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Hooimeyer A, Lines T, Mirzaei J, Pande P, Ganeshamoorthy S, Fabbri A, Parker L, Dunn AG, Mintzes B. Conflict of interest policies at Australian medical schools. Intern Med J 2024; 54:62-73. [PMID: 37255333 DOI: 10.1111/imj.16148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/28/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Pharmaceutical industry exposure is widespread during medical training and may affect education and clinical decision-making. Medical faculties' conflict of interest (COI) policies help to limit this exposure and protect students against commercial influence. AIMS Our aim was to investigate the prevalence, content and strength of COI policies at Australian medical schools and changes since a previous assessment conducted in 2009. METHODS We identified policies by searching medical school and host university websites in January 2021, and contacted deans to identify any missed policies. We applied a modified version of a scorecard developed in previous studies to examine the content of COI policies. All data were coded in duplicate. COI policies were rated on a scale from 0 (no policy) to 2 (strong policy) across 11 items per medical school. Oversight mechanisms and sanctions were also assessed, and current policies were compared with the 2009 study. RESULTS Of 155 potentially relevant policies, 153 were university-wide and two were specific to medical schools. No policies covered sales representatives, on-site sponsored education or free samples. Oversight of consultancies had improved substantially, with 76% of schools requiring preapproval. Disclosure policies, while usually present, were weak, with no public disclosure required. CONCLUSION We found little indication that Australian medical students are protected from commercial influence on medical education, and there has been limited COI policy development within the past decade. More attention is needed to ensure the independence of medical education in Australia.
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Affiliation(s)
- Ashleigh Hooimeyer
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Janet Mirzaei
- School of Medicine, University of Notre Dame Sydney, Sydney, New South Wales, Australia
| | - Preshita Pande
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Sylviya Ganeshamoorthy
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Alice Fabbri
- Department for Health, University of Bath, Bath, United Kingdom
| | - Lisa Parker
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Adam G Dunn
- Biomedical Informatics and Digital Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Barbara Mintzes
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Alexandra JF, Roux D, Maisonneuve H, Chousterman B, Ruszniewski P, Dreyfuss D. Toward improvement of knowledge of financial conflicts of interest in a large medical school in France. PLoS One 2023; 18:e0285894. [PMID: 37216355 DOI: 10.1371/journal.pone.0285894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/04/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION Conflict of interests (COIs) adversely affect the integrity of science and public health. The role of medical schools in the teaching and management of COIs has been highlighted by the publication of an annual evaluation of American medical schools based on their COIs policies by the American Medical Student Association (AMSA). A deontological charter was adopted by French medical schools in 2018 but its impact on COI comprehension by students and its effects on COI prevention were not evaluated. METHODS A 10-item direct survey was conducted among about 1000 students in Paris-Cité University in order to investigate the respect of the charter regarding COIs both in the medical school and in affiliated teaching hospitals. RESULTS Cumulative results show a satisfying respect of prevention policies regarding COIs in the medical school and hospitals despite the fact that the existence of the charter and its major aspects were insufficiently known. Disclosure of COIs by teachers was insufficient. CONCLUSION This first direct study among students shows better results than expected according to current non-academic surveys. Moreover, this study demonstrates the feasibility of this kind of survey whose repetition should be an appropriate tool to improve the implementation of the charter within medical schools and teaching hospitals, in particular mandatory disclosure of COIs by teachers.
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Affiliation(s)
- J F Alexandra
- APHP, Hôpital Bichat Claude Bernard, Service de Médecine Interne DMU Victoire Paris, Paris, France
- Université Paris-Cité, Paris, France
| | - D Roux
- AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Service de Médecine Intensive Réanimation, Colombes, France
- Université Paris Cité, INSERM UMR-S1151, CNRS UMR-S8253, Institut Necker Enfants Malades, Paris, France
| | - H Maisonneuve
- Hervé Maisonneuve, MD, Scientific Editor & Consultant, Paris, France
| | - B Chousterman
- Université Paris-Cité, Paris, France
- Hervé Maisonneuve, MD, Scientific Editor & Consultant, Paris, France
| | - P Ruszniewski
- Doyen de l'UFR de Médecine, Université Paris Cité, Pairs, France
| | - D Dreyfuss
- Université Paris-Cité, Paris, France
- AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Service de Médecine Intensive Réanimation, Colombes, France
- French National Institute of Health and Medical Research (INSERM), UMR_S1155, Common and Rare Kidney Diseases (CORAKID), Hôpital Tenon, Sorbonne Université, Paris, France
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Schultz É, Mancini J, Ward JK. What does the French public consider to be a conflict of interest for medical researchers? Soc Sci Med 2023; 327:115851. [PMID: 37172337 DOI: 10.1016/j.socscimed.2023.115851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 05/14/2023]
Abstract
Conflicts of interests have been at the core of public debate over health and medicine for decades. Social scientists have analysed the diversity of definitions of this label as well as the policies put in place to regulate the relationships between medical researchers and various actors such as private corporations. But little attention has been paid to the way the public define and use this label. In this article, we assess what the French public consider to be a conflict of interest for medical researchers. We draw on the data from a questionnaire-based survey conducted with a representative sample of the French population in December 2021 (n = 2022) where we asked respondents to decide whether different situations constituted a conflict of interest or not. These situations concerned medical researchers' relationships with economic actors but also with politicians and the media, with or without financial compensation for the researcher. We identified three main group profiles in terms of respondents' conception of what counts as a conflict of interest: i) considering that only money matters in the labelling of a given situation as a conflict of interest, ii) considering that any relationship with economic, media and political actors constitutes a conflict of interest (i.e., that medical research should be an ivory tower), and iii) indecision as to what constitutes a conflict of interest. These three groups differed in terms of social composition as well as respondents' relationships to science, politics, and the health care system.
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Affiliation(s)
- Émilien Schultz
- Sciences Po, Médialab, 1 Place Saint-Thomas d'Aquin, 75007, Paris, France; Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de L'Information Médicale, ISSPAM, Equipe CANBIOS, Labellisée Ligue Contre le Cancer, Marseille, France.
| | - Julien Mancini
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de La Santé & Traitement de L'Information Médicale, ISSPAM, Equipe CANBIOS, Labellisée Ligue Contre le Cancer, Marseille, France; BioSTIC, APHM, Timone, 13005, Marseille, France
| | - Jeremy K Ward
- Université Paris Cité, CNRS, Inserm, Cermes3, F-94800 Villejuif, France
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Fabbri A, Mulinari S, Johansson M, Ghaur W, Khalil AM, Lundh A. Content and strength of conflict of interest policies at Scandinavian medical schools: a cross sectional study. BMC MEDICAL EDUCATION 2022; 22:812. [PMID: 36435782 PMCID: PMC9701355 DOI: 10.1186/s12909-022-03881-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Concerns around staffs' and students' interactions with commercial entities, for example drug companies, have led several North American medical schools to implement conflict of interest (COI) policies. However, little is known about COI policies at European medical schools. We analysed the content and strength of COI policies at Scandinavian medical schools. METHODS We searched the websites of medical schools in Denmark, Norway, and Sweden and emailed the Deans for additional information. Using comparable methodology to previous studies, the strength of the COI policies was rated on a scale from 0 to 2 across 11 items (higher score more restrictive); we also assessed the presence of oversight mechanisms and sanctions. RESULTS We identified 77 unique policies for 15 medical schools (range 2-8 per school). Most of the policies (n = 72; 94%) were University wide and only five (6%) were specific for the medical schools. For six of eleven items one or more schools had a restrictive policy (score of two). None of the schools had a restrictive policy for the five additional items (speaking relationships, sales representatives, on-site education activities, medical school curriculum, and drug samples). Honoraria was the item with the highest score, with eight of the 15 schools having a score of two. Thirteen of the 15 schools had policies that identified a party responsible for policy oversight and mentioned sanctions for non-compliance. CONCLUSION Our study provides the first evaluation of all Scandinavian medical schools' COI policies. We found that the content of COI policies varies widely and still has shortcomings. We encourage Scandinavian medical schools to develop more stringent COI policies to regulate industry interactions with both faculty and students.
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Affiliation(s)
- Alice Fabbri
- Department for Health, University of Bath, Claverton Down, BA2 7AY Bath, UK
- Centre for Evidence-Based Medicine Odense (CEBMO), University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Shai Mulinari
- Department of Sociology, Lund University, Lund, Sweden
| | - Martin Johansson
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Paediatric Anaesthesia and Intensive Care, Children’s Hospital, Skane University Hospital, Lund University, Lund, Sweden
| | | | | | - Andreas Lundh
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
- Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark
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Graham SS, Karnes MS, Jensen JT, Sharma N, Barbour JB, Majdik ZP, Rousseau JF. Evidence for stratified conflicts of interest policies in research contexts: a methodological review. BMJ Open 2022; 12:e063501. [PMID: 36123074 PMCID: PMC9486359 DOI: 10.1136/bmjopen-2022-063501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The purpose of this study was to conduct a methodological review of research on the effects of conflicts of interest (COIs) in research contexts. DESIGN Methodological review. DATA SOURCES Ovid. ELIGIBILITY CRITERIA Studies published between 1986 and 2021 conducting quantitative assessments of relationships between industry funding or COI and four target outcomes: positive study results, methodological biases, reporting quality and results-conclusions concordance. DATA EXTRACTION AND SYNTHESIS We assessed key facets of study design: our primary analysis identified whether studies stratified industry funding or COI variables by magnitude (ie, number of COI or disbursement amount), type (employment, travel fees, speaking fees) or if they assessed dichotomous variables (ie, conflict present or absent). Secondary analyses focused on target outcomes and available effects measures. RESULTS Of the 167 articles included in this study, a substantial majority (98.2%) evaluated the effects of industry sponsorship. None evaluated associations between funding magnitude and outcomes of interest. Seven studies (4.3%) stratified industry funding based on the mechanism of disbursement or funder relationship to product (manufacturer or competitor). A fifth of the articles (19.8%) assessed the effects of author COI on target outcomes. None evaluated COI magnitude, and three studies (9.1%) stratified COI by disbursement type and/or reporting practices. Participation of an industry-employed author showed the most consistent effect on favourability of results across studies. CONCLUSIONS Substantial evidence demonstrates that industry funding and COI can bias biomedical research. Evidence-based policies are essential for mitigating the risks associated with COI. Although most policies stratify guidelines for managing COI, differentiating COIs based on the type of relationship or monetary value, this review shows that the available research has generally not been designed to assess the differential risks of COI types or magnitudes. Targeted research is necessary to establish an evidence base that can effectively inform policy to manage COI.
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Affiliation(s)
- S Scott Graham
- Department of Rhetoric & Writing, University of Texas at Austin, Austin, Texas, USA
| | - Martha S Karnes
- Department of English, The University of Texas at Austin, Austin, Texas, USA
| | - Jared T Jensen
- Department of Communication Studies, The Unviersity of Texas at Austin, Austin, TX, USA
| | - Nandini Sharma
- Department of Communication Studies, The Unviersity of Texas at Austin, Austin, TX, USA
| | - Joshua B Barbour
- Department of Communication Studies, The Unviersity of Texas at Austin, Austin, TX, USA
| | - Zoltan P Majdik
- Department of Communication, North Dakota State University, Fargo, North Dakota, USA
| | - Justin F Rousseau
- Department of Population Health and Neurology, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
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Dawson CMP, Abiola AO, Sullivan AM, Schwartz AW. You can't be what you can't see: a systematic website review of Geriatrics Online-Visibility at US medical schools. J Am Geriatr Soc 2022; 70:2996-3005. [PMID: 36082829 DOI: 10.1111/jgs.17997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/23/2022] [Accepted: 07/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Graduating US medical students must build strong skills in caring for older adults, necessitated by shifting population demographics. Little is known, however, about current medical student exposure to geriatrics on a national scale. This systematic website review characterizes geriatrics opportunities at US medical schools, seen through the lens of publicly available information online. METHODS Reviewers searched for 18 online Geriatrics Elements, in the domains of Information Prevalence, Geriatrics Environment, and Geriatrics Education, for all 191 US medical schools accredited as of January 2020. Latent Class Analysis was used to classify schools according to their publicly visible geriatrics opportunities. RESULTS Schools had a median of 7 Geriatrics Elements identified online [IQR 4-10]. Optional geriatrics clinical activity was the most prevalent (76%), while fewer than half of all schools had online evidence of required geriatrics clinical activity (45%). A profile of the three groups of schools identified by Latent Class Analysis, termed Geriatrics Online-Visibility groups (High n = 39, 20%; Medium n = 90, 47%; Low n = 62, 32%), is presented. Online evidence of geriatrics-specific funding was the greatest distinguishing factor among the groups. CONCLUSIONS Examining US medical school websites collectively and comparatively across Geriatrics Online-Visibility groups can ground discussions of geriatrics education in current national data. Though many school websites present optional geriatrics activities, far fewer specify geriatrics requirements. High Geriatrics Online-Visibility schools present an array of both optional and required geriatrics opportunities on their websites, but this cohort comprises only 20% of schools. Recommended next steps are proposed to guide schools inspired to enhance their Geriatrics Online-Visibility.
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Affiliation(s)
- Catherine M P Dawson
- VA Bedford, New England Geriatrics Research Education and Clinical Center, Bedford, MA, USA.,Boston University School of Medicine, Section of Geriatrics, Boston, MA, USA
| | - Aanuoluwa O Abiola
- Marshfield Clinic Health System, Department of Internal Medicine, Marshfield, WI, USA
| | - Amy M Sullivan
- Beth Israel Deaconess Medical Center, Shapiro Institute for Education & Research, Boston, MA, USA.,Harvard Medical School, Department of Medicine, Boston, MA, USA
| | - Andrea W Schwartz
- VA Boston, New England Geriatrics Research Education and Clinical Center, Boston, MA, USA.,Harvard Medical School, Department of Medicine, Boston, MA, USA.,Brigham and Women's Hospital, Division of Aging, Boston, MA, USA
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- Brown University, Providence, RI, USA
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Fabbri A, Hone KR, Hróbjartsson A, Lundh A. Conflict of Interest Policies at Medical Schools and Teaching Hospitals: A Systematic Review of Cross-sectional Studies. Int J Health Policy Manag 2022; 11:1274-1285. [PMID: 33812349 PMCID: PMC9808354 DOI: 10.34172/ijhpm.2021.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/06/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND This systematic review aims to estimate the proportion of medical schools and teaching hospitals with conflicts of interest (COI) policies for health research and education, to describe the provisions included in the policies and their impact on research outputs and educational quality or content. METHODS Experimental and observational studies reporting at least one of the above mentioned aims were included irrespective of language, publication type or geographical setting. MEDLINE, Scopus, Embase and the Cochrane Methodology Register were searched from inception to March 2020. Methodological study quality was assessed using an amended version of the Joanna Briggs Institute's checklist for prevalence studies. RESULTS Twenty-two cross-sectional studies were included; all were conducted in high-income countries. Of these, 20 studies estimated the prevalence of COI policies, which ranged from 5% to 100% (median: 85%). Twenty studies assessed the provisions included in COI policies with different assessment methods. Of these, nine analysed the strength of the content of medical schools' COI policies using various assessment tools that looked at a range of policy domains. The mean standardised summary score of policy strength ranged from 2% to 73% (median: 30%), with a low score indicating a weak policy. North American institutions more frequently had COI policies and their content was rated as stronger than policies from European institutions. None of the included studies assessed the impact of COI policies on research outputs or educational quality or content. CONCLUSION Prevalence of COI policies at medical schools and teaching hospitals varied greatly in high-income countries. No studies estimated the prevalence of policies in low to middle-income countries. The content of COI policies varied widely and while most European institutions ranked poorly, in North America more medical schools had strong policies. No studies were identified on impact of COI policies on research outputs and educational quality or content.
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Affiliation(s)
- Alice Fabbri
- Centre for Evidence-Based Medicine Odense (CEBMO), University of Southern Denmark and Odense University Hospital, Odense, Denmark
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, United Kingdom
| | - Kristine Rasmussen Hone
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Asbjørn Hróbjartsson
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Andreas Lundh
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
- Department of Infectious Diseases, Hvidovre Hospital, Hvidovre, Denmark
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Molina M, Boëffard A, Esvan M, Bastian B. Medical students' exposure to and attitudes towards product promotion and incentives from the pharmaceutical industry in 2019: a national cross-sectional study in France. BMJ Open 2022; 12:e045671. [PMID: 35858728 PMCID: PMC9305804 DOI: 10.1136/bmjopen-2020-045671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To measure medical students' exposure to pharmaceutical product promotion and incentives nationwide, and to evaluate students' attitudes towards the pharmaceutical industry, access to education on promotional strategies and knowledge of institutional policies about drug company-student relationships. DESIGN Cross-sectional survey based on a 48-item anonymous questionnaire. SETTING All 37 French medical schools, from March to April 2019. PARTICIPANTS French medical students in their 4th year of study and beyond, having studied exclusively in France. MAIN OUTCOME MEASURE Cumulative frequency of students' exposure to pharmaceutical product promotion and incentives. SECONDARY OUTCOME MEASURES Exposure within the last 6 months, attitudes regarding interactions with the industry, access to education on pharmaceutical product promotion and incentives and knowledge of institutional policies. RESULTS 6280 responses were analysed (10.4% out of a total of 60 550 eligible students). 5992 students (96.3% poststratification, 99% CI (96.1% to 96.5%)) had already been exposed to pharmaceutical product promotion and incentives and 4650 (78.1%, 99% CI (77.7% to 78.6%)) within the last 6 months. 5140 students (85.4%, 99% CI (84.8% to 85.8%)) had met a pharmaceutical representative. Regarding attitudes, 2195 students (36.8%, 99% CI (36.0% to 37.5%)) thought receiving a gift could influence their own prescriptions while 3252 (53.6%, 99% CI (53.1% to 54.2%)) thought it could influence their colleagues' prescriptions. 4533 students (76.0%, 99% CI (75.6% to 76.5%)) reported never having attended any lecture on promotional strategies. Exposure seemed to depend on the year of study and specialty. 5122 (88.1%, 99% CI (87.7% to 88.4%)) did not know whether their faculty had a policy regarding drug company-student interactions. CONCLUSION In France in 2019, medical students' exposure to pharmaceutical product promotion and incentives remains considerable and starts early during medical training. Education on promotional strategies and institutional policies should be improved to ensure responsible and ethical behaviour in prescribing medications.
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Affiliation(s)
- Martin Molina
- Department of General Practice, Univ Rennes, Rennes, France
| | | | - Maxime Esvan
- Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France
| | - Benjamin Bastian
- Department of General Practice, Univ Rennes, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, France
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Makowska M. How Polish medical students are socialised to cooperate with the pharmaceutical industry: a focus group study of the importance of informal, hidden and null curricula. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2022; 31:81-95. [PMID: 33784212 DOI: 10.1080/14461242.2021.1899842] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/04/2021] [Indexed: 06/12/2023]
Abstract
This study analysed how Polish medical students are socialised to cooperate with the pharmaceutical industry via informal, hidden, and null curricula. Nine focus groups were run with medical students in their second year and upwards at three Polish medical universities. Initially, most students had difficulty in discerning pharmaceutical companies' presence in their education, but on reflection they all recognised this presence. Students said that they were surrounded by small medical gifts provided by companies, met pharmaceutical representatives, and took part in events for physicians organised and/or sponsored by the pharmaceutical industry. Nevertheless, they did not think they were the main target of the industry's marketing activities, saying that these were largely aimed at practicing doctors, and that they were only targeted as opportunities arose. Students' statements make it clear that their socialisation takes place within a culture which consents to medical professionals' cooperation with the industry. Medical students come to perceive cooperation with the industry as natural, and benefits from the industry as a privilege of doctors. Medical schools can prevent this by introducing guidelines, conflict of interest polices, and changing the formal curriculum, but the need for such measures is not currently recognised in Poland.
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Affiliation(s)
- Marta Makowska
- Institute of Sociological Sciences and Pedagogy, Warsaw University of Life Sciences, Warsaw, Poland
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Lajmi H, Lajmi M, Hmaied W. The characteristics of conflict of interest in the doctor's pharmaceutical representative Relationship. LA TUNISIE MEDICALE 2022; 100:127-132. [PMID: 35852246 PMCID: PMC9272449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Studies addressed the influence of pharmaceutical representatives in drug prescribing habits, in terms of quality and quantity. AIM To describe the representatives' strategies, assess their impact on medical prescribing, and study the various factors influencing doctors' prescribing changes. METHODS We conducted a cross-sectional study including 70 participants. All of them had an anonymous questionnaire to determine their socio-demographic data, the pharmaceutical representative visits details, the influence of gifts on the medical prescription, and the predictive factors of this influence. We also analyzed the solutions to alleviate the conflict of interest. RESULTS We found that 52.8% of participants thought that gifts were the source of an ethical dilemma and 85.7% of them thought that the priority of the pharmaceutical representative was the promotion of the product rather than the scientific interest. However, 68.5% of them thought that the gifts were useful and therefore we can continue to receive them. Nineteen participants (27.1% of cases) thought that gifts can modify their medical prescription. However, there were significantly more subjects (p=0.049) who thought that other colleagues would be more influenced (72.8%). Factors that favor the prescription changing by gifts, were age (p=0.002, OR=1.2) and the number of visits per month (p=0.015, OR=8.8). CONCLUSIONS There is a discrepancy between the growing awareness of this ethical issue and the daily practices of physicians who continue to accept gifts. The absence of training in bioethics explains these results.
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Affiliation(s)
- Houda Lajmi
- 1- Hôpital des Forces de Sécurité Intérieure, Faculté de médecine de Tunis
| | - Mokhles Lajmi
- 2- Hôpital militaire principal d’instruction de Tunis, Faculté de médecine de Tunis
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Barbaroux A, Pourrat I, Bouchez T. General practitioners and sales representatives: Why are we so ambivalent? PLoS One 2022; 17:e0261661. [PMID: 35073342 PMCID: PMC8786166 DOI: 10.1371/journal.pone.0261661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 12/09/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Accepting gifts from pharmaceutical sales representatives (sales reps) or meeting them is correlated with excessive, more expensive and sometimes less rational prescribing. French general practitioners (GPs) tend to hold an unfavorable opinion of the pharmaceutical industry, yet the behavior they adopt with sales reps is generally favorable. Until now, no study has sought to explain the reasons for this discrepancy. This study explores GP experiences to better understand their ambivalent behavior. METHOD This qualitative descriptive study was based on semi-structured face-to-face interviews with French GPs in the south-east of France. An interpretative phenomenological approach was chosen to explore individual professional practices and to model the phenomenon through in-depth analysis of semi-structured interviews. A general inductive analysis was carried out. Data were analyzed by researchers from different disciplines (psychology, sociology and general practice). RESULTS Ten GPs were interviewed for an average of 50 minutes. The analysis revealed three forces that combine to motivate GPs to keep meeting sales reps despite their unfavorable opinion of these visits: practical reasons such as the need for a substitute for continuing education; social and cultural reasons such as courtesy towards representatives; and psychological mechanisms such as cognitive dissonance and a hidden curriculum. DISCUSSION The GP-representative relationship is complex and involves psychological mechanisms that the medical profession often fails to recognize. GPs use reps as a convenient tool for continuing education, particularly in the setting of a private practice where GPs feel pressed for time. Cognitive dissonance is a well-supported theory in social psychology that explains how a person maintains a behavior while having an unfavorable opinion of it. Since GP meetings with sales reps start during their internship, they could also be considered as part of a hidden curriculum. The strength of this work is to combine medical, social psychological and sociological perspectives with the original interpretative phenomenological approach. When the veil is lifted on individual ambivalence, the questions raised are more social and political than individual.
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Affiliation(s)
- Adriaan Barbaroux
- Département d’Enseignement et de Recherche en Médecine Générale, RETINES, HEALTHY, Université Côte d’Azur, Nice, France
- LAPCOS, Université Côte d’Azur, Nice, France
| | - Isabelle Pourrat
- Département d’Enseignement et de Recherche en Médecine Générale, RETINES, HEALTHY, Université Côte d’Azur, Nice, France
| | - Tiphanie Bouchez
- Département d’Enseignement et de Recherche en Médecine Générale, RETINES, HEALTHY, Université Côte d’Azur, Nice, France
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Makowska M, Kaczmarek E, Rodzinka M. Transparency or restricting gifts? Polish medical students' opinions about regulating relationships with pharmaceutical sales representatives. New Bioeth 2022; 40:49-70. [PMID: 34100259 PMCID: PMC8183325 DOI: 10.1007/s40592-021-00128-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 01/11/2023]
Abstract
Relationships between physicians and pharmaceutical sales representatives (PSRs) often create conflicts of interest, not least because of the various benefits received by physicians. Many countries attempt to control pharmaceutical industry marketing strategies through legal regulation, and this is true in Poland where efforts are underway to eliminate any practices that might be considered corrupt in medicine. The present research considered Polish medical students' opinions about domestic laws restricting doctors' acceptance of expensive gifts from the industry, the idea of compulsory transparency, and the possibility of introducing a Polish Sunshine Law. A qualitative, focus group-based, interview method was used. Data were gathered from nine focus groups involving 92 medical students from three universities located in major Polish cities. The article presents a classification of opposing student views with regard to the consequences of introducing different legal solutions; this should be useful for policy makers deliberating on how to optimally regulate pharmaceutical marketing. The study's results are discussed in the context of the public bioethical debate in Poland.
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Affiliation(s)
- Marta Makowska
- Institute of Sociological Sciences and Pedagogy, Warsaw University of Life Sciences, Nowoursynowska 166 St., 02-787 Warsaw, Poland
| | - Emilia Kaczmarek
- Faculty of Philosophy, University of Warsaw, Krakowskie Przedmieście 3, 00-927 Warsaw, Poland
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Bechoux L, De Vleeschouwer O, Vanheuverzwijn C, Verhegghen F, Detiffe A, Colle F, Fallon C, Thoreau F. Conflict of interest policies at Belgian medical faculties: Cross-sectional study indicates little oversight. PLoS One 2021; 16:e0245736. [PMID: 33566836 PMCID: PMC7875358 DOI: 10.1371/journal.pone.0245736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/06/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Medical students encounter pharmaceutical promotion from the very start of their training. Medical schools have an important role to play in educating medical students regarding the interactions between healthcare professionals (HCPs) and industry and in protecting them from commercial influence and conflict of interest (COI). In 2019, medical student associations in Belgium and abroad called for more preparation in dealing with COI and for a more independent medical training. As little information is available on the situation in our country, we undertook an assessment of conflict of interest policies at Belgium's medical schools. We relied on a methodology already used in studies from USA, Canada, Australia, France and Germany and adapted it to the Belgian context. METHODS We identified 10 medical schools in Belgium. We searched the website of each medical school in November 2019 with standardized keywords for COI policies and learning activities on COI in the curriculum. The deans of medicine were invited to participate by sending us information that we could have overlooked during our web-based searches. We also consulted personal contacts within faculties among students and teachers. Based on a list of 15 criteria adapted from North American and French studies, we calculated a total for each faculty of medicine with a maximum score of 30 points. RESULTS By December 2019, we had gathered a set of written documents for four faculties of medicine (40%) containing policies with varying degrees of precision and relevance to our survey. We found elements of the curriculum addressing the COI issue for one faculty (10%). In all cases, these policies consisted of "moderate" initiatives with little or no "restrictive" elements. Only one faculty showed interest in our study by providing us with relevant information (10%). Half of the faculty notified us of their refusal to participate in the study (50%) and the other faculties either did not respond or did not provide us with any information (40%). The maximum score obtained was 3 out of 30 points with six faculties scoring 0 (60%). CONCLUSION There is little transparency regarding interactions between medical students and pharmaceutical companies at Belgian medical faculties, which may create COI issues. Initiatives to protect students from pharmaceutical promotion and to train them to manage their future interaction with pharmaceutical companies have a limited scope and are isolated. This is inconsistent with international recommendations from Health Action International, World Health Organization or the American Medical Students' Association. The Belgian government has legislated in favor of more transparency in the relation between HCPs and pharmaceutical industry. Indeed, it made the disclosure of benefits granted by the industry compulsory and limited their value. Our results show that there is still some way to go to ensure an independent medical training for future Belgian physicians.
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Affiliation(s)
- Lucas Bechoux
- Political Science Department, Spiral Research Center, University of Liège, Liège, Belgium
| | | | | | | | | | - Fabian Colle
- Tropical Medicine/Public Health, Housing First NPO, Brussels, Belgium
| | - Catherine Fallon
- Political Science Department, Spiral Research Center, University of Liège, Liège, Belgium
| | - François Thoreau
- Political Science Department, Spiral Research Center, University of Liège, Liège, Belgium
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Grabitz P, Friedmann Z, Gepp S, Hess L, Specht L, Struck M, Tragert SK, Walther T, Klemperer D. Quantity and quality of conflict of interest policies at German medical schools: a cross-sectional study and survey. BMJ Open 2020; 10:e039782. [PMID: 32998930 PMCID: PMC7528426 DOI: 10.1136/bmjopen-2020-039782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To assess the quantity and evaluate the quality of policies and curricula focusing on conflicts of interests (COI) at medical schools across Germany. DESIGN Cross-sectional study, survey of medical schools, standardised web search. SETTING Medical schools, Germany. PARTICIPANTS 38 German medical schools. INTERVENTIONS We collected relevant COI policies, including teaching activities, by conducting a search of the websites of all 38 German medical schools using standardised keywords for COI policies and teaching. Further, we surveyed all medical schools' dean's offices. Finally, we adapted a scoring system for results we obtained with 13 categories based on prior similar studies. MAIN OUTCOMES AND MEASURES Presence or absence of COI-related policies, including teaching activities at medical school. The secondary outcome was the achieved score on a scale from 0 to 26, with high scores representing restrictive policies and sufficient teaching activities. RESULTS We identified relevant policies for one medical school via the web search. The response rate of the deans' survey was 16 of 38 (42.1%). In total, we identified COI-related policies for 2 of 38 (5.3%) German medical schools, yet no policy was sufficient to address all COI-related categories that were assessed in this study. The maximum score achieved was 12 of 26. 36 (94.7%) schools scored 0. No medical school reported curricular teaching on COI. CONCLUSIONS Our results indicate a low level of action by medical schools to protect students from undue commercial influence. No participating dean was aware of any curriculum or instruction on COI at the respective school and only two schools had policies in place. The German Medical Students Association and international counterparts have called for a stronger focus on COI in the classroom. We conclude that for German medical schools, there is still a long way to go.
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Affiliation(s)
- Peter Grabitz
- Universities Allied for Essential Medicines Europe e.V, Berlin, Germany
- QUEST Center for Transforming Biomedical Research, Berlin Institute of Health (BIH),Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Zoe Friedmann
- Universities Allied for Essential Medicines Europe e.V, Berlin, Germany
| | - Sophie Gepp
- Universities Allied for Essential Medicines Europe e.V, Berlin, Germany
| | - Leonard Hess
- Universities Allied for Essential Medicines Europe e.V, Berlin, Germany
| | - Lisa Specht
- Universities Allied for Essential Medicines Europe e.V, Berlin, Germany
| | - Maja Struck
- Universities Allied for Essential Medicines Europe e.V, Berlin, Germany
| | | | - Tobias Walther
- Universities Allied for Essential Medicines Europe e.V, Berlin, Germany
| | - David Klemperer
- Faculty of Social and Health Sciences, Regensburg University of Applied Sciences, Regensburg, Germany
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Salmane-Kulikovska I, Poplavska E, Mezinska S, Dumpe V, Dauvarte H, Lazdina L, Marchockij A, Varzinskas K, Mintzes BJ. Medical, pharmacy and nursing students in the Baltic countries: interactions with the pharmaceutical and medical device industries. BMC MEDICAL EDUCATION 2020; 20:105. [PMID: 32252743 PMCID: PMC7137495 DOI: 10.1186/s12909-020-02008-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Interactions between pharmaceutical and medical device industries and students can lead to commercial influences on educational messages, with a potential to bias future treatment choice. This is the first study in the Baltic countries describing exposure and attitudes of medical, pharmacy and nursing students towards cooperation with industry. METHODS A cross-sectional on-line survey of current medical, pharmacy and nursing students (n = 918) in three Baltic countries was carried out. RESULTS We found that most students participate in events organized or sponsored by industry and accept a range of gifts and benefits. Students in the Baltic countries consider cooperation with industry important; at the same time, most do not feel that they have sufficient training on how to ethically interact with pharmaceutical and medical device companies and believe that these interactions can influence their prescribing or dispensing patterns. There is a tendency to rationalize cooperation with industry by referring to the current economic situation and patient benefits. Pharmacy students have higher rates of participation and they accept gifts and other benefits more often than nursing or medical students; therefore, they are likely to be more vulnerable to potential industry influence. CONCLUSIONS The findings highlight the need to include topics on ethics and conflicts of interests in cooperation with industry in curriculum of health care students in Baltic countries. Without proper training, students continue to be at risk to industry influence and may develop habits for their further practice differing from evidence-based practice in prescribing and dispensing of medicines, as well as use of medical devices.
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Affiliation(s)
| | - Elita Poplavska
- Faculty of Pharmacy and Institute of Public Health, Riga Stradins University, Dzirciema street 16, Riga, LV 1007 Latvia
| | - Signe Mezinska
- Faculty of Medicine and Institute of Clinical and Preventive medicine, University of Latvia, Raina blvd. 19, Riga, LV-1050 Latvia
| | - Vita Dumpe
- Health Projects for Latvia, Baznicas street 5 - 2, Riga, LV 1010 Latvia
| | - Helena Dauvarte
- Riga Stradins University, Dzirciema street 16, Riga, LV 1007 Latvia
| | - Lina Lazdina
- Pauls Stradins Clinical University Hospital, Pilsoņu street 13, Riga, LV-1002 Latvia
| | - Aleksandr Marchockij
- Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, Kaunas, Lithuania
| | - Karolis Varzinskas
- Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, Kaunas, Lithuania
| | - Barbara J. Mintzes
- Faculty of Pharmacy and Charles Perkins Centre, The University of Sydney, Room 6W75, 6th Floor, The Hub, Charles Perkins Centre D17, Sydney, NSW 2006 Australia
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Jazayeri HE, Ganjawalla KP, Lee KC, Akbari M, Chuang SK, Tannyhill RJ. Are Industry Payments Associated With the Level of Evidence in Oral and Maxillofacial Surgery? J Oral Maxillofac Surg 2020; 78:502-506. [DOI: 10.1016/j.joms.2019.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 11/16/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
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Guy-Coichard C, Perraud G, Chailleu A, Gaillac V, Scheffer P, Mintzes B. Inadequate conflict of interest policies at most French teaching hospitals: A survey and website analysis. PLoS One 2019; 14:e0224193. [PMID: 31675383 PMCID: PMC6824557 DOI: 10.1371/journal.pone.0224193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 10/08/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There are 32 teaching hospitals in France, including 30 University hospitals and two Regional teaching hospitals. Teaching hospitals have three roles: health care provision, training of healthcare professionals, and medical research. These roles lead to frequent interactions with pharmaceutical and medical device companies, inevitably raising risks of conflicts of interests. Therefore, policies to manage conflict of interests (COI) are crucial. This study aims to examine COI policies in French teaching hospitals. METHODS All French teaching hospitals (n = 32) were included in this study. All hospitals websites were screened for institutional COI policies and curriculum on COI, using standardized keyword searches. More data were collected through a questionnaire addressed to each chief executive officer (CEO) of the teaching hospital. We used predefined criteria (n = 20) inspired by similar surveys on COI policies in French, US and Canadian medical schools, with some additions to reflect the local hospital context. A global score for each hospital, ranging from 0 to 60 (higher scores denoting stronger policies) was calculated by summing points obtained for each criterion. RESULTS All 32 hospitals had websites; 21 hospitals listed policies or regulations on their websites or provided them on request. In December 2017, 17 (53.1%) had rules and regulations for some items only, four of which (12.5%) have considered implementing a policy, and only two (6.3%) have begun implementation. 15 (46.9%) had no evidence of COI policies and a null score. The maximum score was 24 out of 60. CONCLUSION This is the first systematic assessment of COI policies in teaching hospitals in France. Such policies are needed to protect patients, clinicians and students from undue commercial influence. Despite public and political pressure for better management of COI, few teaching hospitals have implemented comprehensive and protective policies, and some hospitals lacked policies altogether. These results highlight the need for greater attention to management of COI within teaching hospitals. One potential solution would be to integrate COI policies into hospital accreditation procedures, in order to ensure a baseline of management at all teaching hospitals.
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Affiliation(s)
| | | | | | | | - Paul Scheffer
- Sciences of Education Department, Paris 8 University, Saint-Denis, France
| | - Barbara Mintzes
- Faculty of Pharmacy, Charles Perkins Centre, The University of Sydney, Sydney, Australia
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Annane D, Lerolle N, Meuris S, Sibilla J, Olsen KM. Academic conflict of interest. Intensive Care Med 2018; 45:13-20. [PMID: 30426140 DOI: 10.1007/s00134-018-5458-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE We set out to summarize the current challenges in academic conflict of interest. METHODS This is a narrative review by a multidisciplinary, multinational panel of academic officers including deans of medical/pharmacy schools. RESULTS AND CONCLUSIONS Disclosing conflict of interest has become the appropriate professional behavior since the 1990s in response to the necessity to fix moral and financial fences around medical activities. The nature of the conflict of interest is academic when either the conflict relates to academic duties and/or the nature of the interest is academic. People usually distinguish between real conflict of interest, when private interest overtly influences one's professional obligations; potential conflict of interest, when there is no obvious direct link between a person interests and current duties without ruling out that expected changes in duties cause a situation of conflict; and apparent conflict of interest, when the risk does not really exist, but serious doubts remain. Areas at risk of academic conflict of interest include peer review process for grant evaluation or journals, scientific communications such as elaborating and disseminating clinical guidelines, lecturing at meeting, advising decision-makers, teaching activities, and mentoring. The management of academic conflict of interest should consider actions in four domains, i.e., education, prevention, measures for enforcement and solving, and communication. Academic conflicts of interest are as frequent as financial conflicts but more difficult to identify and assess, and much less addressed in the literature. Generating more evidence from high-quality research is mandated to improve the management of academic and more generally non-financial conflicts of interest.
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Affiliation(s)
- Djillali Annane
- Simone Veil Health Science Center, University Versailles SQY, University Paris Saclay, Raymond Poincaré Hospital (APHP), 104 boulevard Raymond Poincaré, 92380, Garches, France.
| | - Nicolas Lerolle
- Faculty for Health Sciences, Angers University, Angers, France.,Angers University Hospital, Angers, France
| | - Sylvain Meuris
- School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean Sibilla
- School of Medicine, University of Strasbourg, Strasbourg, France
| | - Keith M Olsen
- UAMS College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA
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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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The ethical and deontological charter of the French faculties of medicine and odontology. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:151-152. [DOI: 10.1016/j.anorl.2018.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Flu vaccination among patients with diabetes: motives, perceptions, trust, and risk culture - a qualitative survey. BMC Public Health 2018; 18:569. [PMID: 29716565 PMCID: PMC5930433 DOI: 10.1186/s12889-018-5441-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 04/11/2018] [Indexed: 11/13/2022] Open
Abstract
Background Vaccination against seasonal influenza (SIV) is recommended for patients with diabetes, but their vaccination coverage is unsatisfactory in France and elsewhere. This qualitative survey of people with diabetes sought to explore 1) the extent to which SIV-related behaviour is more or less automatic; 2) reasons they choose/reject SIV; 3) their trust/distrust in authorities, science, and medicine. Methods We conducted semi-structured in-depth interviews of 19 adults with diabetes in 2014. We recruited them through physicians or patient associations and implemented an analysis of thematic content. Results Eight patients were vaccinated against flu in the preceding flu season and 11 were not. SIV uptake and refusal were stable over time and justified by multiple arguments. Coupons for free vaccines and regular doctor visits contributed to the habit of vaccination. Vaccination decisions were frequently anchored in past experiences of influenza and its vaccine. Patients often justified non-vaccination with attitudes of trivialisation/relativisation of influenza-associated risks and the perception that these can be controlled by means other than vaccination (e.g., through the avoidance of exposure). Some misbeliefs (e.g., SIV causes influenza) and doubts about SIV effectiveness and safety also existed. Several patients reported increased mistrust of SIV since the A/H1N1 pandemic in 2009. Patients trusted their doctors strongly regardless of their SIV behaviour, but unvaccinated patients had little trust in the government and pharmaceutical companies. Some discordances were found between perceptions and behaviour (e.g., remaining vaccinated despite doubts about SIV effectiveness or remaining unvaccinated despite feelings of vulnerability towards influenza complication), suggesting the existence of some vaccine hesitancy among patients. Conclusion This study among patients with diabetes suggest that SIV uptake is stable, thanks to a favourable environment. Nonetheless, SIV refusal is also stable over time. Unvaccinated patients used multiple arguments to justify SIV refusal, including compensatory health beliefs. Physicians should take every opportunity to recommend SIV. The necessary individualised patient education regarding SIV requires better physician training in patients priorities. While almost all patients strongly trust their doctors, unvaccinated patients distrust distal stakeholders: it is absolutely essential to restore trust in them and to develop new more effective influenza vaccines.
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Andresen NS, Olson TS, Krasowski MD. Medical student and medical school teaching faculty perceptions of conflict of interest. BMC Res Notes 2017; 10:272. [PMID: 28693566 PMCID: PMC5504664 DOI: 10.1186/s13104-017-2596-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 07/04/2017] [Indexed: 11/30/2022] Open
Abstract
Background Attitudes towards conflict of interest (COI) and COI policy are shaped during medical school and influence both the education of medical students and their future medical practice. Understanding the current attitudes of medical students and medical school teaching faculty may provide insight into what is taught about COI and COI policy within the ‘hidden’ medical curriculum. Differences between medical student and medical school teaching faculty perceptions of COI and COI policy have not been compared in detail. The authors surveyed first year medical students and medical school teaching faculty at one academic medical center. Results The response rate was 98.7% (150/152) for students and 34.2% (69/202) for faculty. Students were less likely than faculty to agree that lecturers should disclose COI to any learners (4.06 vs. 4.31, p = 0.01), but more likely to agree that COI disclosure decreases the presentation of biased material (3.80 vs. 3.21, p < 0.001). Student and faculty responses for all other questions were not different. Many of these responses suggest student and faculty support for stronger COI policy at academic medical centers. Conclusions Students and faculty perceptions regarding COI and COI policy are largely similar, but differ in terms of the perceived effectiveness of COI disclosure. This study also suggests that medical students and medical school teaching faculty support for stronger COI policy at academic medical centers.
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Affiliation(s)
- Nicholas S Andresen
- University of Iowa, Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Tyler S Olson
- University of Iowa, Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Matthew D Krasowski
- Department of Pathology, University of Iowa, Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
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