published in seven major general medical journals and 10 speciality medical journals in five clinical disciplines. Results Primary outcomes were surrogate in 223/360 (62%) trials. Neither type of journal nor source of sponsorship was associated with type of primary outcome. Among the interventions evaluated, 233/416 (56%) were drugs, 17/416 (4%) devices and 49/416 (12%) procedures. The majority of trials were non-industry funded (220/360, 61%). Trials of drug interventions and those with industry sponsorship were more common in specialty than general journals (68% vs 48% and 55% vs 25%, respectively). Industry sponsorship was not associated with results for the primary outcome but was strongly associated with trials of drugs and devices. Within the groups of both general and speciality journals, there were wide ranges in the prevalence of industry funding (7–63% and 37–70%, respectively), but in all cases the prevalence of hard primary outcomes was <40%. Conclusions Most randomised clinical trials published in influential journals reported surrogate primary outcomes and assessed drug interventions. Trials that evaluated devices and procedures were infrequently published, despite the prominence of each type of intervention in clinical practice. Industry funding was more common for trials published in specialty than general journals but was not associated with more positive results for primary outcomes or with a greater preponderance of surrogate outcomes.
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Affiliation(s)
- Patrick Grey
- Department of Medicine, University of Auckland, Private Bag 92024, Auckland, New Zealand
| | - Andrew Grey
- Department of Medicine, University of Auckland, Private Bag 92024, Auckland, New Zealand.
| | - Mark J Bolland
- Department of Medicine, University of Auckland, Private Bag 92024, Auckland, New Zealand
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Abbas M, Pires D, Peters A, Morel CM, Hurst S, Holmes A, Saito H, Allegranzi B, Lucet JC, Zingg W, Harbarth S, Pittet D. Conflicts of interest in infection prevention and control research: no smoke without fire. A narrative review. Intensive Care Med 2018; 44:1679-1690. [PMID: 30206643 DOI: 10.1007/s00134-018-5361-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/29/2018] [Indexed: 02/07/2023]
Abstract
Conflicts of interest (COIs) do occur in healthcare research, yet their impact on research in the field of infection prevention and control (IPC) is unknown. We conducted a narrative review aiming to identify examples of COIs in IPC research. In addition to well-known instances, we conducted PubMed and Google searches to identify and report case studies of COIs in IPC and antimicrobial resistance (AMR), which were chosen arbitrarily following consensus meetings, to illustrate different types of COIs. We also searched the Retraction Watch database and blog to systematically identify retracted IPC and/or infectious disease-related papers. Our review highlights COIs in academic research linked to ties between industry and physicians, journal editors, peer-reviewed journals' choice for publication, and guideline committees participants and authors. It explores how COIs can affect research and could be managed. We also present several selected case studies that involve (1) the chlorhexidine industry and how it has used marketing trials and key opinion leaders to promote off-label use of its products; (2) the copper industry and how reporting of its trials in IPC have furthered their agenda; (3) the influence of a company developing "closed infusion systems" for catheters and how this affects networks in low- and middle-income countries and guideline development; (4) potential perverse incentives hospitals may have in reporting healthcare-associated infection or AMR rates and how government intervention may restrict AMR research for fear of bad publicity and subsequent negative economic consequences. Finally, the analysis of reasons for the retraction of previously published papers highlights the fact that misconduct in research may have other motivations than financial gain, the most visible form of COIs. COIs occur in the field of research in general, and IPC and AMR are no exceptions. Their effects pervade all aspects of the research and publication processes. We believe that, in addition to improvements in management strategies of COIs, increased public funding should be available to decrease researchers' dependency on industry ties. Further research is needed on COIs and their management.
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Affiliation(s)
- Mohamed Abbas
- Infection Control Programme, University of Geneva, Hospitals and Faculty of Medicine, WHO Collaborating Centre on Patient Safety (Infection Control and Improving Practices), Geneva, Switzerland.
| | - Daniela Pires
- Infection Control Programme, University of Geneva, Hospitals and Faculty of Medicine, WHO Collaborating Centre on Patient Safety (Infection Control and Improving Practices), Geneva, Switzerland.,Department of Infectious Diseases, Centro Hospitalar Lisboa Norte and Faculdade de Medicine da Universidade de Lisboa, Lisbon, Portugal
| | - Alexandra Peters
- Infection Control Programme, University of Geneva, Hospitals and Faculty of Medicine, WHO Collaborating Centre on Patient Safety (Infection Control and Improving Practices), Geneva, Switzerland
| | - Chantal M Morel
- Infection Control Programme, University of Geneva, Hospitals and Faculty of Medicine, WHO Collaborating Centre on Patient Safety (Infection Control and Improving Practices), Geneva, Switzerland
| | - Samia Hurst
- Institute for Ethics, History, and the Humanities, University of Geneva Medical School, Geneva, Switzerland
| | - Alison Holmes
- Department of Infectious Diseases and the NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - Hiroki Saito
- Infection Prevention and Control Global Unit, Department of Service Delivery and Safety, World Health Organization, 1211, Geneva, Switzerland
| | - Benedetta Allegranzi
- Infection Prevention and Control Global Unit, Department of Service Delivery and Safety, World Health Organization, 1211, Geneva, Switzerland
| | | | - Walter Zingg
- Infection Control Programme, University of Geneva, Hospitals and Faculty of Medicine, WHO Collaborating Centre on Patient Safety (Infection Control and Improving Practices), Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Programme, University of Geneva, Hospitals and Faculty of Medicine, WHO Collaborating Centre on Patient Safety (Infection Control and Improving Practices), Geneva, Switzerland
| | - Didier Pittet
- Infection Control Programme, University of Geneva, Hospitals and Faculty of Medicine, WHO Collaborating Centre on Patient Safety (Infection Control and Improving Practices), Geneva, Switzerland
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DeCensi A, Numico G, Ballatori E, Artioli F, Clerico M, Fioretto L, Livellara V, Ruggeri B, Tomirotti M, Verusio C, Roila F. Conflict of interest among Italian medical oncologists: a national survey. BMJ Open 2018; 8:e020912. [PMID: 29961019 PMCID: PMC6042593 DOI: 10.1136/bmjopen-2017-020912] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 04/03/2018] [Accepted: 05/04/2018] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To assess Italian medical oncologists' opinion on the implications of conflict of interest (COI) on medical education, care and research, and to evaluate their direct financial relationships. DESIGN National cross-sectional survey conducted between March and April 2017 among Italian oncologists. SETTING Online survey sponsored by the Italian College of Medical Oncology Chiefs through its website. PARTICIPANTS Italian oncologists who filled out an anonymous questionnaire including 19 items and individual and working characteristics. MAIN OUTCOME MEASURE The proportion of medical oncologists perceiving COI as an outstanding issue and those receiving direct payments from industry. RESULTS There were 321 respondents, representing 13% of Italian tenured medical oncologists. Overall, 62% declared direct payments from the pharmaceutical industry in the last 3 years. Sixty-eight per cent felt the majority of Italian oncologists have a COI with industry, but 59% suppose this is not greater than that of other specialties. Eighty-two per cent consider that most oncology education is supported by industry. More than 75% believe that current allocation of industry budget on marketing and promotion rather than research and development is unfair, but 75% consider it appropriate to receive travel and lodging hospitality from industry. A median net profit margin of €5000 per patient enrolled in an industry trial was considered appropriate for the employee institution. Sixty per cent agree to receive a personal fee for patients enrolled in industry trials, but 79% state this should be reported in the informed consent. Over 90% believe that scientific societies should publish a financial report of industry support. Finally, 79% disagree to being a coauthor of an article written by a medical writer when no substantial scientific contribution is made. CONCLUSIONS Among Italian oncologists COI is perceived as an important issue influencing costs, education, care and science. A more rigorous policy on COI should be implemented.
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Affiliation(s)
- Andrea DeCensi
- Division of Medical Oncology, Galliera Hospital, Genova, Italy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Gianmauro Numico
- Division of Medical Oncology, SS Antonio e Biagio Hospital, Alessandria, Italy
| | | | - Fabrizio Artioli
- Department of Oncology, Carpi and Mirandola Hospitals, Carpi e Mirandola, Italy
| | - Mario Clerico
- Department of Medical Oncology, Hospital of Biella, Biella, Italy
- CIPOMO, Milan, Italy
| | - Luisa Fioretto
- Department of Oncology, SM Annunziata Hospital, Florence, Italy
| | | | - Benedetta Ruggeri
- Clinical Governance, Area Vasta 5, ASUR Marche, Ascoli Piceno, Italy
| | | | - Claudio Verusio
- Division of Medical Oncology, ASST Valle Olona, Saronno, Italy
| | - Fausto Roila
- Division of Medical Oncology, Ospedale Santa Maria, Terni, Italy
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Original Abstracts from the 14th Annual Meeting of ISMPP. Curr Med Res Opin 2018; 34:9-28. [PMID: 29708453 DOI: 10.1080/03007995.2018.1440994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Bantel C, Laycock HC. Between evidence and commerce - the case of sufentanil sublingual tablet systems. Anaesthesia 2017; 73:143-147. [PMID: 29219168 PMCID: PMC5814728 DOI: 10.1111/anae.14037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 12/12/2022]
Affiliation(s)
- C Bantel
- Pain Medicine and Anaesthesia, Klinikum Oldenburg AöR, Oldenburg, Germany.,Imperial College London, London, UK
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23
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Matheson A. Marketing trials, marketing tricks - how to spot them and how to stop them. Trials 2017; 18:105. [PMID: 28270221 PMCID: PMC5341186 DOI: 10.1186/s13063-017-1827-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 02/08/2017] [Indexed: 01/10/2023] Open
Abstract
Background Last this year in this journal, Barbour and colleagues reported a study of “marketing trials” in leading medical journals (Trials 2016;17:31). In this commentary I discuss their research, describe new analyses of the study cohort and consider measures to address marketing within academic medical literature. Discussion Barbour et al. sought to identify a subgroup of “marketing trials” within leading medical journals, but in reality, nearly all industry-financed trials serve marketing functions, and many exhibit marketing-related features, including biases, in their framing, methodology or reporting. I conducted new analyses of the cohort of Barbour et al., showing that most trials funded exclusively by drug manufacturers had direct involvement of the manufacturer in design, analysis and reporting, and features supportive of product seeding. However, these commercial enterprises were without exception presented to journal readers as academic-led projects, using attributional spin, which should itself be considered an important form of marketing bias. Barbour et al. correctly conclude that commercial bias in industry clinical trials articles often requires expertise to recognize, and in many cases cannot be identified from the published journal report. Several potential remedies are discussed, including independent clinical research, data sharing, improved reporting guidance, improved tools for assessing research quality, reforms to article attribution, submission checklists and new editorial standards. Conclusion Medicine’s journals have a responsibility to uphold rigorous scientific and reporting standards, require ready trials data access and ensure the commercial dimensions of research are brought prominently to their readers’ attention. Failure to meet these responsibilities constitutes an enduring threat to the integrity of biomedical literature. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1827-5) contains supplementary material, which is available to authorized users.
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Dedmon RE. ‘Lies, damned lies, and statistics’: pharmaceutical, device, and academic enterprises ‘in the dock’. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0502.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Robert E. Dedmon
- Medical College of Wisconsin, Milwaukee, Wisconsin 53226, MD MPH FACPFACOEM, 333 Park Drive, Neenah, United States of America
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Angelakis E. Weight gain by gut microbiota manipulation in productive animals. Microb Pathog 2016; 106:162-170. [PMID: 27836763 DOI: 10.1016/j.micpath.2016.11.002] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 06/23/2016] [Accepted: 11/07/2016] [Indexed: 12/16/2022]
Abstract
Antibiotics, prebiotics and probiotics are widely used as growth promoters in agriculture. In the 1940s, use of Streptomyces aureofaciens probiotics resulted in weight gain in animals, which led to the discovery of chlortetracycline. Tetracyclines, macrolides, avoparcin and penicillins have been commonly used in livestock agriculture to promote growth through increased food intake, weight gain, and improved herd health. Prebiotic supplements including oligosaccharides, fructooligosaccharides, and galactosyl-lactose improve the growth performance of animals. Probiotics used in animal feed are mainly bacterial strains of Gram-positive bacteria and have been effectively used for weight gain in chickens, pigs, ruminants and in aquaculture. Antibiotics, prebiotics and probiotics all modify the gut microbiota and the effect of a probiotic species on the digestive flora is probably determined by bacteriocin production. Regulations governing the introduction of novel probiotics and prebiotics vary by geographical region and bias is very common in industry-funded studies. Probiotic and prebiotic foods have been consumed for centuries, either as natural components of food, or as fermented foods and it is possible to cause the same weight gain effects in humans as in animals. This review presents the use of growth promoters in food-producing animals to influence food intake and weight gain.
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Affiliation(s)
- Emmanouil Angelakis
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes: URMITE CNRS-IRD 198 UMR 6236, Aix Marseille Université, Faculté de Médecine, 27 Bd Jean Moulin, 13385, Marseille, France
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Mandrioli D, Kearns CE, Bero LA. Relationship between Research Outcomes and Risk of Bias, Study Sponsorship, and Author Financial Conflicts of Interest in Reviews of the Effects of Artificially Sweetened Beverages on Weight Outcomes: A Systematic Review of Reviews. PLoS One 2016; 11:e0162198. [PMID: 27606602 PMCID: PMC5015869 DOI: 10.1371/journal.pone.0162198] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 08/18/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Artificially sweetened beverage consumption has steadily increased in the last 40 years. Several reviews examining the effects of artificially sweetened beverages on weight outcomes have discrepancies in their results and conclusions. OBJECTIVES To determine whether risk of bias, results, and conclusions of reviews of effects of artificially sweetened beverage consumption on weight outcomes differ depending on review sponsorship and authors' financial conflicts of interest. METHODS We performed a systematic review of reviews of the effects of artificially sweetened beverages on weight. Two assessors independently screened articles for inclusion, extracted data, and assessed risks of bias. We compared risk of bias, results and conclusions of reviews by different industry sponsors, authors' financial conflict of interest and journal sponsor. We also report the concordance between review results and conclusions. RESULTS Artificial sweetener industry sponsored reviews were more likely to have favorable results (3/4) than non-industry sponsored reviews (1/23), RR: 17.25 (95% CI: 2.34 to 127.29), as well as favorable conclusions (4/4 vs. 15/23), RR: 1.52 (95% CI: 1.14 to 2.06). All reviews funded by competitor industries reported unfavorable conclusions (4/4). In 42% of the reviews (13/31), authors' financial conflicts of interest were not disclosed. Reviews performed by authors that had a financial conflict of interest with the food industry (disclosed in the article or not) were more likely to have favorable conclusions (18/22) than reviews performed by authors without conflicts of interest (4/9), RR: 7.36 (95% CI: 1.15 to 47.22). Risk of bias was similar and high in most of the reviews. CONCLUSIONS Review sponsorship and authors' financial conflicts of interest introduced bias affecting the outcomes of reviews of artificially sweetened beverage effects on weight that could not be explained by other sources of bias.
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Affiliation(s)
- Daniele Mandrioli
- Cesare Maltoni Cancer Research Center, Ramazzini Institute, Bentivoglio, Bologna, Italy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Cristin E Kearns
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, United States of America
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, San Francisco, California, United States of America
| | - Lisa A. Bero
- Charles Perkins Centre and Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
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Dal-Ré R. Are the Most Prestigious Medical Journals Transparent Enough? Trends Pharmacol Sci 2016; 37:731-733. [DOI: 10.1016/j.tips.2016.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 06/09/2016] [Indexed: 02/05/2023]
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Newton A, Lloyd-Williams F, Bromley H, Capewell S. Food for thought? Potential conflicts of interest in academic experts advising government and charities on dietary policies. BMC Public Health 2016; 16:735. [PMID: 27495802 PMCID: PMC4975877 DOI: 10.1186/s12889-016-3393-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 07/27/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND A conflict of interest (CoI) can occur between public duty and private interest, in which a public official's private-capacity interest could improperly influence the performance of their official duties and responsibilities. The most tangible and commonly considered CoI are financial. However, CoI can also arise due to other types of influence including interpersonal relationships, career progression, or ideology. CoI thus exist in academia, business, government and non-governmental organisations. However, public knowledge of CoI is currently limited due to a lack of information. The mechanisms of managing potential conflicts of interest also remain unclear due to a lack of guidelines. We therefore examined the independence of academic experts and how well potential CoI are identified and addressed in four government and non-governmental organisations in the UK responsible for the development of food policy. METHODS Policy analysis. We developed an analytical framework to explore CoI in high-level UK food policy advice, using four case studies. Two government policy-making bodies: Department of Health 'Obesity Review Group' (ORG), 'Scientific Advisory Committee on Nutrition' (SACN) and two charities: 'Action on Sugar' (AoS), & 'Heart of Mersey' (HoM). Information was obtained from publicly available sources and declarations. We developed a five point ordinal scale based upon the ideology of the Nolan Principles of Public Life. Group members were individually categorised on the ordinal ConScale from "0", (complete independence from the food and drink industry) to "4", (employed by the food and drink industry or a representative organisation). RESULTS CoI involving various industries have long been evident in policy making, academia and clinical practice. Suggested approaches for managing CoI could be categorised as "deny", "describe", or "diminish". Declared CoI were common in the ORG and SACN. 4 out of 28 ORG members were direct industry employees. In SACN 11 out of 17 members declared industry advisory roles or industry research funding. The two charities appeared to have equally strong academic expertise but fewer conflicts. No HoM members declared CoI. 5 out of 21 AoS members declared links with industry, mainly pharmaceutical companies. We were unable to obtain information on conflicts for some individuals. CONCLUSIONS Conflicts of interest are unavoidable but potentially manageable. Government organisations responsible for policy development and implementation must institutionalize an approach to identify (disclose) and manage (mitigate or eliminate) perceived and actual CoI to improve public confidence in government decision-making relevant to food policy.
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Affiliation(s)
- Alex Newton
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
| | - Ffion Lloyd-Williams
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK.
| | - Helen Bromley
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
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Vercellini P, Buggio L, Viganò P, Somigliana E. Peer review in medical journals: Beyond quality of reports towards transparency and public scrutiny of the process. Eur J Intern Med 2016; 31:15-9. [PMID: 27129625 DOI: 10.1016/j.ejim.2016.04.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 04/08/2016] [Accepted: 04/12/2016] [Indexed: 02/07/2023]
Abstract
Published medical research influences health care providers and policy makers, guides patient management, and is based on the peer review process. Peer review should prevent publication of unreliable data and improve study reporting, but there is little evidence that these aims are fully achieved. In the blinded systems, authors and readers do not know the reviewers' identity. Moreover, the reviewers' reports are not made available to readers. Anonymous peer review poses an ethical imbalance toward authors, who are judged by masked referees, and to the medical community and society at large, in case patients suffer the consequences of acceptance of flawed manuscripts or erroneous rejection of important findings. Some general medical journals have adopted an open process, require reviewers to sign their reports, and links online pre-publication histories to accepted articles. This system increases editors' and reviewers' accountability and allows public scrutiny, consenting readers understand on which basis were decisions taken and by whom. Moreover, this gives credit to reviewers for their apparently thankless job, as online availability of signed and scored reports may contribute to researchers' academic curricula. However, the transition from the blind to the open system could pose problems to journals. Reviewers may be more difficult to find, and publishers or medical societies could resist changes that may affect editorial costs and journals' revenues. Nonetheless, also considering the risk of competing interests in the medical field, general and major specialty journals could consider testing the effects of open review on manuscripts regarding studies that may influence clinical practice.
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Affiliation(s)
- Paolo Vercellini
- Department of Womens' and Children's Health, Istituto "Luigi Mangiagalli", Università degli Studi di Milano, Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy.
| | - Laura Buggio
- Department of Womens' and Children's Health, Istituto "Luigi Mangiagalli", Università degli Studi di Milano, Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy.
| | - Paola Viganò
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Via Olgettina 60, 20132 Milano, Italy.
| | - Edgardo Somigliana
- Infertility Unit, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Via Manfredo Fanti 6, 20122 Milan, Italy.
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Brænd AM, Straand J, Jakobsen RB, Klovning A. Publication and non-publication of drug trial results: a 10-year cohort of trials in Norwegian general practice. BMJ Open 2016; 6:e010535. [PMID: 27067893 PMCID: PMC4838717 DOI: 10.1136/bmjopen-2015-010535] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Previously, we identified a 10-year cohort of protocols from applications to the Norwegian Medicines Agency 1998-2007, consisting of 196 drug trials in general practice. The aim of this study was to examine whether trial results were published and whether trial funding and conflicts of interest were reported. DESIGN Cohort study of trials with systematic searches for published results. SETTING Clinical drug trials in Norwegian general practice. METHODS We performed systematic literature searches of MEDLINE, Embase and CENTRAL to identify publications originating from each trial using characteristics such as test drug, comparator and patient groups as search terms. When no publication was identified, we contacted trial sponsors for information regarding trial completion and reference to any publications. MAIN OUTCOME MEASURES We determined the frequency of publication of trial results and trial characteristics associated with publication of results. RESULTS Of the 196 trials, 5 were never started. Of the remaining 191 trials, 71% had results published in a journal, 11% had results publicly available elsewhere and 18% of trials had no results available. Publication was more common among trials with an active comparator drug (χ(2) test, p=0.040), with a larger number of patients (total sample size≥median, p=0.010) and with a longer trial period (duration≥median, p=0.025). Trial funding was reported in 85% of publications and increased over time, as did reporting of conflicts of interest among authors. Among the 134 main journal articles from the trials, 60% presented statistically significant results for the investigational drug, and the conclusion of the article was favourable towards the test drug in 78% of papers. CONCLUSIONS We did not identify any journal publication of results for 29% of the general practice drug trials. Trials with an active comparator, larger and longer trials were more likely to be published.
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Affiliation(s)
- Anja Maria Brænd
- Faculty of Medicine, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jørund Straand
- Faculty of Medicine, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Rune Bruhn Jakobsen
- Faculty of Medicine, Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Orthopedic Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Atle Klovning
- Faculty of Medicine, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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The ICMJE Recommendations and pharmaceutical marketing--strengths, weaknesses and the unsolved problem of attribution in publication ethics. BMC Med Ethics 2016; 17:20. [PMID: 27044283 PMCID: PMC4820950 DOI: 10.1186/s12910-016-0103-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 03/24/2016] [Indexed: 11/17/2022] Open
Abstract
Background The International Committee of Medical Journal Editors (ICMJE) Recommendations set ethical and editorial standards for article publication in most leading medical journals. Here, I examine the strengths and weaknesses of the Recommendations in the prevention of commercial bias in industry-financed journal literature, on three levels – scholarly discourse, article content, and article attribution. Discussion With respect to overall discourse, the most important measures in the ICMJE Recommendations are for enforcing clinical trial registration and controlling duplicate publication. With respect to article content, the ICMJE promotes stringent author accountability and adherence to established reporting standards. However, the ICMJE accepts the use of commercial editorial teams to produce manuscripts, which is a potential source of bias, and accepts private company ownership and analysis of clinical trial data. New ICMJE guidance on data sharing will address but not eliminate problems of commercial data access. With respect to attribution, the Recommendations oppose guest authorship and encourage clear documentation of author contributions. However, they exclude writers from coauthorship; provide no specific advice on the attribution of commercial literature, for instance with respect to company authorship, author sequence or prominent commercial labeling; and endorse the use of fine print and euphemism. The ICMJE requires detailed author interest disclosures, but overlooks the interests of non-authors and companies, and does not recommend that interests most salient to the publication are highlighted. Together, these weaknesses facilitate “advocacy”-based marketing, in which literature planned, financed and produced by companies is fronted by academics, enabling commercial messages to be presented to customers by their respected clinical peers rather than companies themselves. Conclusions The ICMJE Recommendations set important research and reporting standards, without which commercial bias would likely be a significantly greater problem than it is today. However, they also support practices of commercial data control, content development and attribution that run counter to science’s values of openness, objectivity and truthfulness. These weaknesses could be addressed with appropriate modifications to the Recommendations. The ICMJE should also disclose its own commercial interests and funding – not least because publishing organizations that finance it and pay the salaries of some member editors derive substantial revenues from industry.
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Bassler D, Mueller KF, Briel M, Kleijnen J, Marusic A, Wager E, Antes G, von Elm E, Altman DG, Meerpohl JJ. Bias in dissemination of clinical research findings: structured OPEN framework of what, who and why, based on literature review and expert consensus. BMJ Open 2016; 6:e010024. [PMID: 26801469 PMCID: PMC4735132 DOI: 10.1136/bmjopen-2015-010024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/07/2015] [Accepted: 12/29/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this study is to review highly cited articles that focus on non-publication of studies, and to develop a consistent and comprehensive approach to defining (non-) dissemination of research findings. SETTING We performed a scoping review of definitions of the term 'publication bias' in highly cited publications. PARTICIPANTS Ideas and experiences of a core group of authors were collected in a draft document, which was complemented by the findings from our literature search. INTERVENTIONS The draft document including findings from the literature search was circulated to an international group of experts and revised until no additional ideas emerged and consensus was reached. PRIMARY OUTCOMES We propose a new approach to the comprehensive conceptualisation of (non-) dissemination of research. SECONDARY OUTCOMES Our 'What, Who and Why?' approach includes issues that need to be considered when disseminating research findings (What?), the different players who should assume responsibility during the various stages of conducting a clinical trial and disseminating clinical trial documents (Who?), and motivations that might lead the various players to disseminate findings selectively, thereby introducing bias in the dissemination process (Why?). CONCLUSIONS Our comprehensive framework of (non-) dissemination of research findings, based on the results of a scoping literature search and expert consensus will facilitate the development of future policies and guidelines regarding the multifaceted issue of selective publication, historically referred to as 'publication bias'.
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Affiliation(s)
- Dirk Bassler
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Katharina F Mueller
- Center for Pediatric Clinical Studies, University Children's Hospital Tuebingen, Tuebingen, Germany
| | - Matthias Briel
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Jos Kleijnen
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Ana Marusic
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | | | - Gerd Antes
- German Cochrane Centre, Medical Center—University of Freiburg, Freiburg, Germany
| | - Erik von Elm
- Cochrane Switzerland, IUMSP, University Hospital Lausanne, Lausanne, Switzerland
| | - Douglas G Altman
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Joerg J Meerpohl
- German Cochrane Centre, Medical Center—University of Freiburg, Freiburg, Germany
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Dal-Ré R. Number of citations 1 year after publication of trial results and their relation to medicines regulatory approval. Br J Clin Pharmacol 2015; 81:786-8. [PMID: 26588052 DOI: 10.1111/bcp.12832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/04/2015] [Accepted: 11/12/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
- Rafael Dal-Ré
- Clinical Research, BUC (Biosciences UAM+CSIC) Program, International Campus of Excellence, Universidad Autónoma de Madrid, Madrid, Spain
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Naudet F, Falissard B, Boussageon R, Healy D. Has evidence-based medicine left quackery behind? Intern Emerg Med 2015; 10:631-4. [PMID: 25828467 DOI: 10.1007/s11739-015-1227-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 03/03/2015] [Indexed: 11/25/2022]
Abstract
Evidence-based medicine (EBM) is generally considered as the most complete paradigm in the practice of clinical medicine. Its application should preclude all kinds of quackery. Therapeutic reformers of the second half of the twentieth century have convinced the medical community that the double-blind randomized controlled trial (RCT) versus placebo is the gold standard in clinical research to establish evidence of treatment usefulness. Nevertheless, this paradigm ignores the importance of non-specific effects in the healing process and can generate misrepresentations. Additionally, because of methodological limitations, RCTs as they are used in practice can give rise to new forms of quackery by promoting drugs that are not useful for the patients who actually receive them, or are so expensive that their value is open to criticism. This is precisely the case when surrogate outcomes, with questionable clinical significance, are used. These can divert attention from clinically relevant outcomes, such as safety issues that are probably the core of treatment evaluation. The boundaries between quackery and EBM that clinicians are faced with are not so clear-cut. There is a need for doctors to acknowledge their share in quackery and to be continually conscious of the possible pitfalls of their therapeutic practice.
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Affiliation(s)
- Florian Naudet
- Centre d'Investigation Clinique, CIC-P INSERM 1414, Centre Hospitalier Universitaire de Rennes et Université de Rennes 1, Rennes, France,
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Vardakas KZ, Tsopanakis G, Poulopoulou A, Falagas ME. An analysis of factors contributing to PubMed's growth. J Informetr 2015. [DOI: 10.1016/j.joi.2015.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fordyce CB, Roe MT, Ahmad T, Libby P, Borer JS, Hiatt WR, Bristow MR, Packer M, Wasserman SM, Braunstein N, Pitt B, DeMets DL, Cooper-Arnold K, Armstrong PW, Berkowitz SD, Scott R, Prats J, Galis ZS, Stockbridge N, Peterson ED, Califf RM. Cardiovascular drug development: is it dead or just hibernating? J Am Coll Cardiol 2015; 65:1567-82. [PMID: 25881939 DOI: 10.1016/j.jacc.2015.03.016] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/03/2015] [Accepted: 03/03/2015] [Indexed: 12/19/2022]
Abstract
Despite the global burden of cardiovascular disease, investment in cardiovascular drug development has stagnated over the past 2 decades, with relative underinvestment compared with other therapeutic areas. The reasons for this trend are multifactorial, but of primary concern is the high cost of conducting cardiovascular outcome trials in the current regulatory environment that demands a direct assessment of risks and benefits, using clinically-evident cardiovascular endpoints. To work toward consensus on improving the environment for cardiovascular drug development, stakeholders from academia, industry, regulatory bodies, and government agencies convened for a think tank meeting in July 2014 in Washington, DC. This paper summarizes the proceedings of the meeting and aims to delineate the current adverse trends in cardiovascular drug development, understand the key issues that underlie these trends within the context of a recognized need for a rigorous regulatory review process, and provide potential solutions to the problems identified.
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Affiliation(s)
| | - Matthew T Roe
- Duke Clinical Research Institute, Durham, North Carolina
| | - Tariq Ahmad
- Duke Clinical Research Institute, Durham, North Carolina
| | - Peter Libby
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey S Borer
- State University of New York Downstate Medical Center, Brooklyn, New York
| | | | | | - Milton Packer
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Bertram Pitt
- University of Michigan School of Medicine, Ann Arbor, Michigan
| | - David L DeMets
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Katharine Cooper-Arnold
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Paul W Armstrong
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | | | - Rob Scott
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jayne Prats
- The Medicines Company, Parsippany, New Jersey
| | - Zorina S Galis
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Norman Stockbridge
- Division of Cardiovascular and Renal Products, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, Maryland
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Seshia SS, Makhinson M, Phillips DF, Young GB. Evidence-informed person-centered healthcare part I: do 'cognitive biases plus' at organizational levels influence quality of evidence? J Eval Clin Pract 2014; 20:734-47. [PMID: 25429739 DOI: 10.1111/jep.12280] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2014] [Indexed: 12/17/2022]
Abstract
INTRODUCTION There is increasing concern about the unreliability of much of health care evidence, especially in its application to individuals. HYPOTHESIS Cognitive biases, financial and non-financial conflicts of interest, and ethical violations (which, together with fallacies, we collectively refer to as 'cognitive biases plus') at the levels of individuals and organizations involved in health care undermine the evidence that informs person-centred care. METHODS This study used qualitative review of the pertinent literature from basic, medical and social sciences, ethics, philosophy, law etc. RESULTS Financial conflicts of interest (primarily industry related) have become systemic in several organizations that influence health care evidence. There is also plausible evidence for non-financial conflicts of interest, especially in academic organizations. Financial and non-financial conflicts of interest frequently result in self-serving bias. Self-serving bias can lead to self-deception and rationalization of actions that entrench self-serving behaviour, both potentially resulting in unethical acts. Individuals and organizations are also susceptible to other cognitive biases. Qualitative evidence suggests that 'cognitive biases plus' can erode the quality of evidence. CONCLUSIONS 'Cognitive biases plus' are hard wired, primarily at the unconscious level, and the resulting behaviours are not easily corrected. Social behavioural researchers advocate multi-pronged measures in similar situations: (i) abolish incentives that spawn self-serving bias; (ii) enforce severe deterrents for breaches of conduct; (iii) value integrity; (iv) strengthen self-awareness; and (v) design curricula especially at the trainee level to promote awareness of consequences to society. Virtuous professionals and organizations are essential to fulfil the vision for high-quality individualized health care globally.
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Affiliation(s)
- Shashi S Seshia
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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van Lent M, Overbeke J, Out HJ. Role of editorial and peer review processes in publication bias: analysis of drug trials submitted to eight medical journals. PLoS One 2014; 9:e104846. [PMID: 25118182 PMCID: PMC4130599 DOI: 10.1371/journal.pone.0104846] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 06/25/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Publication bias is generally ascribed to authors and sponsors failing to submit studies with negative results, but may also occur after submission. We evaluated whether submitted manuscripts on randomized controlled trials (RCTs) with drugs are more likely to be accepted if they report positive results. METHODS Manuscripts submitted from January 2010 through April 2012 to one general medical journal (BMJ) and seven specialty journals (Annals of the Rheumatic Diseases, British Journal of Ophthalmology, Gut, Heart, Thorax, Diabetologia, and Journal of Hepatology) were included, if at least one study arm assessed the efficacy or safety of a drug and a statistical test was used to evaluate treatment effects. Publication status was retrospectively retrieved from submission systems or provided by journals. Sponsorship and trial results were extracted from manuscripts and classified according to predefined criteria. Main outcome measure was acceptance for publication. RESULTS Of 15,972 manuscripts submitted, 472 (3.0%) were drug RCTs, of which 98 (20.8%) were published. Among submitted drug RCTs, 287 (60.8%) had positive and 185 (39.2%) negative results. Of these, 60 (20.9%) and 38 (20.5%), respectively, were published. Manuscripts on non-industry trials (n = 213) reported positive results in 138 (64.8%) manuscripts, compared to 71 (47.7%) on industry-supported trials (n = 149), and 78 (70.9%) on industry-sponsored trials (n = 110). Twenty-seven (12.7%) non-industry trials were published, compared to 27 (18.1%) industry-supported and 44 (40.0%) industry-sponsored trials. After adjustment for other trial characteristics, manuscripts reporting positive results were not more likely to be published (OR, 1.00; 95% CI, 0.61 to 1.66). Submission to specialty journals, sample size, multicentre status, journal impact factor, and corresponding authors from Europe or US were significantly associated with publication. CONCLUSIONS For the selected journals, there was no tendency to preferably publish manuscripts on drug RCTs that reported positive results, suggesting that publication bias may occur mainly prior to submission.
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Affiliation(s)
- Marlies van Lent
- Clinical Research Centre Nijmegen, Department of Pharmacology – Toxicology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - John Overbeke
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Henk Jan Out
- Clinical Research Centre Nijmegen, Department of Pharmacology – Toxicology, Radboud University Medical Centre, Nijmegen, The Netherlands
- Teva Pharmaceuticals, Amsterdam, The Netherlands
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Fenton JJ. Journals should lead the way in improving medical press releases. EVIDENCE-BASED MEDICINE 2014; 19:81-82. [PMID: 24578375 DOI: 10.1136/eb-2014-101745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Joshua J Fenton
- Department of Family and Community Medicine, University of California, Davis, California, USA
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Kong NHY, Chow PKH. Conflict of Interest in Research—The Clinician Scientist’s Perspective. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2013. [DOI: 10.47102/annals-acadmedsg.v42n11p623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Conflict of interest (COI) in research represents situations that pose risks of undue influence on scientific objectivity and judgment because of secondary interests. This is complex but is inherent to biomedical research. The role of a clinician scientist can be conflicted when scientific objectivity is perceived to compete with scientific success (publications, grants), partiality to patients (clinical trials), obligations to colleagues (allowing poor scholarship to pass), research sponsors (industry), and financial gains (patents, royalties). While there are many ways which COIs can occur in research, COI mitigations remain reliable. Collaborations between investigators and industry are valuable to the development of novel therapies and undue discouragement of these relationships may inadvertently harm the advancement of healthcare. As a result, proper management of COI is fundamental and crucial to the maintenance of long-term, mutually beneficial relationships between industry and academia. The nature of COI in research and methods of mitigation are discussed from the perspective of a clinician scientist.
Key words: Academia, Disclosure, Industry
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Impact of article language in multi-language medical journals--a bibliometric analysis of self-citations and impact factor. PLoS One 2013; 8:e76816. [PMID: 24146929 PMCID: PMC3798327 DOI: 10.1371/journal.pone.0076816] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 08/27/2013] [Indexed: 11/28/2022] Open
Abstract
Background In times of globalization there is an increasing use of English in the medical literature. The aim of this study was to analyze the influence of English-language articles in multi-language medical journals on their international recognition – as measured by a lower rate of self-citations and higher impact factor (IF). Methods and Findings We analyzed publications in multi-language journals in 2008 and 2009 using the Web of Science (WoS) of Thomson Reuters (former Institute of Scientific Information) and PubMed as sources of information. The proportion of English-language articles during the period was compared with both the share of self-citations in the year 2010 and the IF with and without self-citations. Multivariable linear regression analysis was performed to analyze these factors as well as the influence of the journals‘ countries of origin and of the other language(s) used in publications besides English. We identified 168 multi-language journals that were listed in WoS as well as in PubMed and met our criteria. We found a significant positive correlation of the share of English articles in 2008 and 2009 with the IF calculated without self-citations (Pearson r=0.56, p = <0.0001), a correlation with the overall IF (Pearson r = 0.47, p = <0.0001) and with the cites to years of IF calculation (Pearson r = 0.34, p = <0.0001), and a weak negative correlation with the share of self-citations (Pearson r = -0.2, p = 0.009). The IF without self-citations also correlated with the journal‘s country of origin – North American journals had a higher IF compared to Middle and South American or European journals. Conclusion Our findings suggest that a larger share of English articles in multi-language medical journals is associated with greater international recognition. Fewer self-citations were found in multi-language journals with a greater share of original articles in English.
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Abstract
The evidence-based medicine (EBM) paradigm, introduced in 1992, has had a major and positive impact on all aspects of health care. However, widespread use has also uncovered some limitations; these are discussed from the perspectives of two clinicians in this, the first of a two part narrative review. For example, there are credible reservations about the validity of hierarchical levels of evidence, a core element of the EBM paradigm. In addition, potential and actual methodological and statistical deficiencies have been identified, not only in many published randomized controlled trials but also in systematic reviews, both rated highly for evidence in EBM classifications. Ethical violations compromise reliability of some data. Clinicians need to be conscious of potential limitations in some of the cornerstones of the EBM paradigm, and to deficiencies in the literature.
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Quality of reporting of randomized controlled trials published in Intensive Care Medicine from 2001 to 2010. Intensive Care Med 2013; 39:1386-95. [PMID: 23743522 DOI: 10.1007/s00134-013-2947-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 04/21/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the methodological quality of randomized controlled trials (RCTs) published in Intensive Care Medicine from 2001 to 2010, and to compare it with a previous review of RCTs published from 1975 to 2000. METHODS We assessed the quality of reporting of randomization, blinding and participant flow, both individually and combined within the Jadad scale, and compared them with findings from our previous review. For RCTs published from 2001 to 2010, we also evaluated the frequency of distorted finding presentation (spin) and inflated predicted treatment effect (delta inflation). RESULTS In the 221 RCTs from 2001 to 2010, the sample size was significantly larger than in the older series, and there was a higher proportion of studies with negative findings. Reporting of the rationale for sample size estimation and allocation concealment increased significantly, but reporting of other important individual methodological components did not change substantially compared with the previous period and remained low. Among RCTs from 2001 to 2010, a spin strategy was used in 69 of 111 RCTs with statistically negative results, while delta inflation was present in 7 of 11 RCTs evaluating survival as a primary outcome. Papers with higher Jadad scores were cited more often than the others. CONCLUSIONS Quality of reporting of RCTs published in Intensive Care Medicine has only partly improved over time, and spin and delta bias are of frequent occurrence. There is a need for stronger adherence to CONSORT recommendations, with special emphasis on accurate description of randomization and blindness, and correct reporting of statistically non-significant results.
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Abstract
Publication bias undermines the integrity of the evidence base by inflating apparent drug efficacy and minimizing drug harms, thus skewing the risk-benefit ratio. This paper reviews the topic of publication bias with a focus on drugs prescribed for psychiatric conditions, especially depression, schizophrenia, bipolar disorder, and autism. Publication bias is pervasive; although psychiatry/psychology may be the most seriously afflicted field, it occurs throughout medicine and science. Responsibility lies with various parties (authors as well as journals, academia as well as industry), so the motives appear to extend beyond the financial interests of drug companies. The desire for success, in combination with cognitive biases, can also influence academic authors and journals. Amid the flood of new medical information coming out each day, the attention of the news media and academic community is more likely to be captured by studies whose results are positive or newsworthy. In the peer review system, a fundamental flaw arises from the fact that authors usually write manuscripts after they know the results. This allows hindsight and other biases to come into play, so data can be "tortured until they confess" (a detailed example is given). If a "publishable" result cannot be achieved, non-publication remains an option. To address publication bias, various measures have been undertaken, including registries of clinical trials. Drug regulatory agencies can provide valuable unpublished data. It is suggested that journals borrow from the FDA review model. Because the significance of study results biases reviewers, results should be excluded from review until after a preliminary judgment of study scientific quality has been rendered, based on the original study protocol. Protocol publication can further enhance the credibility of the published literature.
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Affiliation(s)
- Erick H Turner
- Behavioral Health and Neurosciences Division, Portland Veterans Affairs Medical Center, P3MHDC, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA.
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Gleicher N. Avoiding currently unavoidable conflicts of interest in medical publishing by transparent peer review. Reprod Biomed Online 2013; 26:411-5. [DOI: 10.1016/j.rbmo.2013.01.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 11/26/2012] [Accepted: 01/16/2013] [Indexed: 11/28/2022]
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Stamatakis E, Weiler R, Ioannidis JPA. Undue industry influences that distort healthcare research, strategy, expenditure and practice: a review. Eur J Clin Invest 2013; 43:469-75. [PMID: 23521369 DOI: 10.1111/eci.12074] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 02/24/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Expenditure on industry products (mostly drugs and devices) has spiraled over the last 15 years and accounts for substantial part of healthcare expenditure. The enormous financial interests involved in the development and marketing of drugs and devices may have given excessive power to these industries to influence medical research, policy, and practice. MATERIAL AND METHODS Review of the literature and analysis of the multiple pathways through which the industry has directly or indirectly infiltrated the broader healthcare systems. We present the analysis of the industry influences at the following levels: (i) evidence base production, (ii) evidence synthesis, (iii) understanding of safety and harms issues, (iv) cost-effectiveness evaluation, (v) clinical practice guidelines formation, (vi) healthcare professional education, (vii) healthcare practice, (viii) healthcare consumer's decisions. RESULTS We located abundance of consistent evidence demonstrating that the industry has created means to intervene in all steps of the processes that determine healthcare research, strategy, expenditure, practice and education. As a result of these interferences, the benefits of drugs and other products are often exaggerated and their potential harms are downplayed, and clinical guidelines, medical practice, and healthcare expenditure decisions are biased. CONCLUSION To serve its interests, the industry masterfully influences evidence base production, evidence synthesis, understanding of harms issues, cost-effectiveness evaluations, clinical practice guidelines and healthcare professional education and also exerts direct influences on professional decisions and health consumers. There is an urgent need for regulation and other action towards redefining the mission of medicine towards a more objective and patient-, population- and society-benefit direction that is free from conflict of interests.
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Affiliation(s)
- Emmanuel Stamatakis
- Department of Epidemiology and Public Health, University College London, London, UK.
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