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Siopis G. The Global Burden of Disease Consortium Should Not Be Funded by Entities With Industry Ties and Possible Vested Commercial Interests. Med Care 2022; 60:93-94. [PMID: 34510105 DOI: 10.1097/mlr.0000000000001640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- George Siopis
- School of Life and Environmental Sciences, Faculty of Science
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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2
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Singh A, Faris S, Agarwal P, Reynolds LF, Modi PK. Association between Industry Payments and Published Position on Use of Devices for the Treatment of Lower Urinary Tract Symptoms. Urology 2021; 159:87-92. [PMID: 34752849 DOI: 10.1016/j.urology.2021.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/07/2021] [Accepted: 10/24/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the impact of industry payments to authors of opinion articles on the Urolift and Rezum devices. We also examined the extent to which authors omitted acknowledgements of financial conflicts-of-interest. METHODS We searched Google Scholar for all articles that cite either of the respective pivotal trials for these devices. 2 blinded urologists coded the articles as favorable or neutral. A separate blinded researcher recorded industry payments from the manufacturers using the Open Payments Program database. RESULTS We identified 29 articles written by 27 unique authors from an initial screening list of 235 articles. Of these articles, 15 (52%) were coded as positive and 14 (48%) were coded as neutral. 20 (74%) authors have accepted payments from the manufacturer of the device. Since 2014, these authors have collectively received $270,000 from NeoTract and $314,000 from Boston Scientific. Of the 20 authors with payments, 9 (45%) received more than $10,000 from either manufacturer. Of authors with payments, 65% (13/20) contributed to only positive articles. Authors who received payments had more than 4 times the number of article contributions than did authors without payments (42 vs 10). Authors of at least one favorable article were more likely to have received payments from the device manufacturers than authors of neutral articles (P = .014, Chi-squared test). Most (80%, 16/20) authors with payments did not report a relevant conflict-of-interest within any of their articles. CONCLUSION These data suggest a relationship between payments from a manufacturer and positive published position on that company's device. There may be a critical lack of published editorial pieces by authors without financial conflicts of interest.
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Affiliation(s)
- Armaan Singh
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Sarah Faris
- Section of Urology, Department of Surgery, Biological Sciences Division, University of Chicago, Chicago, IL
| | - Piyush Agarwal
- Section of Urology, Department of Surgery, Biological Sciences Division, University of Chicago, Chicago, IL
| | - Luke F Reynolds
- Section of Urology, Department of Surgery, Biological Sciences Division, University of Chicago, Chicago, IL
| | - Parth K Modi
- Section of Urology, Department of Surgery, Biological Sciences Division, University of Chicago, Chicago, IL.
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Abstract
OBJECTIVE To identify all known ties between the medical product industry and the healthcare ecosystem. DESIGN Scoping review. METHODS From initial literature searches and expert input, a map was created to show the network of medical product industry ties across parties and activities in the healthcare ecosystem. Through a scoping review, the ties were then verified, cataloged, and characterized, with data abstracted on types of industry ties (financial, non-financial), applicable policies for conflict of interests, and publicly available data sources. MAIN OUTCOME MEASURES Presence and types of medical product industry ties to activities and parties, presence of policies for conflict of interests, and publicly available data. RESULTS A map derived through synthesis of 538 articles from 37 countries shows an extensive network of medical product industry ties to activities and parties in the healthcare ecosystem. Key activities include research, healthcare education, guideline development, formulary selection, and clinical care. Parties include non-profit entities, the healthcare profession, the market supply chain, and government. The medical product industry has direct ties to all parties and some activities through multiple pathways; direct ties extend through interrelationships among parties and activities. The most frequently identified parties were within the healthcare profession, with individual professionals described in 422 (78%) of the included studies. More than half (303, 56%) of the publications documented medical product industry ties to research, with clinical care (156, 29%), health professional education (145, 27%), guideline development (33, 6%), and formulary selection (8, 1%) appearing less often. Policies for conflict of interests exist for some financial and a few non-financial ties; publicly available data sources seldom describe or quantify these ties. CONCLUSIONS An extensive network of medical product industry ties to activities and parties exists in the healthcare ecosystem. Policies for conflict of interests and publicly available data are lacking, suggesting that enhanced oversight and transparency are needed to protect patient care from commercial influence and to ensure public trust.
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Affiliation(s)
- Susan Chimonas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY 10017, USA
| | - Maha Mamoor
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY 10017, USA
| | - Sophia A Zimbalist
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY 10017, USA
| | - Brooke Barrow
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Peter B Bach
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY 10017, USA
- Delfi Diagnostics, Baltimore, MD, USA
| | - Deborah Korenstein
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY 10017, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Affiliation(s)
- Judy Illes
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Patrick J. McDonald
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Chloe Lau
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Viorica M. Hrincu
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mary B. Connolly
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Pediatric Neurology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Abstract
Health promotion involves social and environmental interventions designed to benefit and protect health. It often harmfully impacts the environment through air and water pollution, medical waste, greenhouse gas emissions, and other externalities. We consider potential conflicts between health promotion and environmental protection and why and how the healthcare industry might promote health while protecting environments. After probing conflicts between promoting health and protecting the environment we highlight the essential role that environmental resources play in health and healthcare to show that environmental protection is a form of health promotion. We then explore relationships between three radical forms of health promotion and the environment: (1) lowering the human birth rate; (2) transforming the food system; and (3) genetically modifying mosquitos. We conclude that healthcare and other industries and their institutions and leaders have responsibilities to re-consider and modify their priorities, policies, and practices.
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Affiliation(s)
- Cheryl C Macpherson
- Bioethics Division, Department of Clinical Skills, St George's University, and the Windward Islands Research and Education Foundation (WINDREF), St George's, Grenada
| | - Elise Smith
- The Centre de recherche en éthique (CRÉ), and the Department of Social and Preventative Medicine, University of Montreal, Canada
| | - Travis N Rieder
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, USA
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Affiliation(s)
- Matthew S McCoy
- Department of Medical Ethics and Health Policy, University of Pennsylvania
| | - Steven Joffe
- Department of Medical Ethics and Health Policy, University of Pennsylvania
| | - Ezekiel J Emanuel
- Perelman School of Medicine, Department of Medical Ethics and Health Policy, University of Pennsylvania
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7
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Harbut RF. How Should One Live Everlasting Life? AMA J Ethics 2019; 21:E470-474. [PMID: 31127930 DOI: 10.1001/amajethics.2019.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
New and emerging life-extension technologies require careful consideration of ethical implications related to resource scarcity and justice, prompting an analysis of what, if anything, is intrinsic to experiences we define as human. Furthermore, extended lifespans suggest the importance of reinterpreting traditional roles of health care professionals as the needs of patients, communities, and clinicians shift.
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Affiliation(s)
- Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Michael Bibens
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Cole Wayant
- Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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Abstract
We do not always benefit from the expansion of our choice sets. This is because some options change the context in which we must make decisions in ways that render us worse off than we would have been otherwise. One promising argument against paid living kidney donation holds that having the option of selling a 'spare' kidney would impact people facing financial pressures in precisely this way. I defend this argument from two related criticisms: first, that having the option to sell one's kidney would only be harmful if one is pressured or coerced to take this specific course of action; and second, that such forms of pressure are unlikely to feature in a legal market.
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Affiliation(s)
- Marius-Ionuţ Ungureanu
- Department of Public Health, Babeş-Bolyai University, Cluj-Napoca, 400376, Romania; Romanian Health Observatory, Bucharest, Romania.
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Lysaght T, Lipworth W, Hendl T, Kerridge I, Lee TL, Munsie M, Waldby C, Stewart C. The deadly business of an unregulated global stem cell industry. J Med Ethics 2017; 43:744-746. [PMID: 28356490 DOI: 10.1136/medethics-2016-104046] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/09/2017] [Indexed: 06/06/2023]
Abstract
In 2016, the Office of the State Coroner of New South Wales released its report into the death of an Australian woman, Sheila Drysdale, who had died from complications of an autologous stem cell procedure at a Sydney clinic. In this report, we argue that Mrs Drysdale's death was avoidable, and it was the result of a pernicious global problem of an industry exploiting regulatory systems to sell unproven and unjustified interventions with stem cells.
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Affiliation(s)
- Tamra Lysaght
- Centre for Biomedical Ethics, Clinical Research Centre, National University of Singapore, Singapore, Singapore
| | - Wendy Lipworth
- Centre for Values Ethics and the Law in Medicine, University of Sydney, Sydney, Australia
| | - Tereza Hendl
- Centre for Values Ethics and the Law in Medicine, University of Sydney, Sydney, Australia
| | - Ian Kerridge
- Centre for Values Ethics and the Law in Medicine, University of Sydney, Sydney, Australia
- Haematology Department, Royal North Shore Hospital, Sydney, Australia
| | - Tsung-Ling Lee
- Centre for Biomedical Ethics, Clinical Research Centre, National University of Singapore, Singapore, Singapore
| | - Megan Munsie
- Stem Cells Australia, University of Melbourne, Melbourne, Australia
| | - Catherine Waldby
- College of Arts and Social Sciences, Australian National University, Canberra, Australia
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13
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Heidt-Forsythe E. Morals or markets? Regulating assisted reproductive technologies as morality or economic policies in the states. AJOB Empir Bioeth 2017; 8:58-67. [PMID: 28949871 DOI: 10.1080/23294515.2016.1209595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The availability of assisted reproductive technologies (ARTs) in the medical marketplace complicates our understanding of reproductive public policy in the United States. Political debates over ARTs often are based on fundamental moral principles of life, reproduction, and kinship, similar to other reproductive policies in the United States. However, ARTs are an important moneymaking private enterprise for the U.S. biotechnology industry. This project investigates how the U.S. states regulate these unique and challenging technologies as either moral policies or economic policies. METHODS This study employs ordinary least squares (OLS) regression to estimate the significance of morality and economic policy variables on ART policies at the state level, noting associations between state-level political, economic, and gender variables on restrictive and permissive state-level ART policies. RESULTS Economic variables (reflecting the biotechnology industry) and advocacy for access to ART on behalf of infertility patients increase the chances of states passing policies that enable consumer use of ARTs. Additionally, individual ART policies are distinct from one another in the ways that morality variables increase the chances of ART regulations. Surprisingly, the role of religious adherence among state residents varied in positive and negative relationships with individual policy passage. CONCLUSIONS In general, these results support the hypothesis that ART laws are associated with economic as well as moral concerns of the states-ARTs lie at the intersection of issues of life and reproduction and of scientific innovation and health. What is most striking about these results is that they do not follow patterns seen in the legislation of abortion, contraception, and sexuality in general-those reproductive policies that are considered "morality policy." Similarly, economic variables are not consistently significant in the expected direction.
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Affiliation(s)
- Erin Heidt-Forsythe
- a Departments of Women's Studies and Political Science, Pennsylvania State University
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14
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Morciano C, Basevi V, Faralli C, Hilton Boon M, Tonon S, Taruscio D. Policies on Conflicts of Interest in Health Care Guideline Development: A Cross-Sectional Analysis. PLoS One 2016; 11:e0166485. [PMID: 27846255 PMCID: PMC5113001 DOI: 10.1371/journal.pone.0166485] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/28/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess whether organisations that develop health care guidelines have conflict of interest (COI) policies and to review the content of the available COI policies. METHODS Survey and content analysis of COI policies available in English, French, Spanish, and Italian conducted between September 2014 and June 2015. A 24-item data abstraction instrument was created on the basis of guideline development standards. RESULTS The survey identified 29 organisations from 19 countries that met the inclusion criteria. From these organisations, 19 policies were eligible for inclusion in the content analysis. Over one-third of the policies (7/19, 37%) did not report or did not clearly report whether disclosure was a prerequisite for membership of the guideline panel. Strategies for the prevention of COI such as divestment were mentioned by only two organisations. Only 21% of policies (4/19) used criteria to determine whether an interest constitutes a COI and to assess the severity of the risk imposed. CONCLUSIONS The finding that some organisations, in contradiction of widely available standards, still do not have COI policies publicly available is concerning. Also troubling were the findings that some policies did not clearly report critical steps in obtaining, managing and communicating disclosure of relationships of interest. This in addition to the variability encountered in content and accessibility of COI policies may cause confusion and distrust among guideline users. It is in the interest of guideline users and developers to design an agreed-upon, comprehensive, clear, and accessible COI policy.
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Affiliation(s)
- Cristina Morciano
- Centro Nazionale Malattie Rare, Istituto Superiore di Sanità, Rome, Italy
| | - Vittorio Basevi
- Centro di Documentazione sulla Salute Perinatale e Riproduttiva, Servizio assistenza distrettuale, medicina generale, pianificazione e sviluppo dei servizi sanitari, Regione Emilia-Romagna, Bologna, Italy
| | - Carla Faralli
- Servizio Informatico, Documentazione, Biblioteca e Attività Editoriali, Istituto Superiore di Sanità, Rome, Italy
| | - Michele Hilton Boon
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Sabina Tonon
- Formerly Centro Nazionale Malattie Rare, Istituto Superiore di Sanità, Rome, Italy
| | - Domenica Taruscio
- Centro Nazionale Malattie Rare, Istituto Superiore di Sanità, Rome, Italy
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15
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Affiliation(s)
- Bolaji Samson Aregbeshola
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos 23401, Nigeria.
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16
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Abstract
It is accepted throughout the world today that a new approach is needed to health care, one that brings to the forefront the role of economic development. This situation has also increased the importance of the health care sector and health data have begun to take a significant place in countries’ development indicators. Health care services as a basic indicator of social and economic development in Turkey, as in the rest of the world, continue to gain in importance. However, there is a significant difference between health indicators for Turkey, which is a candidate for full membership of the European Union, and European Union countries.
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Affiliation(s)
- Nüket Ornek Büken
- Nüket Ornek Büken, Hacettepe Universitesi Tip Fakultesi, Deontoloji-Tip Etigi AD, Sihhiye, 06100, Ankara, Türkiye.
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Abstract
In this article I attempt to transcend the mainstream conception of health care ethics, including nursing ethics, by bringing into the foreground a tension between a sense of life and an industrial-bureaucratic style of health care, with its emphasis on the systematic and procedural work culture necessary for mass production. I use the concept of ‘a sense of life’ to draw attention to the wisdom, sensitivity and responsibility that is necessary for the authentic care of others to be given a chance in the development of modern health care. I emphasize the mindfulness that the professional requires for genuine care, and how the systematic organization of modern health care, on the whole, ignores, obstructs and even suppresses such mindfulness.
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Fan R. Nonegalitarian Social Responsibility for Health: A Confucian Perspective on Article 14 of the UNESCO: Declaration on Bioethics and Human Rights. Kennedy Inst Ethics J 2016; 26:195-218. [PMID: 27477196 DOI: 10.1353/ken.2016.0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This essay offers a Confucian evaluation of Article 14 of the UNESCO Declaration on Bioethics and Human Rights, with a focus given to its statement that "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being." It indicates that "a right to health" contained in the statement is open to two different interpretations, one radically egalitarian, another a decent minimum. It shows that Confucianism has strong moral considerations to reject the radical egalitarian interpretation, and argues that a Confucian nonegalitarian health distribution ethics of differentiated and graded love and obligation can reasonably be supported with a right to the decent minimum of health at the international level.
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Abstract
Public health's reliance on law to define and carry out public activities makes it impossible to define a set of ethical principles unique to public health. Public health ethics must be encompassed within--and consistent with--a broader set of principles that define the power and limits of governmental institutions. These include human rights, health law, and even medical ethics. The human right to health requires governments not only to respect individual human rights and personal freedoms, but also, importantly, to protect people from harm from external sources and third parties, and to fulfill the health needs of the population. Even if human rights are the natural language for public health, not all public health professionals are comfortable with the language of human rights. Some argue that individual human rights--such as autonomy and privacy--unfairly limit the permissible means to achieve the goal of health protection. We argue that public health should welcome and promote the human rights framework. In almost every instance, this will make public health more effective in the long run, because the goals of public health and human rights are the same: to promote human flourishing.
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McCarthy M. Many in US Congress hold health industry investments, news site reports. BMJ 2015; 351:h6546. [PMID: 26631272 DOI: 10.1136/bmj.h6546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Borus JF, Alexander EK, Bierer BE, Bringhurst FR, Clark C, Klanica KE, Stewart EC, Friedman LS. The Education Review Board: A Mechanism for Managing Potential Conflicts of Interest in Medical Education. Acad Med 2015; 90:1611-1617. [PMID: 26083402 DOI: 10.1097/acm.0000000000000788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Concerns about the influence of industry support on medical education, research, and patient care have increased in both medical and political circles. Some academic medical centers, questioning whether industry support of medical education could be appropriate and not a conflict of interest, banned such support. In 2009, a Partners HealthCare System commission concluded that interactions with industry remained important to Partners' charitable academic mission and made recommendations to transparently manage such relationships. An Education Review Board (ERB) was created to oversee and manage all industry support of Partners educational activities.Using a case review method, the ERB developed guidelines to implement the commission's recommendations. A multi-funder rule was established that prohibits industry support from only one company for any Partners educational activity. Within that framework, the ERB established guidelines on industry support of educational conferences, clinical fellowships, and trainees' expenses for attending external educational programs; gifts of textbooks and other educational materials; promotional opportunities associated with Partners educational activities; Partners educational activities under contract with an industry entity; and industry-run programs using Partners resources.Although many changes have resulted from the implementation of the ERB guidelines, the number of industry grants for Partners educational activities has remained relatively stable, and funding for these activities declined only moderately during the first three full calendar years (2011-2013) of ERB oversight. The ERB continually educates both the Partners community and industry about the rationale for its guidelines and its openness to their refinement in response to changes in the external environment.
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Affiliation(s)
- Jonathan F Borus
- J.F. Borus is Stanley Cobb Distinguished Professor, Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. E.K. Alexander is associate professor, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. B.E. Bierer is professor, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. F.R. Bringhurst is associate professor, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. C. Clark is director, Office for Interactions with Industry, and senior counsel, Office of the General Counsel, Partners HealthCare, Boston, Massachusetts. K.E. Klanica was manager, Office for Interactions with Industry, Partners HealthCare, Boston, Massachusetts, at the time this article was written. She is currently senior associate general counsel, Allina Health, Minneapolis, Minnesota. E.C. Stewart is senior project specialist, Office for Interactions with Industry, Partners HealthCare, Boston, Massachusetts. L.S. Friedman is Anton R. Fried Chair, Department of Medicine, Newton-Wellesley Hospital, Newton, Massachusetts, and professor of medicine, Harvard Medical School and Tufts University School of Medicine, Boston, Massachusetts
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Affiliation(s)
- Eli Y Adashi
- Professor of medical science and the former dean of medicine and biological sciences at the Warren Alpert Medical School of Brown University in Providence, Rhode Island, and a member of the Institute of Medicine, the Association of American Physicians, and the American Association for the Advancement of Science, Dr. Adashi has focused his scholarship on domestic and global health policy at the nexus of medicine, law, ethics, and social justice
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Abstract
At an early stage of its foundation, new China became clear about the nature of public welfare and quickly developed medical and health services, which was well received by the World Health Organization. The marketization and the reduction of input into medical and health services from the 1980s created severe adverse consequences. After the SARS' outbreak in 2003, China started to give serious consideration to its medical and health system, and to work at developing medical and health services. The new healthcare reform launched in 2009 re-emphasizes fairness and public welfare, and China's achievements have been remarkable. Of course, there are still many problems to be solved in the reform, which also paves the way for increasing the reform in future.
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Powell R. The ethics of biomedical markets. J Med Ethics 2015; 41:431-432. [PMID: 26002918 DOI: 10.1136/medethics-2015-102879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Bagcchi S. Website to report corruption in medicine launches in India. BMJ 2014; 349:g7539. [PMID: 25487875 DOI: 10.1136/bmj.g7539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Treichler PA. "When pirates feast … who pays?" condoms, advertising, and the visibility paradox, 1920s and 1930s. J Bioeth Inq 2014; 11:479-505. [PMID: 25421819 DOI: 10.1007/s11673-014-9583-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 08/25/2014] [Indexed: 06/04/2023]
Abstract
For most of the 20th century, the condom in the United States was a cheap, useful, but largely unmentionable product. Federal and state statutes prohibited the advertising and open display of condoms, their distribution by mail and across state lines, and their sale for the purpose of birth control; in some states, even owning or using condoms was illegal. By the end of World War I, condoms were increasingly acceptable for the prevention of sexually transmitted disease, but their unique dual function--for disease prevention and contraception--created ongoing ambiguities for sellers, consumers, and distributors as well as for legal, political, health, and moral leaders. Not until the 1970s did condoms emerge from the shadows and join other personal hygiene products on open drugstore and supermarket shelves and in national advertisements. Then came the 1980s and AIDS when, despite the rise of Ronald Reagan, the radical right's demonization of condoms, and the initial reluctance of condom merchants to market to gay constituencies, the HIV/AIDS epidemic slowly but inexorably propelled the condom to the top of the prevention agenda. The condom's journey from lewd device to global superstar was fitful, but colorful. The Comstock Act of 1873, prohibiting birth control information and devices, created a vast underground operation--periodically illuminated, however, by arrests, protests, legal proceedings, and media coverage. This essay chronicles one such moment of illumination: the legal battle in the 1920s and 1930s over the legitimacy and legality of the Trojan Brand condom trademark and the unusual series of advertisements produced by the Youngs Rubber Corporation, makers of Trojans, to dramatize the ethical and economic issues of the trademark battle. Culminating in Youngs Rubber Corporation v. C.I. Lee & Co., Inc. (45 F, U.S. Court of Appeals for the Second Circuit 103 [1930]), this landmark case in trademark law established the right of the Trojan Brand condom, despite its ambiguous dual function, to the protection of a federal trademark. I seek to show how the Youngs antipiracy ad series illuminates the paradox of visibility by illuminating the paradox of any binary division: to establish the one depends inevitably on invoking or making visible--even if to suppress--the other. This essay is a case study in the negotiation of such a dialectic.
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Affiliation(s)
- Paula A Treichler
- Department of Media and Cinema Studies, University of Illinois at Urbana-Champaign, 119 Gregory Hall, Urbana, IL, 61801, USA,
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28
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Abstract
It has been suggested that human organs should be bought and sold on a regulated market as any other material property belongingto an individual. This would have the advantage of both addressing the grave shortage of organs available for transplantation and respecting the freedom of individuals to choose to do whatever they want with their body parts. The old arguments against such a market in human organs are, therefore, being brought back into question. The article examines the different arguments both in favour and against the sale of human organs. It concludes that the body and any of its elements is a full expression of the whole person. As such, they cannot have a price if the individual is to retain his or her full inherent dignity and if society is to retain and protect this very important concept.
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Marasović Šušnjara I. [Corruption and health care system]. Acta Med Croatica 2014; 68:243-246. [PMID: 26016214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Corruption is a global problem that takes special place in health care system. A large number of participants in the health care system and numerous interactions among them provide an opportunity for various forms of corruption, be it bribery, theft, bureaucratic corruption or incorrect information. Even though it is difficult to measure the amount of corruption in medicine, there are tools that allow forming of the frames for possible interventions.
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Abstract
This article describes the shortage of generic injectable medications in Canada that affected hospitals in 2012. It traces the events leading up to the drug shortage, the causes of the shortage, and the responses by health administrators, pharmacists, and ethicists. The article argues that generic drug shortages are an ethical problem because health care organizations and governments have an obligation to avoid exposing patients to resource scarcity. The article also discusses some options governments could pursue in order to secure the drug supply and thereby fulfill their ethical obligations.
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Affiliation(s)
- Chris Kaposy
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada,
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Kekewich MA. Market liberalism in health care: a dysfunctional view of respecting "consumer" autonomy. J Bioeth Inq 2014; 11:21-29. [PMID: 24363176 DOI: 10.1007/s11673-013-9492-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 04/24/2013] [Indexed: 06/03/2023]
Abstract
The unfortunately vast history of paternalism in both medicine and clinical research has resulted in perpetually increasing respect for patient autonomy and free choice in Western health care systems. Beginning with the negative right to informed consent, the principle of respect for autonomy has for many patients evolved into a positive right to request treatments and expect accommodation. This evolution of patient autonomy has mirrored a more general social attitude of market liberalism where increasing numbers of patients have come to embody the role of the "consumer." This paper explores this transformation and critiques the current way in which respect for patient autonomy is put into practice. Ultimately, this paper concludes that the consumer view of patient autonomy is dysfunctional. Moreover, this paper argues that, based on the inherent goals of medicine, some form of paternalism is required in any meaningfully therapeutic relationship.
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Affiliation(s)
- Michael A Kekewich
- Department of Clinical and Organizational Ethics, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada,
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Bedard J, Moore CD, Shelton W. A survey of healthcare industry representatives' participation in surgery: some new ethical concerns. J Clin Ethics 2014; 25:238-244. [PMID: 25192348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To provide preliminary evidence of the types and amount of involvement by healthcare industry representatives (HCIRs) in surgery, as well as the ethical concerns of those representatives. METHODS A link to an anonymous, web-based survey was posted on several medical device boards of the website http://www. cafepharma.com. Additionally, members of two different medical device groups on LinkedIn were asked to participate. Respondents were self-identified HCIRs in the fields of orthopedics, cardiology, endoscopic devices, lasers, general surgery, ophthalmic surgery, oral surgery, anesthesia products, and urologic surgery. RESULTS A total of 43 HCIRs replied to the survey over a period of one year: 35 men and eight women. Respondents reported attending an average of 184 surgeries in the prior year and had an average of 17 years as an HCIR and six years with their current employer. Of the respondents, 21 percent (nine of 43) had direct physical contact with a surgical team or patient during a surgery, and 88 percent (38 of 43) provided verbal instruction to a surgical team during a surgery. Additionally, 37 percent (16 of 43) had participated in a surgery in which they felt that their involvement was excessive, and 40 percent (17 of 43) had attended a surgery in which they questioned the competence of the surgeon. CONCLUSIONS HCIRs play a significant role in surgery. Involvement that exceeds their defined role, however, can raise serious ethical and legal questions for surgeons and surgical teams. Surgical teams may at times be substituting the knowledge of the HCIR for their own competence with a medical device or instrument. In some cases, contact with the surgical team or patient may violate the guidelines not only of hospitals and medical device companies, but the law as well. Further study is required to determine if the patients involved have any knowledge or understanding of the role that an HCIR played in their surgery.
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Affiliation(s)
- Jeffrey Bedard
- Albany Medical College, MC153, 47 New Scotland, Albany, New York 12208 USA
| | - Crystal Dea Moore
- Skidmore College, Department of Social Work, Sarasota Springs, New York 12866 USA
| | - Wayne Shelton
- Albany Medical College, MC153, 47 New Scotland, Albany, New York 12208 USA.
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Steiner DJ. Pharmaceuticals and medical devices: business practices. Issue Brief Health Policy Track Serv 2013:1-36. [PMID: 24482889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Fisher JA. Expanding the frame of "voluntariness" in informed consent: structural coercion and the power of social and economic context. Kennedy Inst Ethics J 2013; 23:355-79. [PMID: 24552076 DOI: 10.1353/ken.2013.0018] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
This paper introduces the term "structural coercion" to underscore the ways in which broader social, economic, and political contexts act upon individuals to compel them to enroll as subjects in clinical research. The paper challenges the adequacy of the concepts of "coercion" and "undue influence" in determining when research participation is voluntary. Acknowledging structural coercion shifts the frame of ethical deliberation away from specific individuals and specific studies to see important patterns in research participation by salient demographic characteristics. The effects of structural coercion manifest themselves in particular research settings, but unlike the conventional form of coercion, it is not rooted in the researcher-participant relationship or linked to particular study protocols. By extracting voluntariness from entrenched conceptions of the researcher-participant dyad, this paper proposes approaches to minimize the effects of structural coercion while creating new ethical imaginaries for review boards and researchers alike.
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Affiliation(s)
- Jill A Fisher
- Center for Bioethics, University of North Carolina at Chapel Hill, USA
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Johnstone MJ. Organisational and leadership ethics. Aust Nurs J 2013; 20:39. [PMID: 23822004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Vischer RK. The uneasy (and changing) relationship of health care and religion in our legal system. Theor Med Bioeth 2013; 34:161-170. [PMID: 23546737 DOI: 10.1007/s11017-013-9248-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This article provides a brief introduction to the interplay between law and religion in the health care context. First, I address the extent to which the commitments of a faith tradition may be written into laws that bind all citizens, including those who do not share those commitments. Second, I discuss the law's accommodation of the faith commitments of individual health care providers-hardly a static inquiry, as the degree of accommodation is increasingly contested. Third, I expand the discussion to include institutional health care providers, arguing that the legal system's resistance to accommodating the morally distinct identities of institutional providers reflects a short-sighted view of the liberty of conscience. Finally, I offer some tentative thoughts about why these dynamics become even more complicated in the context of Islamic health care providers.
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Affiliation(s)
- Robert K Vischer
- University of St. Thomas School of Law, 1000 LaSalle Ave., Minneapolis, MN 55403, USA.
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40
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Abstract
Has not the time fully come to lift the prohibition on a regulated market in organs for transplantation? Is there a price for such a market that would be too high to pay? The author revisits the cases for and against organ markets in the light of cultural shifts in society and asks whether the traditional insistence on altruism represents a hindrance to much needed developments or a safeguard for much valued public goods.
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Gillick MR. The medical ecoculture at work: the case of the metal-on-metal hip. Perspect Biol Med 2013; 56:584-601. [PMID: 24769749 DOI: 10.1353/pbm.2013.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The United States has the most expensive, technologically intensive system of medical care in the world, but not the most effective. Reforming health care will require understanding the interactions among the many individuals and institutions that collectively constitute the health-care ecoculture, an ecosystem with a major human component. Because technology is a key driver of health-care costs and a critical component of the patient's experience of American medicine, it is fruitful to consider an example of a particular technology: why it was embraced, who benefited from its use, and the response of the ecoculture when a critical flaw in the technology emerged. The case of the introduction, diffusion, and withdrawal of metal-on-metal hip prostheses will be discussed from the perspective of patients, physicians, device manufacturers, regulators, and the legal system. Each of these groups responded to external stimuli by adaptation in an attempt to maximize its own interests. Interactions between the groups served as a further mechanism of maintaining the status quo within medicine. A single change, such as modification of the payment system or incentivizing patients, is thus unlikely to be effective in transforming health care; instead, a multi-pronged approach, along with reforms outside medicine, will likely be necessary.
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Abstract
The NHS in England is an organisation undergoing substantial change. The passage of the Health and Social Care Act 2012, consolidates and builds on previous health policies and introduces further 'market-style' reforms of the NHS. One of the main aspects of these reforms is to encourage private and third sector providers to deliver NHS services. The rationale for this is to foster a more competitive market in healthcare to encourage greater efficiency and innovation. This changing healthcare environment in the English NHS sharpens the need for attention to be paid to the ethical operation of healthcare organisations. All healthcare organisations need to consider the ethical aspects of their operation, whether state or privately run. However, the changes in the type of organisations used to provide healthcare (such as commercial companies) can create new relationships and ethical tensions. This paper will chart the development of organisational ethics as a concern in applied ethics and how it arose in the USA largely owing to changes in the organisation of healthcare financing and provision. It will be argued that an analogous transition is happening in the NHS in England. The paper will conclude with suggestions for the development of organisational ethics programmes to address some of the possible ethical issues raised by this new healthcare environment that incorporates both private and public sector providers.
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Affiliation(s)
- Lucy Frith
- Health Services Research, University of Liverpool, Liverpool, UK.
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44
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Kiefer B. [The Supra case, a thick fog and jamming]. Rev Med Suisse 2012; 8:2416. [PMID: 23346683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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45
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Junod V. [Whistle blowing in health care sector: finding balance between divergent interests]. Rev Med Suisse 2012; 8:956-958. [PMID: 22675828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Valérie Junod
- Université de Genève, Facultè des HEC, Université de Lausanne.
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European Society of Cardiology. Relations between professional medical associations and the healthcare industry, concerning scientific communication and continuing medical education--a policy statement from the European Society of Cardiology. Acta Cardiol 2012; 67:265-71. [PMID: 22641990 DOI: 10.2143/AC.67.2.2154223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Lehoux P, Hivon M, Williams-Jones B, Miller FA, Urbach DR. How do medical device manufacturers' websites frame the value of health innovation? An empirical ethics analysis of five Canadian innovations. Med Health Care Philos 2012; 15:61-77. [PMID: 21290189 DOI: 10.1007/s11019-011-9312-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
While every health care system stakeholder would seem to be concerned with obtaining the greatest value from a given technology, there is often a disconnect in the perception of value between a technology's promoters and those responsible for the ultimate decision as to whether or not to pay for it. Adopting an empirical ethics approach, this paper examines how five Canadian medical device manufacturers, via their websites, frame the corporate "value proposition" of their innovation and seek to respond to what they consider the key expectations of their customers. Our analysis shows that the manufacturers' framing strategies combine claims that relate to valuable socio-technical goals and features such as prevention, efficiency, sense of security, real-time feedback, ease of use and flexibility, all elements that likely resonate with a large spectrum of health care system stakeholders. The websites do not describe, however, how the innovations may impact health care delivery and tend to obfuscate the decisional trade-offs these innovations represent from a health care system perspective. Such framing strategies, we argue, tend to bolster physicians' and patients' expectations and provide a large set of stakeholders with powerful rhetorical tools that may influence the health policy arena. Because these strategies are difficult to counter given the paucity of evidence and its limited use in policymaking, establishing sound collective health care priorities will require solid critiques of how certain kinds of medical devices may provide a better (i.e., more valuable) response to health care needs when compared to others.
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Affiliation(s)
- P Lehoux
- Department of Health Administration, University of Montreal, and Institute of Public Health Research of the University of Montreal (IRSPUM), C.P. 6128, Succursale Centre-ville, Montreal, QC, H3C 3J7, Canada.
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Patwary MA, O'Hare WT, Sarker MH. An illicit economy: scavenging and recycling of medical waste. J Environ Manage 2011; 92:2900-6. [PMID: 21820235 DOI: 10.1016/j.jenvman.2011.06.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 06/14/2011] [Accepted: 06/27/2011] [Indexed: 05/23/2023]
Abstract
This paper discusses a significant illicit economy, including black and grey aspects, associated with medical waste scavenging and recycling in a megacity, considering hazards to the specific group involved in scavenging as well as hazards to the general population of city dwellers. Data were collected in Dhaka, Bangladesh, using a variety of techniques based on formal representative sampling for fixed populations (such as recycling operatives) and adaptive sampling for roaming populations (such as scavengers). Extremely hazardous items (including date expired medicines, used syringes, knives, blades and saline bags) were scavenged, repackaged and resold to the community. Some HCE employees were also observed to sell hazardous items directly to scavengers, and both employees and scavengers were observed to supply contaminated items to an informal plastics recycling industry. This trade was made possible by the absence of segregation, secure storage and proper disposal of medical waste. Corruption, a lack of accountability and individual responsibility were also found to be contributors. In most cases the individuals involved with these activities did not understand the risks. Although motivation was often for personal gain or in support of substance abuse, participants sometimes felt that they were providing a useful service to the community.
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Affiliation(s)
- Masum A Patwary
- School of Science and Engineering, Teesside University, Middlesbrough, TS1 3BA, UK.
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Penney K, Snyder J, Crooks VA, Johnston R. Risk communication and informed consent in the medical tourism industry: a thematic content analysis of Canadian broker websites. BMC Med Ethics 2011; 12:17. [PMID: 21943392 PMCID: PMC3189886 DOI: 10.1186/1472-6939-12-17] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 09/26/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medical tourism, thought of as patients seeking non-emergency medical care outside of their home countries, is a growing industry worldwide. Canadians are amongst those engaging in medical tourism, and many are helped in the process of accessing care abroad by medical tourism brokers - agents who specialize in making international medical care arrangements for patients. As a key source of information for these patients, brokers are likely to play an important role in communicating the risks and benefits of undergoing surgery or other procedures abroad to their clientele. This raises important ethical concerns regarding processes such as informed consent and the liability of brokers in the event that complications arise from procedures. The purpose of this article is to examine the language, information, and online marketing of Canadian medical tourism brokers' websites in light of such ethical concerns. METHODS An exhaustive online search using multiple search engines and keywords was performed to compile a comprehensive directory of English-language Canadian medical tourism brokerage websites. These websites were examined using thematic content analysis, which included identifying informational themes, generating frequency counts of these themes, and comparing trends in these counts to the established literature. RESULTS Seventeen websites were identified for inclusion in this study. It was found that Canadian medical tourism broker websites varied widely in scope, content, professionalism and depth of information. Three themes emerged from the thematic content analysis: training and accreditation, risk communication, and business dimensions. Third party accreditation bodies of debatable regulatory value were regularly mentioned on the reviewed websites, and discussion of surgical risk was absent on 47% of the websites reviewed, with limited discussion of risk on the remaining ones. Terminology describing brokers' roles was somewhat inconsistent across the websites. Finally, brokers' roles in follow up care, their prices, and the speed of surgery were the most commonly included business dimensions on the reviewed websites. CONCLUSION Canadian medical tourism brokers currently lack a common standard of care and accreditation, and are widely lacking in providing adequate risk communication for potential medical tourists. This has implications for the informed consent and consequent safety of Canadian medical tourists.
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Affiliation(s)
- Kali Penney
- Faculty of Medicine, University of Calgary, 2500 University Drive, NW, Calgary, Alberta, Canada
| | - Jeremy Snyder
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada
| | - Valorie A Crooks
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada
| | - Rory Johnston
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada
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