Our Postpandemic World: What Will It Take to Build a Better Future for People and Planet?

Policy Points Despite the pandemic's ongoing devastating impacts, it also offers the opportunity and lessons for building a better, fairer, and sustainable world. Transformational change will require new ways of working, challenging powerful individuals and industries who worsened the crisis, will act to exploit it for personal gain, and will work to ensure that the future aligns with their interests. A flourishing world needs strong and equitable structures and systems, including strengthened democratic, research, and educational institutions, supported by ideas and discourses that are free of opaque and conflicted influence and that challenge the status quo and inequitable distribution of power.

Existing clinical evidence on the use of cellular bone matrix grafts in spinal fusion: updated systematic review of the literature

OBJECTIVE

Spinal fusion surgery is increasingly common; however, pseudarthrosis remains a common complication affecting as much as 15% of some patient populations. Currently, no clear consensus on the best bone graft materials to use exists. Recent advances have led to the development of cell-infused cellular bone matrices (CBMs), which contain living components such as mesenchymal stem cells (MSCs). Relatively few clinical outcome studies on the use of these grafts exist, although the number of such studies has increased in the last 5 years. In this study, the authors aimed to summarize and critically evaluate the existing clinical evidence on commercially available CBMs in spinal fusion and reported clinical outcomes.

METHODS

The authors performed a systematic search of the MEDLINE and PubMed electronic databases for peer-reviewed, English-language original articles (1970-2020) in which the articles' authors studied the clinical outcomes of CBMs in spinal fusion. The US National Library of Medicine electronic clinical trials database (www.ClinicalTrials.gov) was also searched for relevant ongoing clinical trials.

RESULTS

Twelve published studies of 6 different CBM products met inclusion criteria: 5 studies of Osteocel Plus/Osteocel (n = 354 unique patients), 3 of Trinity Evolution (n = 114), 2 of ViviGen (n = 171), 1 of map3 (n = 41), and 1 of VIA Graft (n = 75). All studies reported high radiographic fusion success rates (range 87%-100%) using these CBMs. However, this literature was overwhelmingly limited to single-center, noncomparative studies. Seven studies disclosed industry funding or conflicts of interest (COIs). There are 4 known trials of ViviGen (3 trials) and Bio4 (1 trial) that are ongoing.

CONCLUSIONS

CBMs are a promising technology with the potential of improving outcome after spinal fusion. However, while the number of studies conducted in humans has tripled since 2014, there is still insufficient evidence in the literature to recommend for or against CBMs relative to cheaper alternative materials. Comparative, multicenter trials and outcome registries free from industry COIs are indicated.

Pervasive Undisclosed Conflicts of Interest in Applied Behavior Analysis Autism Literature

Many autistic people (including researchers and non-researchers) are becoming increasingly involved in, and increasingly critical of, autism intervention research. They have expressed concerns regarding applied behavior analysis (ABA) interventions on a number of grounds, one of which is the prevalence of conflicts of interests (COIs) among autism intervention researchers. These concerns are now also being addressed by non-autistic researchers. COIs can introduce bias into the research process, and allow researchers to demonstrate positive effects for interventions that are not actually effective. Despite these concerns, there are no studies to date that examine the prevalence of COIs in behavioral journals. Because ABA services are routinely provided to autistic people in the United States as a means to address difficulties experienced by autistic people, this is an important area of investigation. We tallied author COIs in articles published over a 1-year period that tested, commented on, or reviewed ABA autism intervention strategies, extracted from eight journals devoted to publishing behavioral research. We coded included studies for COIs related to researcher employment as an ABA clinical provider or a training consultant to ABA clinical providers. We found that 84% of studies had at least one author with this type of COI, but they were only disclosed as COIs in 2% of studies. Additionally, 87% of studies with statements claiming the authors did not have COIs, were authored by researchers found to have clinical/training consultancy COIs. Pervasive, undisclosed COIs likely lead to researcher bias, and could at least partially account for persistent poor quality research in this area. The high prevalence of COIs among this research corroborates the concerns expressed by many autistic people. The autism community - including autistic people, autism researchers, and other stakeholders - should be aware of the prevalence of undisclosed COIs in this literature and take this into account when using, providing, or recommending ABA services.

Triaging ethical issues in the coronavirus pandemic: how to prioritize bioethics research during public health emergencies

Much of the ethical discourse concerning the coronavirus pandemic has focused on the allocation of scarce resources, be it potentially beneficial new treatments, ventilators, intensive care beds, or oxygen. Somewhat ironically, the more important ethical issues may lie elsewhere, just as the more important medical issues do not concern intensive care or treatment for COVID-19 patients, but rather the diversion towards these modes of care at the expense of non-Covid patients and treatment. In this article I explore how ethicists can and should prioritize which ethical issues to deal with, and develop a method of triage for identification and prioritization of ethical issues both in the next public health emergency and in bioethics more widely.

The Impact of Author Financial Conflicts on Robotic-Assisted Joint Arthroplasty Research

BACKGROUND

Recent studies have suggested clinical superiority with robotic-assisted arthroplasty compared to traditional techniques. However, concerns exist regarding the author's financial conflicts of interest (COI), which may influence research outcomes. This study aimed to determine whether COI relating to robotic-assisted arthroplasty influences the results of published outcomes following total hip (THA), total knee (TKA), and unicompartmental knee arthroplasty (UKA).

METHODS

We performed a systematic review to identify all studies evaluating the use of robotics in THA, TKA, and UKA. An author's financial COI was identified if they reported a relevant disclosure through the American Academy of Orthopedic Surgeons or within the study article. We then queried the Open Payments website to record all payments made from a robotic company in the year prior to publication. Each study was categorized as either favoring robotics (n = 42), neutral (n = 10), or favoring traditional techniques (n = 2). We then compared the number of conflicted authors, journal impact factor, level of evidence, and mean annual industry payment to each author.

RESULTS

Of the 54 studies meeting inclusion criteria, 49 (91%) had an author financial COI. Conflicted studies were more likely to report favorable results of robotics than nonconflicted studies. When compared to studies favoring conventional techniques, those demonstrating favorable robotics outcomes had a higher number of conflicted authors and a higher mean industry payment per author. There was no difference in the level of evidence or journal impact factor.

DISCUSSION

Nearly all studies comparing robotic THA, TKA, and UKA to conventional techniques involve financially conflicted authors. Further studies without COI may provide unbiased results.

Association Between Conflict of Interest and Published Position on Hypoglossal Nerve Stimulation for Sleep Apnea

OBJECTIVE

To determine if there is an association between authors' financial conflict of interest and published position on clinical use of hypoglossal nerve stimulation for obstructive sleep apnea.

STUDY DESIGN

Retrospective cross-sectional analysis.

SETTING

International roster of authors and articles analyzed.

METHODS

A Google Scholar search was performed for editorials and reviews citing the 2014 New England Journal of Medicine article on hypoglossal nerve stimulation for obstructive sleep apnea. Included articles were coded as favorable or neutral. Conflict of interest was recorded as declared by the authors in these articles and as independently searched in the Open Payments registry.

RESULTS

Sixteen articles from 45 independent authors were analyzed. Nine articles by authors were coded as favorable. Among authors of articles with favorable views, 16 (59%) had a financial conflict of interest with the manufacturer of the hypoglossal nerve stimulator device, as opposed to only 1 of 21 (5%) authors of neutral/unfavorable articles. When we included only authors to whom payments could be identified or excluded on Open Payments, 16 of 20 (80%; 95% CI, 62%-98%) authors of favorable articles had a financial conflict, while 1 of 10 (10%; 95% CI, 0%-29.6%) of neutral/unfavorable articles did (P = .004).

CONCLUSION

Our study demonstrates an association between published position on hypoglossal nerve stimulator use and financial conflict with the device manufacturer. Several undeclared conflicts were also found, suggesting a role for independent search for conflicts during the review process.

Research Review: Conflicts of Interest (COIs) in autism early intervention research - a meta-analysis of COI influences on intervention effects

BACKGROUND

The presence, types, disclosure rates, and effects of conflicts of interest (COIs) on autism early intervention research have not previously been studied. The purpose of this study was to examine these issues.

METHODS

This study is a secondary analysis of a comprehensive meta-analysis of all group-design, nonpharmacological early intervention autism research conducted between 1970 and 2018. We coded reports for the presence/absence of COI statements, the types of COIs that were disclosed, and for 8 types of COIs, including (a) the author developed the intervention, (b) the author is affiliated with a clinical provider, (c) the author is employed by a clinical provider, (d) the author is affiliated with an institution that trains others to use the intervention, (e) the author receives payment or royalties related to the intervention, (f) the study was funded by an intervention provider, (g) the study used a commercially available measure developed by the author, and (h) proceeds of the intervention fund the author's research. Frequencies and proportions were calculated to determine prevalence of COIs and COI disclosures. Meta-analysis was used to estimate summary effects by COI type and to determine if they were larger than for reports with no coded COIs.

RESULTS

Seventy percent of reports were coded for ≥ 1 COI, but only ~ 6% of reports contained COI statements fully accounting for all coded COIs. Metaregressions did not detect significant influences of any COI type on summary effects; however, point estimates for each COI type were larger than for reports with no coded COIs.

CONCLUSIONS

Conflicts of interest are prevalent but under-reported in autism early intervention research. Improved reporting practices are necessary for researcher transparency and would enable more robust examination of the effects of COIs on research outcomes.

Mortality & Hydroxychloroquine; Politics & Pandemic: Strange liaisons lead to strange correlations: Mortalité & Hydroxychloroquine; Politiques & Pandémie: D'étranges liaisons impliquent d'étranges corrélations

In the wake of the Covid-19 phenomenon, a new world economic order is emerging. This upheaval is unprecedented in the collective memory with as a result, profound social changes. The first sign appears in human behaviour, lucidity is increasingly an elite sport that few people practice. This leaves more and more room for conformism, the illusion of free will, and the irrational and impulsive crowd reasoning that was exploited during this pandemic by politicians and pharmaceutical industries. Strong and strange correlations result, on which we shed light in this work and that links the prescription of hydroxychloroquine, the behaviour of populations, their political prejudices, and their fatality rates. The urgency imposes rigid communication between rulers and governed. The pandemic brings to light the contradictions of this liaison.

Nursing Journal Policies on Disclosure and Management of Conflicts of Interest

PURPOSE

Concerns about conflicts of interest (COIs) in research and health care are well known, but recent reports of authors failing to disclose potential COIs in journal articles threatens the integrity of the scholarly literature. While many nursing journals have published editorials on this topic, review of nursing journal policies on and experiences with COIs has not been reported. The purposes of this study were to examine the extent to which nursing journals have COI policies and require disclosures by authors, peer reviewers, editorial board members, and editors who have a role in journal content decisions.

DESIGN

This cohort study addressed top-ranked nursing journal policies about and experiences with COIs in scholarly publications.

METHODS

An analysis of COI policies in the instructions for authors of 118 journals listed in the nursing category of Clarivate Analytics Journal Citation Reports was completed in 2019. An electronic survey of the editors was also conducted to determine their awareness and experience with COI policies for their journals. Characteristics of the journals and policies were assessed. Information on polices about COIs for editors and peer reviewers were also reviewed. A content analysis of the policies included assessment of best practices and gaps in requirements.

FINDINGS

For the journal policy assessment, 116 journals that publish only in the English language were eligible. The majority (n = 113; 97.4%) of journals had a statement on COI policies for authors, but only 42 (36.2%) had statements for peer reviewers and only 37 (31.9%) had statements for editors. A total of 117 journal editors were sent the survey. One declined to participate, leaving a total of 116 eligible editors; 82 (70.6%) responded and 34 did not respond. Sixty-seven (81.7%) of the 82 editors indicated that their journal had a policy about COIs for authors. Seventy-four editors (63.7%) responded to the question about their journal having a policy about COIs for peer reviewers and editors. Thirty-three (44.5%) of the respondents indicated their journal had a COI policy for peer reviewers, and 29 (39.1%) stated they had a policy for editors. Few editors (n = 7; 9%) indicated that they had encountered problems pertaining to author COIs.

CONCLUSIONS

Findings from this study may help promote ethical publication practices through comprehensive policies on disclosure and management of nursing journal authors, peer reviewers, and editors.

CLINICAL RELEVANCE

Declarations of potential conflicts of interest promote transparency and allows the consumer of research to take that into consideration when considering the findings of a study.

Health risks from radiofrequency radiation, including 5G, should be assessed by experts with no conflicts of interest

The fifth generation, 5G, of radiofrequency (RF) radiation is about to be implemented globally without investigating the risks to human health and the environment. This has created debate among concerned individuals in numerous countries. In an appeal to the European Union (EU) in September 2017, currently endorsed by >390 scientists and medical doctors, a moratorium on 5G deployment was requested until proper scientific evaluation of potential negative consequences has been conducted. This request has not been acknowledged by the EU. The evaluation of RF radiation health risks from 5G technology is ignored in a report by a government expert group in Switzerland and a recent publication from The International Commission on Non-Ionizing Radiation Protection. Conflicts of interest and ties to the industry seem to have contributed to the biased reports. The lack of proper unbiased risk evaluation of the 5G technology places populations at risk. Furthermore, there seems to be a cartel of individuals monopolizing evaluation committees, thus reinforcing the no-risk paradigm. We believe that this activity should qualify as scientific misconduct.

Food Industry Donations to Academic Programs: A Cross-Sectional Examination of the Extent of Publicly Available Data

No studies have documented the prevalence of the food industry’s funding of academic programs, which is problematic because such funding can create conflicts of interest in research and clinical practice. We aimed to quantify the publicly available information on the food industry’s donations to academic programs by documenting the amount of donations given over time, categorizing the types of academic programs that receive food industry donations, cataloguing the source of the donation information, and identifying any stated reasons for donations. Researchers cataloged online data from publicly available sources (e.g., official press releases, news articles, tax documents) on the food industry’s donations to academic programs from 2000 to 2016. Companies included 26 food and beverage corporations from the 2016 Fortune 500 list in the United States. Researchers recorded the: (1) monetary value of the donations; (2) years the donations were distributed; (3) the name and type of recipient; (4) source of donation information; and (5) reasons for donations. Adjusting for inflation, we identified $366 million in food industry donations (N = 3274) to academic programs. Universities received 45.2% (n = 1480) of donations but accounted for 67.9% of total dollars given in the sample. Community colleges, schools (i.e., preschool, elementary, middle, and high schools), and academic nonprofits, institutes, foundations, and research hospitals collectively received 54.8% of the donations, but made up less than one-third of the monetary value of donations. Half of the donations (49.0%) did not include a stated reason for the donation. In our sample, donations grew from $3 million in 2000 to $24 million in 2016. Food companies in our sample donated millions of dollars to universities and other academic programs but disclosed little information on the purpose of the donations. Achieving transparency in donation practices may only be possible if federal policies begin to require disclosures or if companies voluntarily disclose information.

The impact of reducing pharmaceutical industry payments on physician prescribing

Policymakers in the U.S. have expressed the hope that reducing payments from pharmaceutical companies to physicians will result in lower drug expenditures by reducing branded prescribing. This paper analyzes how the overall use and charges for generic and branded prescriptions change in an inpatient setting after a physician has had a payment from a pharmaceutical company reduced or cut off entirely. This research analyzes the impact of a pharmaceutical company cutting speaking payments to physicians in order to use fewer physicians more often, so the removal of payments is unrelated to a change in the company's product offering. Using hospital discharge data from New Jersey, this research employs a within-physician differences-in-differences design and finds that physicians who have payments reduced do not alter the number of or charges for prescriptions relative to unpaid physicians, neither do physicians who have their payments cut off but are still being paid by other pharmaceutical companies. Physicians who have their payments cut but who are not being paid by other companies, however, increase in the charges for and number of prescriptions written (both branded and generic) relative to their unpaid peers.

Development, implementation, and evaluation of a curriculum for medical students on conflicts of interest and communicating risk

Background: Insufficient risk competence of physicians, conflicts of interests from interactions with pharmaceutical companies, and the often distorted presentation of benefits and risks of therapies compromise the advising of patients by physicians in the framework of shared decision-making. An important cause of this is that teaching on this subject is mostly lacking, or fragmented when it does take place [1], [2], [3], [4]. Even though the German National Competence-Based Catalog of Learning Goals in Medicine defines learning goals on the topics of conflicts of interest and communication of risk, there are no classes that integrate both topics. Our goal was to develop a model curriculum to teach conflicts of interest and communication of risk that would integrate statistical know-how, communicational competency on the presentation of benefits and risks, and the meaning and management of conflicts of interest. Project Description: The development of the curriculum took place according to the six-step cycle of Kern et al [5]. An integrated curriculum was conceptualized, piloted, and adapted with the support of experts for the topics of shared decision-making, conflicts of interest, and communication of risk. The final version of the curriculum was implemented at the medical schools of Mainz and Heidelberg and evaluated by the students. Results: The final curriculum consists of 19 lesson units. The contents are the fundamentals of statistics, theory of risk communication, practical exercises on communication of risk, and the fundamentals of the mechanisms of effect of conflicts of interest, recognition of distortions in data, and introductions to professional management of conflicts of interest. The course was implemented three times at two different medical schools with a total of 32 students, and it was positively rated by most of the 27 participating students who evaluated it on the 1-6 German school grading scale (mean: 1.4; SD: 0.49; range: 1-2). Discussion: The curriculum we developed fills a gap in the current medical education. The innovative concept, which sensibly connects the transmission of theory and practice, was positively received by the students. The next steps are an evaluation of the curriculum by means of a two-center randomized study and the implementation at German and international medical schools. The process should be accompanied by continuous evaluation and further improvement.

Protecting Breastfeeding From Conflicts of Interest

In order to maximize profits from sales of breastmilk substitutes, manufacturers use a whole gamut of strategies to interfere with the effective implementation of policies that protect, promote, and support breastfeeding (e.g., the International Code of Marketing of Breastmilk Substitutes with its subsequent World Health Assembly resolutions and the Global Strategy on Infant and Young Child Feeding). Their strategies create, among other problems, personal and institutional conflicts of interest. Effective Conflict of Interest policies are therefore needed for ensuring that governments, international organizations, non-governmental organizations, and health professionals can protect their independence, integrity, and credibility in order to work in the best interests of children. Conflicts of interest are discussed by Dr Lida Lhotska and Dr Judith Richter, who have been actively involved in these issues internationally. Lida Lhotska holds a BSc in Biology and a PhD in Anthropology. Her international work spans over 25 years. She headed the Infant Feeding and Care team for UNICEF and subsequently joined the IBFAN-Geneva Infant Feeding Association team, always focusing on advancing the protection of breastfeeding through legal and other policy measures. Judith Richter has a multidisciplinary background combining knowledge in the humanities with health sciences (PhD Social Sciences; MA Development Studies; MSc Pharmaceutical Sciences). Her work as a freelance researcher for United Nations agencies, governments, and civil society organizations and networks has centered on safeguarding their capacity to hold transnational corporations accountable. In her interview, Judith Richter explains why conflict of interest regulation matters to health professionals working in the field of lactation. (MA = Maryse Arendt; LL = Lida Lhotska; JR = Judith Richter).

Highly esteemed science: An analysis of attitudes towards and perceived attributes of science in letters to the editor in two Dutch newspapers

Understanding attitudes towards science is crucial to safeguard the future of science, the application of its results and the inclusivity of decision-making processes related to science and technology. Most studies focus on attributes of social groups to explain attitudes towards science. In this study, we aim to move the discussion forward by focusing on perceived attributes of science itself by analysing over 300 letters to the editor in two Dutch national newspapers. The authors of these letters express a large degree of trust in science as a source of societal progress, if research is conducted according to a specific set of rules. Yet, they believe that these rules are under attack. The interests of universities as organizations and individual academics as well as the involvement of industry and government in research are perceived as conflicting with these rules. We conclude with recommendations for further research and practice.

Managing conflicts of interest in pharmacy and therapeutics committees: A proposal for multicentre formulary development

WHAT IS KNOWN AND OBJECTIVE

While many countries have central agencies responsible for formulary development, within the United States, each hospital, health care system, or insurance provider has their own pharmacy and therapeutic committee, leading to both inefficiencies and inequalities across formularies. The number and variety of processes within pharmacy and therapeutic committees also increases the likelihood that conflicts of interest will influence the development of formularies. We sought to determine how such influences could be reduced by reviewing international evidence related to the presence and harms of conflicts of interest in formulary development.

METHODS

Several approaches have been taken to reduce the influence of conflicts of interest in pharmacy and therapeutics committee processes, including include disclosure, recusal, exclusion, universal consideration and dual committees. The feasibility of each of these approaches is considered in the context of the United States.

RESULTS AND DISCUSSION

A proposal is drawn from the discussion of various approaches to conflicts of interest in pharmacy and therapeutics committees: multicenter formulary development.

WHAT IS NEW AND CONCLUSION

Multicentre formulary development, where resources are pooled across institutions, may lead to a reduction in the influence of conflicts of interest in pharmacy and therapeutics committee processes in the United States, increasing the chances of including the most safe, efficacious and cost-effective drugs on formularies.

Editors' and authors' individual conflicts of interest disclosure and journal transparency. A cross-sectional study of high-impact medical specialty journals

OBJECTIVE

To assess the fulfilment of authors' and editors' individual disclosure of potential conflicts of interest in a group of highly influential medicine journals across a variety of specialties.

DESIGN

Cross-sectional analysis.

SETTING AND PARTICIPANTS

Top-ranked five journals as per 2017 Journal Citation Report impact factor of 26 medical, surgery and imaging specialties.

INTERVENTIONS

Observational analysis.

PRIMARY AND SECONDARY OUTCOME MEASURES

Percentage of journals requiring disclosure of authors' and editors' individual potential conflicts of interest (CoI). Journals that were listed as followers of the International Committee of Medical Journal Editors (ICMJE) Recommendations, members of the Committee on Publication Ethics (COPE) and linked to a third party (ie, college, professional association/society, public institution).

RESULTS

Although 99% (129/130) of journals required author's CoI disclosure, only 12% (16/130) reported individual editors' potential CoIs. Forty-five per cent (58/130) of journals were followers of the ICMJE Recommendations, and 73% (95/130) were COPE members. Most (69%; 90/130) were linked to a college, professional society/association or public institution. Only one journal did not have policies on individual authors' and editors' CoI disclosure.

CONCLUSION

Very few high-impact medical journals disclosed their editorial teams' individual potential CoIs-conversely, almost all required disclosure of authors' individual CoIs. Journal followers of the ICMJE Recommendations should regularly disclose the editors' individual CoIs, as this is the only legitimate way to ask the same transparency of authors.

Congress of the United States, Ramazzini Institute and its affiliates, IARC: questions on scientific transparency

No abstract available.

Conflict of interest policies and disclosure requirements in neurosurgical journals

OBJECTIVE

An increasing amount of funding in neurosurgery research comes from industry, which may create a conflict of interest (COI) and the potential to bias results. The reporting and handling of COIs have become difficult, particularly as explicit policies themselves and definitions thereof continue to vary between medical journals. In this study, the authors sought to evaluate the prevalence and comprehensiveness of COI policies among leading neurosurgical journals.

METHODS

The authors conducted a cross-sectional study of publicly available online disclosure policies in the 20 highest-ranking neurosurgical journals, as determined by Google Scholar Metrics, in July 2016.

RESULTS

Overall, 89.5% of the highest-impact neurosurgical journals included COI policy statements. Ten (53%) journals requested declaration of nonfinancial conflicts, while 2 journals specifically set a time period for COIs. Sixteen journals required declaration from the corresponding author, 13 from all authors, 6 from reviewers, and 5 from editors. Four journals were included in the International Committee of Medical Journal Editors (ICMJE) list of publications that follow the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (currently known as Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals). Five journal policies included COI declaration verification, management, or enforcement. The neurosurgery journals with more comprehensive COI policies were significantly more likely to have higher h5-indices (p = 0.003) and higher impact factors (p = 0.01).

CONCLUSIONS

In 2016, the majority of, but not all, high-impact neurosurgical journals had publically available COI disclosure policies. Policy inclusiveness and comprehensiveness varied substantially across neurosurgical journals, but COI comprehensiveness was associated with other established markers of individual journals' favorability and influence, such as impact factor and h5-index.

Clinician, student and faculty perspectives on the audiology-industry interface: implications for ethics education

Objective: Supporting audiologists to work ethically with industry requires theory-building research. This study sought to answer: How do audiologists view their relationship with industry in terms of ethical implications? What do audiologists do when faced with ethical tensions? How do social and systemic structures influence these views and actions? Design: A constructivist grounded theory study was conducted using semi-structured interviews of clinicians, students and faculty. Study sample: A purposive sample of 19 Canadian and American audiologists was recruited with representation across clinical, academic, educational and industry work settings. Theoretical sampling of grey literature occurred alongside audiologist sampling. Interpretations were informed by the concepts of ethical tensions as ethical uncertainty, dilemmas and distress. Results: Findings identified the audiology-industry relationship as symbiotic but not wholly positive. A range of responses included denying ethical tensions to avoiding any industry interactions altogether. Several of our participants who had experienced ethical distress quit their jobs to resolve the distress. Systemic influences included the economy, professional autonomy and the hidden curriculum. Conclusions: In direct response to our findings, the authors suggest a move to include virtues-based practice, an explicit curriculum for learning ethical industry relations, theoretically-aligned ethics education approaches and systemic and structural change.

Financial Conflicts of Interest in Inflammatory Bowel Disease Guidelines

BACKGROUND

Industry payments can lead to financial conflicts of interest (FCOI) among authors of clinical practice guidelines (CPGs). Guidelines for inflammatory bowel disease (IBD) may be at particularly high risk. We determined the prevalence of FCOI in IBD CPGs produced by various gastroenterology societies.

METHODS

We conducted a cross-sectional analysis of FCOI disclosure among CPGs related to the management of IBD. We ascertained the prevalence and types of FCOI for each guideline and determined adherence to National Academy of Medicine (NAM) standards. FCOI disclosures were compared between societies producing CPGs.

RESULTS

We identified 11 relevant CPGs with 173 total authors. There were 117 (68%) authors who declared a payment. A total of 107 (62%) authors declared FCOI related to a medication recommended in the guideline. There was a significant difference (P < 0.001) between the proportion of authors with FCOI between countries or regions. Authors of US CPGs had a significantly lower FCOI prevalence (19%) compared with other societies. Authors of UK CPGs had a significantly lower FCOI prevalence (56%) compared with Canadian (84%) and European (94%) CPGs. Three (27%) guidelines adhered to both NAM standards.

CONCLUSIONS

A substantial portion of authors of IBD CPGs had FCOI. Our study found a significant difference in FCOI prevalence based on CPG sponsor nationality. Most CPGs for IBD did not adhere to NAM standards for FCOI disclosure.

Effect of the public disclosure of industry payments information on patients: results from a population-based natural experiment

OBJECTIVE

To determine the effect of the public disclosure of industry payments to physicians on patients' awareness of industry payments and knowledge about whether their physicians had accepted industry payments.

DESIGN

Interrupted time series with comparison group (difference-in-difference analyses of longitudinal survey).

SETTING

Nationally representative US population-based surveys. Surveys were conducted in September 2014, shortly prior to the public release of Open Payments information, and again in September 2016.

PARTICIPANTS

Adults aged 18 and older (n=2180).

MAIN OUTCOME MEASURES

Awareness of industry payments as an issue; awareness that industry payments information was publicly available; knowledge of whether own physician had received industry payments.

RESULTS

Public disclosure of industry payments information through Open Payments did not significantly increase the proportion of respondents who knew whether their physician had received industry payments (p=0.918). It also did not change the proportion of respondents who became aware of the issue of industry payments (p=0.470) but did increase the proportion who knew that payments information was publicly available (9.6% points, p=0.011).

CONCLUSIONS

Two years after the public disclosure of industry payments information, Open Payments does not appear to have achieved its goal of increasing patient knowledge of whether their physicians have received money from pharmaceutical and medical device firms. Additional efforts will be required to improve the use and effectiveness of Open Payments for consumers.

Undisclosed financial ties between guideline writers and pharmaceutical companies: a cross-sectional study across 10 disease categories

OBJECTIVES

To investigate the proportion of potentially relevant undisclosed financial ties between clinical practice guideline writers and pharmaceutical companies.

DESIGN

Cross-sectional study of a stratified random sample of Australian guidelines and writers.

SETTING

Guidelines available from Australia's National Health and Medical Research Council guideline database, 2012-2014, stratified across 10 health priority areas.

POPULATION

402 authors of 33 guidelines, including up to four from each area, dependent on availability: arthritis/musculoskeletal (3); asthma (4); cancer (4); cardiovascular (4); diabetes (4); injury (3); kidney/urogenital (4); mental health (4); neurological (1); obesity (1). For guideline writers with no disclosures, or who disclosed no ties, a search of disclosures in the medical literature in the 5 years prior to guideline publication identified potentially relevant ties, undisclosed in guidelines. Guidelines were included if they contained recommendations of medicines, and writers included if developing or writing guidelines.

MAIN OUTCOME MEASURES

Proportions of guideline writers with potentially relevant undisclosed financial ties to pharmaceutical companies active in the therapeutic area; proportion of guidelines including at least one writer with a potentially relevant undisclosed tie.

RESULTS

344 of 402 writers (86%; 95% CI 82% to 89%) either had no published disclosures (228) or disclosed they had no ties (116). Of the 344 with no disclosed ties, 83 (24%; 95% CI 20% to 29%) had potentially relevant undisclosed ties. Of 33 guidelines, 23 (70%; 95% CI 51% to 84%) included at least one writer with a potentially relevant undisclosed tie. Writers of guidelines developed and funded by governments were less likely to have undisclosed financial ties (8.1%vs30.6%; risk ratio 0.26; 95% CI 0.13 to 0.53; p<0.001).

CONCLUSIONS

Almost one in four guideline writers with no disclosed ties may have potentially relevant undisclosed ties to pharmaceutical companies. These data confirm the need for strategies to ensure greater transparency and more independence in relationships between guidelines and industry.