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Alvarenga-Brant R, Notaro SQ, Stefani CM, De Luca Canto G, Pereira AG, Póvoa-Santos L, Souza-Oliveira AC, Campos JR, Martins-Pfeifer CC. Pediatric dentistry systematic reviews using the GRADE approach: methodological study. BMC Oral Health 2024; 24:787. [PMID: 39003480 PMCID: PMC11245772 DOI: 10.1186/s12903-024-04542-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 06/27/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND To assess the reporting of the certainty of the evidence using the GRADE approach in systematic reviews of interventions in pediatric dentistry. METHODS The inclusion criteria were systematic reviews of randomized clinical trials (RCTs) and non-randomized studies of interventions (NRSIs) in pediatric dentistry that reported the certainty of the evidence through the GRADE approach. Paired independent reviewers screened the studies, extracted data, and appraised the methodological quality using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR 2) tool. The certainty of the evidence was extracted for each outcome. A descriptive analysis was conducted. RESULTS Around 28% of pediatric dentistry reviews of interventions used the GRADE approach (n = 24). Twenty reviews reported 112 evidence outcomes from RCTs and 13 from NRSIs using GRADE evidence profile tables. The methodological quality was high (16.7%), moderate (12.5%), low (37.5%), and critically low (33.3%), fulfilling the majority of the AMSTAR 2 criteria. The certainty of the evidence for outcomes generated from RCTs and NRSIs was very low (40.2% and 84.6%), low (33.1% and 7.7%), moderate (17.8% and 7.7%), and high (9.8% and 0.0%). The main reasons to downgrade the certainty were due to (for RCTs and NRSIs, respectively): risk of bias (68.8% and 84.6%), imprecision (67.8% and 100.0%), inconsistency (18.8% and 23.1%), indirectness (17.8% and 0.0%), and publication bias (7.1% and 0.0%). CONCLUSION The proportion of systematic reviews assessing the certainty of the evidence using the GRADE approach was considered small, considering the total initial number of published pediatric dentistry reviews of intervention. The certainty of the evidence was mainly very low and low, and the main problems for downgrading the certainty of evidence were due to risk of bias and imprecision. REGISTRATION PROSPERO database #CRD42022365443.
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Affiliation(s)
- Rachel Alvarenga-Brant
- Department of Surgery, Clinical Dentistry and Oral Pathology and Oral Surgery, Dental School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Sarah Queiroz Notaro
- Department of Pediatric Dentistry, Dental School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Alexandre Godinho Pereira
- Department of Surgery, Clinical Dentistry and Oral Pathology and Oral Surgery, Dental School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Luciana Póvoa-Santos
- Department of Pediatric Dentistry, Dental School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ana Clara Souza-Oliveira
- Department of Pediatric Dentistry, Dental School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Julya Ribeiro Campos
- Department of Surgery, Clinical Dentistry and Oral Pathology and Oral Surgery, Dental School, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Klasova J, Hussain N, Umer I, Al-Hindawi A, ElSaban M, Lahori S, D'Souza RS. Emotional and psychosocial function after dorsal column spinal cord stimulator implantation: a systematic review and meta-analysis. Reg Anesth Pain Med 2024:rapm-2024-105523. [PMID: 38942426 DOI: 10.1136/rapm-2024-105523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 06/08/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND The efficacy of spinal cord stimulation (SCS) in chronic pain studies is traditionally assessed by pain scores, which do not reflect the multidimensional nature of pain perception. Despite the evidence of SCS's influence on emotional functioning comprehensive assessments of its effect remain lacking. OBJECTIVE To assess changes in emotional and psychosocial functioning in patients who underwent SCS implantation for chronic pain. EVIDENCE REVIEW Ovid MEDLINE, EMBASE, PsychINFO, Cochrane CENTRAL and Scopus databases were searched for original peer-reviewed publications reporting emotional functioning after SCS. The primary outcomes were a pooled mean difference (MD) in anxiety, depression, global functioning, mental well-being and pain catastrophizing at 12 months. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to determine the quality of evidence. FINDINGS Thirty-two studies were included in the primary analysis. Statistically significant improvements were observed in anxiety (MD -2.16; 95% CI -2.84 to -1.49; p<0.001), depression (MD -4.66; 95% CI -6.26 to -3.06; p<0.001), global functioning (MD 20.30; 95% CI 14.69 to 25.90; p<0.001), mental well-being (MD 4.95; 95% CI 3.60 to 6.31; p<0.001), and pain catastrophizing (MD -12.09; 95% CI -14.94 to -9.23; p<0.001). Subgroup analyses revealed differences in Global Assessment of Functioning and mental well-being based on study design and in depression based on waveform paradigm. CONCLUSION The results highlight the statistically and clinically significant improvements in emotional and psychosocial outcomes in patients with chronic pain undergoing SCS therapy. However, these results need to be interpreted with caution due to the very low certainty of evidence per the GRADE criteria. PROSPERO REGISTRATION CRD42023446326.
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Affiliation(s)
- Johana Klasova
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ibrahim Umer
- Department of Anesthesiology, St Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Ahmed Al-Hindawi
- Royal College of Surgeons in Ireland Medical University of Bahrain, Al Muharraq, Bahrain
| | - Mariam ElSaban
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Simmy Lahori
- Department of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Murayama A, Kugo H, Kamamoto S. Evaluation of non-research and research industry payments to pediatric hematologist/oncologists in the United States between 2013 and 2021. Leuk Lymphoma 2024; 65:774-782. [PMID: 38349842 DOI: 10.1080/10428194.2024.2317344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 02/06/2024] [Indexed: 02/15/2024]
Abstract
Financial interactions between healthcare industry and pediatric hematologist/oncologists (PHOs) could be conflicts of interest. Nevertheless, little is known about financial relationships between healthcare industry and PHOs. This cross-sectional analysis of the Open Payments Database examined general and research payments to PHOs from healthcare industry in the United States between 2013 and 2021. Payments to the PHOs were analyzed descriptively. Trends in payments were assessed using generalized estimating equation models. Of 2784 PHOs, 2142 (76.9%) PHOs received payments totaling $187.3 million from the healthcare industry between 2013 and 2021. Approximately, $46.3 million (24.8%) were general payments and $137.7 million (73.5%) were funding for research where PHOs served as principal investigators (associated research funding). Both general payments and associated research funding considerably increased between 2014 and 2019. The number of PHOs receiving general payments and associated research funding annually increased by 2.2% (95% CI: 1.2-3.3%, p < .001) and 5.0% (95% CI: 3.3-6.8%, p < .001) between 2014 and 2019, respectively.
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Affiliation(s)
- Anju Murayama
- School of Medicine, Tohoku University, Sendai City, Japan
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Hinari Kugo
- School of Medicine, Tohoku University, Sendai City, Japan
| | - Sae Kamamoto
- Hamamatsu University School of Medicine, Hamamatsu, Japan
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4
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Coderre-Ball A, Phillips SP. Extent, transparency and impact of industry funding for pelvic mesh research: a review of the literature. Res Integr Peer Rev 2024; 9:4. [PMID: 38685078 PMCID: PMC11059718 DOI: 10.1186/s41073-024-00145-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 04/09/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Conflicts of interest inherent in industry funding can bias medical research methods, outcomes, reporting and clinical applications. This study explored the extent of funding provided to American physician researchers studying surgical mesh used to treat uterine prolapse or stress urinary incontinence, and whether that funding was declared by researchers or influenced the ethical integrity of resulting publications in peer reviewed journals. METHODS Publications identified via a Pubmed search (2014-2021) of the terms mesh and pelvic organ prolapse or stress urinary incontinence and with at least one US physician author were reviewed. Using the CMS Open Payments database industry funding received by those MDs in the year before, of and after publication was recorded, as were each study's declarations of funding and 14 quality measures. RESULTS Fifty-three of the 56 studies reviewed had at least one American MD author who received industry funding in the year of, or one year before or after publication. For 47 articles this funding was not declared. Of 247 physician authors, 60% received > $100 while 13% received $100,000-$1,000,000 of which approximately 60% was undeclared. While 57% of the studies reviewed explicitly concluded that mesh was safe, only 39% of outcomes supported this. Neither the quality indicator of follow-up duration nor overall statements as to mesh safety varied with declaration status. CONCLUSIONS Journal editors' guidelines re declaring conflicts of interest are not being followed. Financial involvement of industry in mesh research is extensive, often undeclared, and may shape the quality of, and conclusions drawn, resulting in overstated benefit and overuse of pelvic mesh in clinical practice.
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Affiliation(s)
| | - Susan P Phillips
- Centre for Studies in Primary Care, Queen's University, Kingston, Canada.
- Family Medicine and Public Health Sciences, Queen's University, Kingston, Canada.
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5
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Zhao L, Kherani J, Li PY, Zhang K, Horta A, Lin C, Li A, Eshaghpour A, Crowther MA. Primary prevention of venous thromboembolism for cancer patients in randomized controlled trials: a bibliographical analysis of funding and trial characteristics. Res Pract Thromb Haemost 2024; 8:102315. [PMID: 38404943 PMCID: PMC10884502 DOI: 10.1016/j.rpth.2024.102315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 02/27/2024] Open
Abstract
Background The majority of randomized controlled trials (RCTs) investigating venous thromboembolism (VTE) prophylaxis in patients with cancer involve commercial sponsorship. Commercial sponsorship overcomes feasibility limitations inherent in RCTs, such as recruitment and funding, but has attracted scrutiny for its potential for bias. Objectives In RCTs of VTE prophylaxis in patients with cancer, how do trial characteristics compare between commercially sponsored RCTs and noncommercially sponsored RCTs? Methods Medline, Embase, and Cochrane Central Register of Controlled Trials were searched for RCTs that investigated at least 1 pharmacologic intervention for VTE prophylaxis in adult patients with cancer. Screening and data extraction were conducted by independent reviewers. Outcomes included trial characteristics, reporting of favorable outcomes, protocol-manuscript discrepancies, and appraisal of spin. Outcomes were compared using the independent t-test, Mann-Whitney U-test, Pearson chi-squared test, and Fisher's exact test. Logistic regression was performed to identify factors associated with possible bias. Results Of the 54 trials analyzed, 34 (63%) reported commercial sponsorship. Commercial sponsorship was not associated with the reporting of favorable outcomes, presence of spin, retrospective registration, or protocol-manuscript discrepancy. Spin was most prevalent in the abstract conclusions (9 out of 17 [53.3%]) and manuscript conclusions (8 out of 17 [46.7%]).Commercially sponsored trials had a higher rate of intention-to-treat analysis. Noncommercially sponsored trials were more likely to report retrospective registration of trial protocol and the use of composite primary outcomes. Conclusion There were few significant differences between trial characteristics, suggesting that the evidence from commercially sponsored trials investigating VTE prophylaxis in patients with cancer is unlikely to be subject to bias attributable to commercial sponsorship.
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Affiliation(s)
- Lucy Zhao
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jayhan Kherani
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Pei Ye Li
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Zhang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Angelina Horta
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Christine Lin
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Allen Li
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ali Eshaghpour
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Suzuki I, Chiba T, Yoshimatsu K, Takebayashi J. [A Study on the Scientific Reliability of Notification Data in the Foods with Function Claims]. SHOKUHIN EISEIGAKU ZASSHI. JOURNAL OF THE FOOD HYGIENIC SOCIETY OF JAPAN 2024; 65:31-39. [PMID: 38658345 DOI: 10.3358/shokueishi.65.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
We conducted a comprehensive survey of Foods with Function Claims (FFC) submitted from April to August 2022 to examine the scientific reliability of the systematic review (SR), which is the basis for functional claims. The results of the review of 611 functional claims for 398 products showed that there were 121 functionally active substances and 87 health claims (Hc) that were labeled, with some functionally active substances having multiple functions. SRs, meta-analyses, and clinical studies were submitted as the basis of functionality for 87%, 10%, and 3% of the reports, respectively. Of these SRs, 39% of the SRs included a single paper. In 67% of the SRs with a single paper included, some of the authors of the included paper and the person who conducted the SR had the same affiliation, which raises concerns about conflicts of interest. The median of clinical trial participants in papers included for SR was relatively small, 38, and the smallest total number of SRs was 6. Thus, it was shown that there are many SRs for FFC that are based on only a single paper or a small-scale clinical trial and that lack reliability as scientific evidence.
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Affiliation(s)
- Ippei Suzuki
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Tsuyoshi Chiba
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Kayo Yoshimatsu
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Jun Takebayashi
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
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Murayama A, Kamamoto S, Kugo H, Saito H, Ozaki A. Research and Nonresearch Industry Payments to Nephrologists in the United States between 2014 and 2021. J Am Soc Nephrol 2023; 34:1709-1720. [PMID: 37488676 PMCID: PMC10561777 DOI: 10.1681/asn.0000000000000172] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 05/29/2023] [Indexed: 07/26/2023] Open
Abstract
SIGNIFICANCE STATEMENT Concerns about the financial relationships between nephrologists and the health care industry have been reported in the United States over the past decade. However, since the 2014 launch of the federal transparency database, Open Payments, few documents have explored the whole picture of research and nonresearch payments to US nephrologists from industry sources. In this study, the authors found that 87% of nephrologists have received nonresearch payments, and the aggregate amount of these payments has been increasing since 2014. Only 12% of nephrologists received research payments; these recipients were disproportionately male. In addition, the top 5% of nephrologists receiving nonresearch funds received 81% of all such payments. Nonresearch payments were larger among male nephrologists than among female nephrologists and increased by 8% annually among male nephrologists between 2014 and 2019. BACKGROUND Financial relationships between nephrologists and the health care industry have been a concern in the United States over the past decade. METHODS To evaluate industry payments to nephrologists, we conducted a cross-sectional study examining nonresearch and research payments to all US nephrologists registered in the National Plan and Provider Enumeration System between 2014 and 2021, using the Open Payments database. Payment data were descriptively analyzed on the basis of monetary value, and payment trends were evaluated by using a generalized estimating equations model. RESULTS From 2014 through 2021, 10,463 of 12,059 nephrologists (87%) received at least one payment from the US health care industry, totaling $778 million. The proportion of nephrologists who did not receive nonresearch payments varied each year, ranging from 38% to 51%. Nonresearch payments comprised 22% ($168 million) of overall industry payments in monetary value but 87% in the number of payments. Among those receiving payments, the median per-physician 8-year aggregated payment values were $999 in nonresearch payments and $102,329 in associated research payments. Male nephrologists were more likely than female nephrologists to receive research payments, but the per-physician amount did not differ. However, nonresearch payments were three times larger for male nephrologists and increased by 8% annually between 2014 and 2019 among male nephrologists but remained stable among female nephrologists. The top 5% of nephrologists receiving nonresearch payments received 81% of all such payments. CONCLUSIONS Between 2014 and 2021, 87% of US nephrologists received at least one payment from the health care industry. Notably, nonresearch payments to nephrologists have been increasing since the Open Payments database's 2014 launch. Male nephrologists were more likely than female nephrologists to receive research payments.
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Affiliation(s)
- Anju Murayama
- School of Medicine, Tohoku University, Sendai, Japan
| | - Sae Kamamoto
- School of Medicine, Hamamatsu University, Hamamatsu, Japan
| | - Hinari Kugo
- School of Medicine, Tohoku University, Sendai, Japan
| | - Hiroaki Saito
- Medical Governance Research Institute, Tokyo, Japan
- Department of Internal Medicine, Soma Central Hospital, Fukushima, Japan
| | - Akihiko Ozaki
- Medical Governance Research Institute, Tokyo, Japan
- Department of Breast and Thyroid Surgery, Jyoban Hospital, Fukushima, Japan
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Murayama A, Saito H, Tanimoto T, Ozaki A. Financial conflicts of interest between pharmaceutical companies and executive board members of internal medicine subspecialty societies in Japan between 2016 and 2020. J Eval Clin Pract 2023; 29:883-886. [PMID: 37283452 DOI: 10.1111/jep.13877] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/12/2023] [Accepted: 05/19/2023] [Indexed: 06/08/2023]
Abstract
RATIONALE Pharmaceutical companies make payments to physicians such as compensations for lecturing or consulting. Of particular, financial relationships between pharmaceutical companies and leaders of professional medical societies are concern in medical community. However, little was known about them in Japan. AIMS AND OBJECTIVES This study aimed to evaluate the magnitude and prevalence of personal payments to executive board members (EBMs) of 15 medical associations representing different subspecialties within the Japanese Society of Internal Medicine. METHOD All EBMs of 15 medical associations representing internal medicine subspecialties were collected from each association webpage. Payments to the EBMs were extracted from the pharmaceutical companies belonging to the Japan Pharmaceutical Manufacturers Association between 2016 and 2020. We performed descriptive analysis on the payment data. RESULTS Of the 353 different EBMs identified, 350 (99.2%) received one or more personal payments from the pharmaceutical companies over the 5 years. 99.2% (350) and 97.2% (343) of all EBMs received personal payments 3 years before and in the year of their board membership. A total of $70,796,014 were made to the EBMs over the 5 years. The median 5-year combined personal payments per EBM was $150,849 (interquartile range [IQR]: $73,412-$282,456). EBMs who were chairman or vice chairman of executive board received significantly larger median personal payments than those who were not ($225,685 vs. $143,885, p = 0.01 in the U test). Among the 15 societies, there were 12 (80.0%) societies with all (100%) EBMs receiving personal payments from the pharmaceutical companies. Although every society has their own conflicts of interest policy, none publicly discloses the financial relationships between pharmaceutical companies and their EBMs due to their privacy. CONCLUSION This study demonstrated that nearly all EBMs of 15 medical associations representing internal medicine subspecialties had substantial financial relationships with the pharmaceutical companies in Japan over the past 5 years.
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Affiliation(s)
- Anju Murayama
- School of Medicine, Tohoku University, Sendai, Miyagi, Japan
| | - Hiroaki Saito
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
- Department of Internal Medicine, Soma Central Hospital, Soma, Fukushima, Japan
| | - Tetsuya Tanimoto
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
- Department of Internal Medicine, Navitas Clinic Tachikawa, Tachikawa, Tokyo, Japan
| | - Akihiko Ozaki
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
- Department of Breast and Thyroid Surgery, Jyoban Hospital, Iwaki, Fukushima, Japan
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Murayama A. Industry-sponsored research funding to allergists and clinical immunologists in the United States. Ann Allergy Asthma Immunol 2023; 131:395-397. [PMID: 37353050 DOI: 10.1016/j.anai.2023.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 06/25/2023]
Affiliation(s)
- Anju Murayama
- School of Medicine, Tohoku University, Sendai City, Miyagi, Japan.
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Murayama A, Hirota S. Industry payments to pathologists in the USA between 2013 and 2021. J Clin Pathol 2023; 76:566-570. [PMID: 37085323 DOI: 10.1136/jcp-2023-208901] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 04/23/2023]
Abstract
Although proper physician-industry financial relationships are essential for improving patient care, they can also cause potential conflicts of interest. However, little is known about the pathologist-industry financial relationships. Using the 2013-2021 Open Payments Database, this cross-sectional study investigated both research and non-research payments to all pathologists in the USA. Payment data were analyzed descriptively. Of 21,664 pathologists, 49.5% of all pathologists have received payments totaling $356.7 million from the healthcare industry, of which 68.2% were research payments. Median per-physician general and associated research payments (IQR) were $145($49-$575) and $70,926 ($17,450-$299,285) over the nine years. The top 1% of pathologists receiving general payments received 68.0% of all general payments. Male pathologists specializing in blood banking and transfusion medicine and hematopathology are significantly more likely than those not to receive research and non-research payments. This first study provides valuable insights into the financial relationships between pathologists and the healthcare industry.
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Affiliation(s)
- Anju Murayama
- School of Medicine, Tohoku University, Sendai, Miyagi, Japan
| | - Shuto Hirota
- School of Medicine, Tohoku University, Sendai, Miyagi, Japan
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Pereira AG, Martins CC, Campos JR, Faria SFS, Notaro SQ, Poklepović-Peričić T, Costa LCM, Costa FO, Cota LOM. Critical appraisal of systematic reviews of intervention studies in periodontology using AMSTAR 2 and ROBIS tools. J Clin Exp Dent 2023; 15:e678-e694. [PMID: 37674600 PMCID: PMC10478201 DOI: 10.4317/jced.60197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 05/22/2023] [Indexed: 09/08/2023] Open
Abstract
Background Systematic reviews of intervention studies are used to support treatment recommendations. The aim of this study was to assess the methodological quality and risk of bias of systematic reviews of intervention studies in in the field of periodontology using AMSTAR 2 and ROBIS. Material and Methods Systematic reviews of randomized and non-randomized clinical trials, published between 2019 and 2020, were searched at MedLine, Embase, Web of Science, Scopus, Cochrane Library, LILACS with no language restrictions between October 2019 to October 2020. Additionally, grey literature and hand search was performed. Paired independent reviewers screened studies, extracted data and assessed the methodological quality and risk of bias through the AMSTAR 2 and ROBIS tools. Results One hundred twenty-seven reviews were included. According to AMSTAR 2, the methodological quality was mainly critically low (64.6%) and low (24.4%), followed by moderate (0.8%) and high (10.2%). According to ROBIS, 90.6% were at high risk of bias, followed by 7.1% low, and 2.4% unclear risk of bias. The risk of bias decreased with the increased in the impact factor of the journal. Conclusions Current systematic reviews of intervention studies in periodontics were classified as low or critically low methodological quality and high risk of bias. Both tools led to similar conclusions. Better adherence to established reporting guidelines and stricter research practices when conducting systematic reviews are needed. Key words:Bias, evidence-based dentistry, methods, periodontics, systematic review.
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Affiliation(s)
- Alexandre-Godinho Pereira
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, BrazilDepartment of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Carolina-Castro Martins
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Julya-Ribeiro Campos
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, BrazilDepartment of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sandro-Felipe-Santos Faria
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, BrazilDepartment of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sarah-Queiroz Notaro
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Tina Poklepović-Peričić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | | | - Fernando-Oliveira Costa
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, BrazilDepartment of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Luís-Otávio-Miranda Cota
- Department of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, BrazilDepartment of Dental Clinics, Oral Pathology, and Oral Surgery, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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ElSaban M, Kleppel DJ, Kubrova E, Martinez Alvarez GA, Hussain N, D'Souza RS. Physical functioning following spinal cord stimulation: a systematic review and meta-analysis. Reg Anesth Pain Med 2023; 48:302-311. [PMID: 37080578 DOI: 10.1136/rapm-2022-104295] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/07/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Spinal cord stimulation (SCS) has emerged as an important treatment for chronic pain disorders. While there is evidence supporting improvement in pain intensity with SCS therapy, efforts to synthesize the evidence on physical functioning are lacking. OBJECTIVE The primary objective of this meta-analysis was to assess long-term physical function following 12 months of SCS for chronic back pain. EVIDENCE REVIEW PubMed, EMBASE, Scopus, and CENTRAL databases were searched for original peer-reviewed publications investigating physical function following SCS. The primary outcome was physical function at 12 months following SCS therapy for chronic back pain compared with baseline. A random effects model with an inverse variable method was used. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was used to determine the certainty of evidence. FINDINGS A total of 518 studies were screened, of which 36 were included. Twenty-two studies were pooled in the meta-analysis. There was a significant reduction in Oswestry Disability Index (ODI) scores at all time frames up to 24 months following implantation. Pooled results revealed significant improvement in ODI scores at 12 months with a mean difference of -17.00% (95% CI -23.07 to -10.94, p<0.001). There was a very low certainty of evidence in this finding as per the GRADE framework. There was no significant difference in subgroup analyses based on study design (randomised controlled trials (RCTs) vs non-RCTs), study funding, or stimulation type. CONCLUSION This meta-analysis highlights significant improvements in physical function after SCS therapy. However, this finding was limited by a very low GRADE certainty of evidence and high heterogeneity.
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Affiliation(s)
- Mariam ElSaban
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Donald J Kleppel
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Eva Kubrova
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
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Graham SS, Sharma N, Karnes MS, Majdik ZP, Barbour JB, Rousseau JF. A Content Analysis of Self-Reported Financial Relationships in Biomedical Research. AJOB Empir Bioeth 2023; 14:91-98. [PMID: 36576202 PMCID: PMC10182247 DOI: 10.1080/23294515.2022.2160509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
INTRODUCTION Financial conflicts of interest (fCOI) present well documented risks to the integrity of biomedical research. However, few studies differentiate among fCOI types in their analyses, and those that do tend to use preexisting taxonomies for fCOI identification. Research on fCOI would benefit from an empirically-derived taxonomy of self-reported fCOI and data on fCOI type and payor prevalence. METHODS We conducted a content analysis of 6,165 individual self-reported relationships from COI statements distributed across 378 articles indexed with PubMed. Two coders used an iterative coding process to identify and classify individual fCOI types and payors. Inter-rater reliability was κ = 0.935 for fCOI type and κ = 0.884 for payor identification. RESULTS Our analysis identified 21 fCOI types, 9 of which occurred at prevalences greater than 1%. These included research funding (24.8%), speaking fees (20.8%), consulting fees (18.8%), advisory relationships (11%), industry employment (7.6%), unspecified fees (4.8%), travel fees (3.2%), stock holdings (3.1%), and patent ownership (1%). Reported fCOI were held with 1,077 unique payors, 22 of which were present in more than 1% of financial relationships. The ten most common payors included Pfizer (4%), Novartis (3.9%), MSD (3.8%), Bristol Myers Squibb (3.2%), AstraZeneca (3.1%), GSK (3%), Boehringer Ingelheim (2.9%), Roche (2.8%), Eli LIlly (2.5%), and AbbVie (2.4%). CONCLUSIONS These results provide novel multi-domain prevalence data on self-reported fCOI and payors in biomedical research. As such, they have the potential to catalyze future research that can assess the differential effects of various types of fCOI. Specifically, the data suggest that comparative analyses of the effects of different fCOI types are needed and that special attention should be paid to the diversity of payor types for research relationships.
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Affiliation(s)
- S Scott Graham
- Department of Rhetoric & Writing, Center for Health Communication, The University of Texas at Austin, Austin, TX, USA
| | - Nandini Sharma
- Moody College of Communication, The University of Texas at Austin, Austin, TX, USA
| | - Martha S Karnes
- Department of English, The University of Texas at Austin, Austin, TX, USA
| | - Zoltan P Majdik
- Department of Communication, North Dakota State University, Fargo, ND, USA
| | - Joshua B Barbour
- Moody College of Communication, The University of Texas at Austin, Austin, TX, USA
| | - Justin F Rousseau
- Departments of Population Health and Neurology, The Dell Medical School at The University of Texas at Austin, Austin, TX, USA
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Nejstgaard CH, Laursen DRT, Lundh A, Hróbjartsson A. Commercial funding and estimated intervention effects in randomized clinical trials: Systematic review of meta-epidemiological studies. Res Synth Methods 2023; 14:144-155. [PMID: 36357935 DOI: 10.1002/jrsm.1611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022]
Abstract
We investigated to which degree commercial funding is associated with estimated intervention effects in randomized trials. We included meta-epidemiological studies with published data on the association between commercial funding and results or conclusions of randomized trials. We searched five databases and other sources. We selected one result per meta-epidemiological study, preferably unadjusted ratio of odds ratios (ROR), for example, odds ratio(commercial funding)/odds ratio(noncommercial funding). We pooled RORs in random-effects meta-analyses (ROR <1 indicated exaggerated intervention effects in commercially funded trials), subgrouped (preplanned) by study aim: commercial funding per se versus risk of commercial funder influence. We included eight meta-epidemiological studies (264 meta-analyses, 2725 trials). The summary ROR was 0.95 (95% confidence interval 0.85-1.06). Subgroup analysis revealed a difference (p = 0.02) between studies of commercial funding per se, ROR 1.06 (0.95-1.17) and studies of risk of commercial funder influence, ROR 0.88 (0.79-0.97). In conclusion, we found no statistically significant association between commercial funding and estimated intervention effects when combining studies of commercial funding per se and studies of risk of commercial funder influence. A preplanned subgroup analysis indicated that trials with high risk of commercial funder influence exaggerated intervention effects by 12% (21%-3%), on average. Our results differ from previous theoretical considerations and findings from methodological studies and therefore call for confirmation. We suggest it is prudent to interpret results from commercially funded trials with caution, especially when there is a risk that the funder had direct influence on trial design, conduct, analysis, or reporting.
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Affiliation(s)
- Camilla Hansen Nejstgaard
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - David Ruben Teindl Laursen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Andreas Lundh
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
- Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark
| | - Asbjørn Hróbjartsson
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
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Via GG, Brueggeman DA, Lyons JG, Ely IC, Froehle AW, Krishnamurthy AB. Funding has no effect on clinical outcomes of total joint arthroplasty emerging technologies: a systematic review of bibliometrics and conflicts of interest. ARTHROPLASTY (LONDON, ENGLAND) 2022; 4:45. [PMID: 36316729 PMCID: PMC9623935 DOI: 10.1186/s42836-022-00146-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/14/2022] [Indexed: 11/06/2022]
Abstract
Background The use of new total joint arthroplasty technologies, including patient-specific implants/instrumentation (PSI), computer-assisted (CA), and robotic-assisted (RA) techniques, is increasing. There is an ongoing debate regarding the value provided and potential concerns about conflicts of interest (COI). Methods PRISMA guidelines were followed. PubMed, MEDLINE, and Web of Science databases were searched for total hip and knee arthroplasties, unicompartmental knee arthroplasties (UKA), PSI, CA, and RA. Bibliometric data, financial COI, clinical/functional scores, and patient-reported outcomes were assessed. Results Eighty-seven studies were evaluated, with 35 (40.2%) including at least one author reporting COI, and 13 (14.9%) disclosing industry funding. COI and industry funding had no significant effects on outcomes (P = 0.682, P = 0.447), and there were no significant effects of conflicts or funding on level of evidence (P = 0.508, P = 0.826). Studies in which author(s) disclosed COI had significantly higher relative citation ratio (RCR) and impact factor (IF) than those without (P < 0.001, P = 0.032). Subanalysis demonstrated RA and PSI studies were more likely to report COI or industry funding (P = 0.045). RA (OR = 6.31, 95% CI: 1.61–24.68) and UKA (OR = 9.14, 95% CI: 1.43–58.53) had higher odds of reporting favorable outcomes than PSI. Conclusions Author COIs (about 40%) may be lower than previously reported in orthopedic technologies/techniques reviews. Studies utilizing RA and PSI were more likely to report COI, while RA and UKA studies were more likely to report favorable outcomes than PSI. No statistically significant association between the presence of COIs and/or industry funding and the frequency of favorable outcomes or study level of evidence was found. Level of evidence Level V Systematic Review Supplementary Information The online version contains supplementary material available at 10.1186/s42836-022-00146-3.
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Affiliation(s)
- Garrhett G. Via
- grid.268333.f0000 0004 1936 7937Department of Orthopedic Surgery, Wright State University, 30 E. Apple St., Ste 2200, Dayton, OH 45409 USA
| | - David A. Brueggeman
- grid.268333.f0000 0004 1936 7937Department of Orthopedic Surgery, Wright State University, 30 E. Apple St., Ste 2200, Dayton, OH 45409 USA
| | - Joseph G. Lyons
- grid.268333.f0000 0004 1936 7937Department of Orthopedic Surgery, Wright State University, 30 E. Apple St., Ste 2200, Dayton, OH 45409 USA
| | - Isabelle C. Ely
- grid.268333.f0000 0004 1936 7937Department of Orthopedic Surgery, Wright State University, 30 E. Apple St., Ste 2200, Dayton, OH 45409 USA
| | - Andrew W. Froehle
- grid.268333.f0000 0004 1936 7937Department of Orthopedic Surgery, Wright State University, 30 E. Apple St., Ste 2200, Dayton, OH 45409 USA
| | - Anil B. Krishnamurthy
- grid.268333.f0000 0004 1936 7937Department of Orthopedic Surgery, Wright State University, 30 E. Apple St., Ste 2200, Dayton, OH 45409 USA
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16
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Zhang N, Yan P, Zhao H, Feng L, Chu X, Li J, Chen N, Yang K, Liu X. The Impact of Drug Trials With Financial Conflict of Interests on the Meta-analyses: A Meta-epidemiological Study. Int J Health Policy Manag 2022; 11:2038-2045. [PMID: 34923810 PMCID: PMC9808270 DOI: 10.34172/ijhpm.2021.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 11/17/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND To assess the impact of trials with potential financial conflict of interests (FCOIs) on evidence synthesis in meta-analyses (MAs). METHODS A total of 96 MAs from the Cochrane Library about drug trials were investigated. The primary outcomes examined the proportion of conclusions that would change with the exclusion of trials with potential FCOIs. If the proportion of changed conclusions was below the non-inferiority margin of 10%, we considered that it was not inferior to include the trials with potential FCOIs in the MAs. RESULTS Only 54.17% of MAs reported the funding sources of each included trial, and in 21.88% of MAs, the author-industry-related financial ties of each included trial were reported. When trials with FCOIs were excluded, the changed conclusions of effectiveness and major adverse events were 13.16% and 11.11%, respectively, and the I2 decreased by 13.56% and 10.09%, respectively. For serious adverse events, the exclusion of FCOIs trials did not lead to any change in conclusions; however, the I2 decreased by 24.24%. The impact of trials without reported FCOIs was also examined on evidence synthesis, and the results showed that the changed conclusions of effectiveness and major adverse events were 5.26% and 6.25%, respectively, indicating non-inferiority. However, the I2 increased by 13.60% and 12.37%, respectively. CONCLUSION In this meta-epidemiological study, we demonstrated that trials with FCOIs may not only influence the final outcome of MAs but may also increase the heterogeneity of results. It is suggested that all MAs fully report the FCOIs involved in evidence-based research and explore the impact of its FCOIs to better provide a more valuable reference for patients, clinicians, and policy-makers.
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Affiliation(s)
- Na Zhang
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Health Technology Assessment Center of Lanzhou University, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Peijing Yan
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Haitong Zhao
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Health Technology Assessment Center of Lanzhou University, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Lufang Feng
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Health Technology Assessment Center of Lanzhou University, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Xiajing Chu
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Health Technology Assessment Center of Lanzhou University, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Jingwen Li
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Health Technology Assessment Center of Lanzhou University, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Nan Chen
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Health Technology Assessment Center of Lanzhou University, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Kehu Yang
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Health Technology Assessment Center of Lanzhou University, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Xingrong Liu
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
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Graham SS, Karnes MS, Jensen JT, Sharma N, Barbour JB, Majdik ZP, Rousseau JF. Evidence for stratified conflicts of interest policies in research contexts: a methodological review. BMJ Open 2022; 12:e063501. [PMID: 36123074 PMCID: PMC9486359 DOI: 10.1136/bmjopen-2022-063501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The purpose of this study was to conduct a methodological review of research on the effects of conflicts of interest (COIs) in research contexts. DESIGN Methodological review. DATA SOURCES Ovid. ELIGIBILITY CRITERIA Studies published between 1986 and 2021 conducting quantitative assessments of relationships between industry funding or COI and four target outcomes: positive study results, methodological biases, reporting quality and results-conclusions concordance. DATA EXTRACTION AND SYNTHESIS We assessed key facets of study design: our primary analysis identified whether studies stratified industry funding or COI variables by magnitude (ie, number of COI or disbursement amount), type (employment, travel fees, speaking fees) or if they assessed dichotomous variables (ie, conflict present or absent). Secondary analyses focused on target outcomes and available effects measures. RESULTS Of the 167 articles included in this study, a substantial majority (98.2%) evaluated the effects of industry sponsorship. None evaluated associations between funding magnitude and outcomes of interest. Seven studies (4.3%) stratified industry funding based on the mechanism of disbursement or funder relationship to product (manufacturer or competitor). A fifth of the articles (19.8%) assessed the effects of author COI on target outcomes. None evaluated COI magnitude, and three studies (9.1%) stratified COI by disbursement type and/or reporting practices. Participation of an industry-employed author showed the most consistent effect on favourability of results across studies. CONCLUSIONS Substantial evidence demonstrates that industry funding and COI can bias biomedical research. Evidence-based policies are essential for mitigating the risks associated with COI. Although most policies stratify guidelines for managing COI, differentiating COIs based on the type of relationship or monetary value, this review shows that the available research has generally not been designed to assess the differential risks of COI types or magnitudes. Targeted research is necessary to establish an evidence base that can effectively inform policy to manage COI.
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Affiliation(s)
- S Scott Graham
- Department of Rhetoric & Writing, University of Texas at Austin, Austin, Texas, USA
| | - Martha S Karnes
- Department of English, The University of Texas at Austin, Austin, Texas, USA
| | - Jared T Jensen
- Department of Communication Studies, The Unviersity of Texas at Austin, Austin, TX, USA
| | - Nandini Sharma
- Department of Communication Studies, The Unviersity of Texas at Austin, Austin, TX, USA
| | - Joshua B Barbour
- Department of Communication Studies, The Unviersity of Texas at Austin, Austin, TX, USA
| | - Zoltan P Majdik
- Department of Communication, North Dakota State University, Fargo, North Dakota, USA
| | - Justin F Rousseau
- Department of Population Health and Neurology, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
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18
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Funck-Brentano C. Evidence-based medicine: Friend and foe. Therapie 2022:S0040-5957(22)00143-3. [PMID: 36192190 DOI: 10.1016/j.therap.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/13/2022] [Indexed: 12/03/2022]
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Fabbri A, Hone KR, Hróbjartsson A, Lundh A. Conflict of Interest Policies at Medical Schools and Teaching Hospitals: A Systematic Review of Cross-sectional Studies. Int J Health Policy Manag 2022; 11:1274-1285. [PMID: 33812349 PMCID: PMC9808354 DOI: 10.34172/ijhpm.2021.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/06/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND This systematic review aims to estimate the proportion of medical schools and teaching hospitals with conflicts of interest (COI) policies for health research and education, to describe the provisions included in the policies and their impact on research outputs and educational quality or content. METHODS Experimental and observational studies reporting at least one of the above mentioned aims were included irrespective of language, publication type or geographical setting. MEDLINE, Scopus, Embase and the Cochrane Methodology Register were searched from inception to March 2020. Methodological study quality was assessed using an amended version of the Joanna Briggs Institute's checklist for prevalence studies. RESULTS Twenty-two cross-sectional studies were included; all were conducted in high-income countries. Of these, 20 studies estimated the prevalence of COI policies, which ranged from 5% to 100% (median: 85%). Twenty studies assessed the provisions included in COI policies with different assessment methods. Of these, nine analysed the strength of the content of medical schools' COI policies using various assessment tools that looked at a range of policy domains. The mean standardised summary score of policy strength ranged from 2% to 73% (median: 30%), with a low score indicating a weak policy. North American institutions more frequently had COI policies and their content was rated as stronger than policies from European institutions. None of the included studies assessed the impact of COI policies on research outputs or educational quality or content. CONCLUSION Prevalence of COI policies at medical schools and teaching hospitals varied greatly in high-income countries. No studies estimated the prevalence of policies in low to middle-income countries. The content of COI policies varied widely and while most European institutions ranked poorly, in North America more medical schools had strong policies. No studies were identified on impact of COI policies on research outputs and educational quality or content.
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Affiliation(s)
- Alice Fabbri
- Centre for Evidence-Based Medicine Odense (CEBMO), University of Southern Denmark and Odense University Hospital, Odense, Denmark
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, United Kingdom
| | - Kristine Rasmussen Hone
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Asbjørn Hróbjartsson
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Andreas Lundh
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
- Department of Infectious Diseases, Hvidovre Hospital, Hvidovre, Denmark
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Graham SS, Majdik ZP, Barbour JB, Rousseau JF. Associations Between Aggregate NLP-Extracted Conflicts of Interest and Adverse Events by Drug Product. Stud Health Technol Inform 2022; 290:405-409. [PMID: 35673045 PMCID: PMC9186043 DOI: 10.3233/shti220106] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
This study evaluates associations between aggregate conflicts of interest (COI) and drug safety. We used a machine-learning system to extract and classify COI from PubMed-indexed disclosure statements. Individual conflicts were classified as Type 1 (personal fees, travel, board memberships, and non-financial support), Type 2 (grants and research support), or Type 3 (stock ownership and industry employment). COI were aggregated by type compared to adverse events by product. Type 1 COI are associated with a 1.1-1.8% increase in the number of adverse events, serious events, hospitalizations, and deaths. Type 2 COI are associated with a 1.7-2% decrease in adverse events across severity levels. Type 3 COI are associated with an approximately 1% increase in adverse events, serious events, and hospitalizations, but have no significant association with adverse events resulting in death. The findings suggest that COI policies might be adapted to account the relative risks of different types of financial relationships.
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Affiliation(s)
- S. Scott Graham
- Department of Rhetoric & Writing, The University of Texas at Austin, Austin, TX, USA
| | - Zoltan P. Majdik
- Department of Communication, North Dakota State University, Fargo, ND, USA
| | - Johua B. Barbour
- Moody College of Communication, The University of Texas at Austin, Austin, TX, USA
| | - Justin F. Rousseau
- Departments of Neurology & Population Health, The Dell Medical School at The University of Texas at Austin, Austin, TX, USA
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Trayer J, Rowbotham NJ, Boyle RJ, Smyth AR. Industry influence in healthcare harms patients: myth or maxim? Breathe (Sheff) 2022; 18:220010. [PMID: 36337122 PMCID: PMC9584590 DOI: 10.1183/20734735.0010-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/31/2022] [Indexed: 11/05/2022] Open
Abstract
Healthcare is a major global industry accounting for a significant proportion of government spending. Drug and medical device manufacturers are publicly traded companies with a responsibility to their shareholders to maximise profits by increasing sales. In order to achieve this, industry exerts influence over every part of healthcare including academic research, medical education, clinical guideline development, physician prescribing and through direct interactions with patients. In contrast, healthcare services seek to provide effective, safe and evidence-based treatments. This article examines interactions with industry across these domains and seeks to identify mutually beneficial relationships and potential conflict leading to patient harms. Case studies are used to illustrate these interactions. There is no single solution for improving healthcare's relationship with industry, although increased transparency has raised awareness of this issue. We briefly discuss some successful interventions that have been tried at national and regulatory level. While industry influence is widespread in healthcare and this has benefits for shareholders, healthcare practitioners have an ethical obligation to prioritise their patients' best interests. Industry interactions with healthcare professionals have a valid role in product development and distribution, but industry sponsorship of healthcare education and practice, guideline development or regulatory decision-making can have harmful consequences for patients. Healthcare practitioners need to carefully consider these issues when deciding whether to collaborate with industry. Educational aims To explore the many areas where industry influences healthcare and the subsequent effects on patient care. Case studies are used to illustrate examples of beneficial and harmful effects of this influence.To raise awareness of the effects of industry influence and for readers to consider their own potential conflicts of interest.To suggest potential ways to improve the current system with a focus on solutions which have successfully been trialled already.
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Affiliation(s)
- James Trayer
- Dept of Paediatric Allergy, Imperial College Healthcare NHS Trust, London, UK
| | - Nicola J. Rowbotham
- Evidence Based Child Health Group, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Robert J. Boyle
- Dept of Paediatric Allergy, Imperial College Healthcare NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Alan R. Smyth
- Evidence Based Child Health Group, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
- Dept of Paediatric Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Phillips MC. Metabolic Strategies in Healthcare: A New Era. Aging Dis 2022; 13:655-672. [PMID: 35656107 PMCID: PMC9116908 DOI: 10.14336/ad.2021.1018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 10/18/2021] [Indexed: 12/14/2022] Open
Abstract
Modern healthcare systems are founded on a disease-centric paradigm, which has conferred many notable successes against infectious disorders in the past. However, today's leading causes of death are dominated by non-infectious "lifestyle" disorders, broadly represented by the metabolic syndrome, atherosclerosis, cancer, and neurodegeneration. Our disease-centric paradigm regards these disorders as distinct disease processes, caused and driven by disease targets that must be suppressed or eliminated to clear the disease. By contrast, a health-centric paradigm recognizes the lifestyle disorders as a series of hormonal and metabolic responses to a singular, lifestyle-induced disease of mitochondria dysfunction, a disease target that must be restored to improve health, which may be defined as optimized mitochondria function. Seen from a health-centric perspective, most drugs target a response rather than the disease, whereas metabolic strategies, such as fasting and carbohydrate-restricted diets, aim to restore mitochondria function, mitigating the impetus that underlies and drives the lifestyle disorders. Substantial human evidence indicates either strategy can effectively mitigate the metabolic syndrome. Preliminary evidence also indicates potential benefits in atherosclerosis, cancer, and neurodegeneration. Given the existing evidence, integrating metabolic strategies into modern healthcare systems should be identified as a global health priority.
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Guo XM, Barber EL. The Invisible Hand of Industry. Clin Obstet Gynecol 2022; 65:260-267. [PMID: 35476619 PMCID: PMC9060382 DOI: 10.1097/grf.0000000000000697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Over the last decades, federal funding for medical research has decreased, while industry funding has increased. The majority of clinical trials are now industry funded. Involvement of industry raises documented concerns of reporting and publication bias, data suppression, and conclusions that may more favorably align with funder motivations rather than study results. However, industry involvement may also lead to scientific innovation, efficiency, and a more rapid timeline to bring new developments to patients. Through a careful review of a manuscript, the reader can understand the nature of industry involvement and interpret the results in this context.
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Affiliation(s)
- X Mona Guo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - Emma L Barber
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology
- Robert H Lurie Comprehensive Cancer Center, Northwestern University
- Surgical Outcomes and Quality Improvement Center, Institute for Public Health in Medicine, Chicago, Illinois
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Abstract
Medical pharmaceutical and device manufacturers are essential in making products that benefit patients, and collaboration between health care clinicians and the industry is necessary for the design and manufacture of these medical products. However, health care clinicians must recognize that their duties and the interests of the industry may at times diverge. Relationships with the industry, even seemingly minor ones, have the potential to shape the decisions made on behalf of patients. The marketing divisions of pharmaceutical and medical device firms view health care clinicians as targets of their efforts, and some of the interactions that occur between the industry and health care clinicians have the potential to alter decision making in ways that may not necessarily benefit patients. Health care clinicians have an ethical duty to recognize situations and marketing strategies that are designed to influence their choice of diagnostic and therapeutic options for their patients. At a minimum, health care clinicians should be aware of the techniques used to attempt to alter their behavior and guard against them.
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25
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Gu YF, Lin FP, Epstein RJ. How aging of the global population is changing oncology. Ecancermedicalscience 2022; 15:ed119. [PMID: 35211208 PMCID: PMC8816510 DOI: 10.3332/ecancer.2021.ed119] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Indexed: 11/24/2022] Open
Abstract
Population aging is causing a demographic redistribution with implications for the future of healthcare. How will this affect oncology? First, there will be an overall rise in cancer affecting older adults, even though age-specific cancer incidences continue to fall due to better prevention. Second, there will be a wider spectrum of health functionality in this expanding cohort of older adults, with differences between “physiologically older” and “physiologically younger” patients becoming more important for optimal treatment selection. Third, greater teamwork with supportive care, geriatric, mental health and rehabilitation experts will come to enrich oncologic decision-making by making it less formulaic than it is at present. Success in this transition to a more nuanced professional mindset will depend in part on the development of user-friendly computational tools that can integrate a complex mix of quantitative and qualitative inputs from evidence-based medicine, functional and cognitive assessments, and the personal priorities of older adults.
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Affiliation(s)
- Yan Fei Gu
- New Hope Cancer Center, United Family Hospitals, 9 Jiangtai W Rd, Chaoyang, Beijing 100015, China
| | - Frank P Lin
- Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, Sydney 2010, Australia.,NH&MRC Clinical Trials Centre, 92 Parramatta Rd, Camperdown, Sydney 2050, Australia
| | - Richard J Epstein
- New Hope Cancer Center, United Family Hospitals, 9 Jiangtai W Rd, Chaoyang, Beijing 100015, China.,Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, Sydney 2010, Australia.,UNSW Clinical School, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney 2010, Australia.,https://orcid.org/0000-0002-4640-0195
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26
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Torgerson T, Wayant C, Cosgrove L, Akl EA, Checketts J, Dal Re R, Gill J, Grover SC, Khan N, Khan R, Marušić A, McCoy MS, Mitchell A, Prasad V, Vassar M. Ten years later: a review of the US 2009 institute of medicine report on conflicts of interest and solutions for further reform. BMJ Evid Based Med 2022; 27:46-54. [PMID: 33177167 DOI: 10.1136/bmjebm-2020-111503] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 01/17/2023]
Abstract
Conflicts of interest (COIs) in healthcare are increasingly discussed in the literature, yet these relationships continue to influence healthcare. Research has consistently shown that financial COIs shape prescribing practices, medical education and guideline recommendations. In 2009, the Institute of Medicine (IOM, now the National Academy of Medicine) published Conflicts of Interest in Medical Research, Practice, and Education-one of the most comprehensive reviews of empirical research on COIs in medicine. Ten years after publication of theIOM's report, we review the current state of COIs within medicine. We also provide specific recommendations for enhancing scientific integrity in medical research, practice, education and editorial practices.
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Affiliation(s)
- Trevor Torgerson
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Cole Wayant
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Lisa Cosgrove
- Department of Counseling Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Jake Checketts
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Rafael Dal Re
- Epidemiology Unit, Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad, Autónoma de Madrid, Madrid, Spain
| | - Jennifer Gill
- Division of Hematology Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Samir C Grover
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Gastroenterology, St Michael's Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Nasim Khan
- Division of Rheumatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Rishad Khan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Gastroenterology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Ana Marušić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Matthew S McCoy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aaron Mitchell
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vinay Prasad
- Division of Hematology Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Senior Scholar in the Center for Health Care Ethics, Oregon Health & Science University, Portland, Oregon, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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Nejstgaard CH, Lundh A, Abdi S, Clayton G, Gelle MHA, Laursen DRT, Olorisade BK, Savović J, Hróbjartsson A. Combining meta-epidemiological study datasets on commercial funding of randomised clinical trials: Database, methods, and descriptive results of the COMFIT study. Res Synth Methods 2021; 13:214-228. [PMID: 34558198 DOI: 10.1002/jrsm.1527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/09/2021] [Accepted: 09/20/2021] [Indexed: 11/08/2022]
Abstract
Randomised trials are often funded by commercial companies and methodological studies support a widely held suspicion that commercial funding may influence trial results and conclusions. However, these studies often have a risk of confounding and reporting bias. The risk of confounding is markedly reduced in meta-epidemiological studies that compare fairly similar trials within meta-analyses, and risk of reporting bias is reduced with access to unpublished data. Therefore, we initiated the COMmercial Funding In Trials (COMFIT) study aimed at investigating the impact of commercial funding on estimated intervention effects in randomised clinical trials based on a consortium of researchers who agreed to share meta-epidemiological study datasets with information on meta-analyses and trials included in meta-epidemiological studies. Here, we describe the COMFIT study, its database, and descriptive results. We included meta-epidemiological studies with published or unpublished data on trial funding source and results or conclusions. We searched five bibliographic databases and other sources. We invited authors of eligible meta-epidemiological studies to join the COMFIT consortium and to share data. The final construction of the COMFIT database involves checking data quality, identifying trial references, harmonising variable categories, and removing non-informative meta-analyses as well as correlated meta-analyses and trial results. We included data from 17 meta-epidemiological studies, covering 728 meta-analyses and 6841 trials. Seven studies (405 meta-analyses, 3272 trials) had not published analyses on the impact of commercial funding, but shared unpublished data on funding source. On this basis, we initiated the construction of a combined database. Once completed, the database will enable comprehensive analyses of the impact of commercial funding on trial results and conclusions with increased statistical power and a markedly reduced risk of confounding and reporting bias.
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Affiliation(s)
- Camilla Hansen Nejstgaard
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Open Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Andreas Lundh
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Open Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark.,Department of Infectious Diseases, Hvidovre Hospital, Hvidovre, Denmark
| | - Suhayb Abdi
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Open Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Gemma Clayton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mustafe Hassan Adan Gelle
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Open Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - David Ruben Teindl Laursen
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Open Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Babatunde Kazeem Olorisade
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Jelena Savović
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,NIHR Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Asbjørn Hróbjartsson
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Open Patient Data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
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Abstract
Micro- or minimally invasive glaucoma surgeries (MIGS) have been the latest addition to the glaucoma surgical treatment paradigm. This term refers not to a single surgery, but rather to a group of distinct procedures and devices that aim to decrease intraocular pressure. Broadly, MIGS can be categorized into surgeries that increase the trabecular outflow [Trabectome, iStent (first and second generations), Hydrus microstent, Kahook Dual Blade and gonioscopy-assisted transluminal trabeculotomy], surgeries that increase suprachoroidal outflow (Cypass microstent and iStent Supra), and conjunctival bleb-forming procedures (Xen gel stent and InnFocus microshunt). Compared to traditional glaucoma surgeries, such as trabeculectomy and glaucoma drainage device implantation (Ahmed, Baerveldt, and Molteno valves), MIGS are touted to have less severe complications and shorter surgical time. MIGS represent an evolving field, and the efficacy and complications of each procedure should be considered independently, giving more importance to high-quality and longer-term studies.
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Affiliation(s)
- David J Mathew
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario M5T 2S8, Canada;
| | - Yvonne M Buys
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario M5T 2S8, Canada;
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29
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Metzger AL, Kusi Appiah A, Wright CM, Jairam V, Amini A, Park HS, Welsh JW, Thomas CR, Verma V, Ludmir EB. Financial relationships between industry and principal investigators of US cooperative group randomized cancer clinical trials. Int J Cancer 2021; 149:1683-1690. [PMID: 34173669 DOI: 10.1002/ijc.33719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/09/2022]
Abstract
Financial conflicts of interest (FCOIs) could bias the potentially practice-changing oncologic randomized clinical trials (RCTs) of tomorrow. This investigation characterized the FCOIs of the principal investigators (PIs) of all currently accruing trials of the four (adult) cooperative groups of the National Clinical Trials Network. For our study, the PI list was first compiled, and each name was then searched in the CMS Open Payments database. For each transaction (general payments (GPs) or research funding (RF)), the amount/number/source of payments was recorded. Results showed that from 2014 to 2019, the 91 PIs collectively accepted nearly one-third of a billion dollars ($10 477 023 GPs and $320 096 233 RF). The mean and median GP was $6505 and $945, respectively, and $301 693 and $49 824 RF, respectively. Multivariable Gamma regression analysis revealed that higher GP sums were associated with RCTs involving any type of systemic therapy, and higher RF sums with medical oncologist PIs, trials with phase III components, and RCTs involving radiotherapy (P < .05 for all). Both higher-volume GPs and RF were predicted by PIs having accepted payment(s) from the manufacturer of the drug utilized in their RCT (P < .001 GP, P = .008 RF). Taken together, the main message of this investigation is that FCOIs may be particularly high in PIs of phase III systemic therapy trials, especially if the PI accepted payments from the manufacturer of the drug utilized in their trial. Such RCTs should be thoroughly scrutinized by medical journals, the FDA, and insurance companies for potential "industry bias" that could influence the integrity of their conclusions.
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Affiliation(s)
- April L Metzger
- Department of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania, USA
| | - Adams Kusi Appiah
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Christopher M Wright
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vikram Jairam
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Henry S Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - James W Welsh
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Charles R Thomas
- Department of Radiation Oncology, Norris Cotton Cancer Center @ Dartmouth University, Lebanon, New Hampshire, USA
| | - Vivek Verma
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Ethan B Ludmir
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
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30
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Okpechi IG, Tinwala MM, Muneer S, Zaidi D, Ye F, Hamonic LN, Khan M, Sultana N, Brimble S, Grill A, Klarenbach S, Lindeman C, Molnar A, Nitsch D, Ronksley P, Shojai S, Soos B, Tangri N, Thompson S, Tuot D, Drummond N, Mangin D, Bello AK. Prevalence of polypharmacy and associated adverse health outcomes in adult patients with chronic kidney disease: protocol for a systematic review and meta-analysis. Syst Rev 2021; 10:198. [PMID: 34218816 PMCID: PMC8256607 DOI: 10.1186/s13643-021-01752-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 06/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Polypharmacy, often defined as the concomitant use of ≥ 5 medications, has been identified as a significant global public health threat. Aging and multimorbidity are key drivers of polypharmacy and have been linked to a broad range of adverse health outcomes and mortality. Patients with chronic kidney disease (CKD) are particularly at high risk of polypharmacy and use of potentially inappropriate medications given the numerous risk factors and complications associated with CKD. The aim of this systematic review will be to assess the prevalence of polypharmacy among adult patients with CKD, and the potential association between polypharmacy and adverse health outcomes within this population. METHODS/DESIGN We will search empirical databases such as MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, and PsycINFO and grey literature from inception onwards (with no language restrictions) for observational studies (e.g., cross-sectional or cohort studies) reporting the prevalence of polypharmacy in adult patients with CKD (all stages including dialysis). Two reviewers will independently screen all citations, full-text articles, and extract data. Potential conflicts will be resolved through discussion. The study methodological quality will be appraised using an appropriate tool. The primary outcome will be the prevalence of polypharmacy. Secondary outcomes will include any adverse health outcomes (e.g., worsening kidney function) in association with polypharmacy. If appropriate, we will conduct random effects meta-analysis of observational data to summarize the pooled prevalence of polypharmacy and the associations between polypharmacy and adverse outcomes. Statistical heterogeneity will be estimated using Cochran's Q and I2 index. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., sex, kidney replacement therapy, multimorbidity). DISCUSSION Given that polypharmacy is a major and a growing public health issue, our findings will highlight the prevalence of polypharmacy, hazards associated with it, and medication thresholds associated with adverse outcomes in patients with CKD. Our study will also draw attention to the prognostic importance of improving medication practices as a key priority area to help minimize the use of inappropriate medications in patients with CKD. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: [ CRD42020206514 ].
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Affiliation(s)
- Ikechi G. Okpechi
- Department of Medicine, University of Alberta, Edmonton, AB Canada
- Division of Nephrology, University of Cape Town, Cape Town, South Africa
| | | | - Shezel Muneer
- Department of Medicine, University of Alberta, Edmonton, AB Canada
| | - Deenaz Zaidi
- Department of Medicine, University of Alberta, Edmonton, AB Canada
| | - Feng Ye
- Department of Medicine, University of Alberta, Edmonton, AB Canada
| | - Laura N. Hamonic
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta Canada
| | - Maryam Khan
- Faculty of Science, University of Alberta, Edmonton, Alberta Canada
| | - Naima Sultana
- Faculty of Science, University of Alberta, Edmonton, Alberta Canada
| | - Scott Brimble
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Allan Grill
- Department of Family and Community Medicine, University of Toronto, Toronto, ON Canada
| | - Scott Klarenbach
- Department of Medicine, University of Alberta, Edmonton, AB Canada
| | - Cliff Lindeman
- Department of Family Medicine, University of Alberta, Edmonton, AB Canada
| | - Amber Molnar
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul Ronksley
- Department of Community Health Sciences, University of Calgary, Calgary, AB Canada
| | - Soroush Shojai
- Department of Medicine, University of Alberta, Edmonton, AB Canada
| | - Boglarka Soos
- Department of Community Health Sciences, University of Calgary, Calgary, AB Canada
- Department of Family Medicine, University of Calgary, Calgary, AB Canada
| | - Navdeep Tangri
- Department of Medicine, Max Rady College of Medicine, Winnipeg, MB Canada
| | | | - Delphine Tuot
- Division of Nephrology, University of California, San Francisco, CA USA
- Kidney Health Research Institute, University of California, San Francisco, CA USA
| | - Neil Drummond
- Department of Family Medicine, University of Alberta, Edmonton, AB Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, ON Canada
| | - Aminu K. Bello
- Department of Medicine, University of Alberta, Edmonton, AB Canada
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta Canada
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31
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Rulon Z, Powers K, Anderson JM, Weaver M, Johnson A, Hartwell M, Vassar M. Conflicts of Interest Among Authors of Systematic Reviews and Meta-analyses Investigating Interventions for Melanoma: Cross-sectional Literature Study. JMIR DERMATOLOGY 2021; 4:e25858. [PMID: 37632810 PMCID: PMC10501528 DOI: 10.2196/25858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/11/2021] [Accepted: 04/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous studies have highlighted the potential influence that industry relationships may have on the outcomes of medical research. OBJECTIVE We aimed to determine the prevalence of author conflicts of interest (COIs) in systematic reviews focusing on melanoma interventions, as well as to determine whether the presence of these COIs were associated with an increased likelihood of reporting favorable results and conclusions. METHODS This cross-sectional study included systematic reviews with or without meta-analyses focusing on interventions for melanoma. We searched MEDLINE and Embase for eligible systematic reviews published between September 1, 2016, and June 2, 2020. COI disclosures were cross-referenced with information from the CMS (Centers for Medicare & Medicaid Services) Open Payments database, Dollars for Profs, Google Patents, the United States Patent and Trademark Office, and previously published COI disclosure statements. Results were quantified using descriptive statistics, and relationships were evaluated by Fisher exact tests. RESULTS Of the 23 systematic reviews included in our sample, 12 (52%) had at least one author with a COI. Of these 12 reviews, 7 (58%) reported narrative results favoring the treatment group and 9 (75%) reported conclusions favoring the treatment group. Of the 11 systematic reviews without a conflicted author, 4 (36%) reported results favoring the treatment group and 5 (45%) reported conclusions favoring the treatment group. We found no significant association between the presence of author COIs and the favorability of results (P=.53) or conclusions (P=.15). CONCLUSIONS Author COIs did not appear to influence the outcomes of systematic reviews regarding melanoma interventions. Clinicians and other readers of dermatology literature should be cognizant of the influence that industry may have on the nature of reported outcomes, including those from systematic reviews and meta-analyses.
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Affiliation(s)
- Zane Rulon
- Center for Health Sciences, Oklahoma State University, Tulsa, OK, United States
| | - Kalyn Powers
- College of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK, United States
| | - J Michael Anderson
- Center for Health Sciences, Oklahoma State University, Tulsa, OK, United States
| | - Michael Weaver
- College of Osteopathic Medicine, Kansas City University of Medicine and Biosciences, Joplin, OK, United States
| | - Austin Johnson
- Center for Health Sciences, Oklahoma State University, Tulsa, OK, United States
| | - Micah Hartwell
- Center for Health Sciences, Oklahoma State University, Tulsa, OK, United States
| | - Matt Vassar
- Center for Health Sciences, Oklahoma State University, Tulsa, OK, United States
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32
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Wise A, Mannem D, Anderson JM, Weaver M, Hartwell M, Vassar M. Do Author Conflicts of Interest and Industry Sponsorship Influence Outcomes of Systematic Reviews and Meta-Analyses Regarding Glaucoma Interventions? A Cross-sectional Analysis. J Glaucoma 2021; 30:293-299. [PMID: 33769356 DOI: 10.1097/ijg.0000000000001798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/09/2021] [Indexed: 11/27/2022]
Abstract
PRCIS In our sample of systematic reviews focusing on treatments for glaucoma, reviews conducted by authors with a conflict of interest were more likely to reach favorable conclusions compared with reviews without conflicted authors. PURPOSE Previous studies have demonstrated that authors' conflict of interest can influence outcomes of systematic reviews. Therefore, we aimed to determine whether the presence of 1 of more conflicts was associated with more favorable results and conclusions in systematic reviews of glaucoma interventions. MATERIALS AND METHODS MEDLINE and Embase were searched for systematic reviews of glaucoma treatments published between September 1, 2016 and June 2, 2020. Author conflicts of interest were located using multiple databases (eg, CMS Open Payments Database, Dollars for Profs, Google Patents, the United States Patent and Trademark Office USPTO) and previously published disclosure statements. Study sponsorship was determined using each review's funding disclosure statement. RESULTS Our study included 26 systematic reviews conducted by 108 authors. Of these reviews, 9 (35%) were conducted by at least 1 author with an undisclosed conflict of interest. Of those 9, 3 (33%) reported results favoring the treatment group, and 5 (56%) reported conclusions favoring the treatment group. Of the 17 systematic reviews with no conflicted authors, 1 (6%) reported results favoring the treatment group, and 2 (12%) reported conclusions favoring the treatment group. The Fisher exact tests demonstrated that these differences held a statistically significant association between author conflicts and the favorability of the reviews' conclusions toward the treatment group (P=0.04). CONCLUSIONS We found that systematic reviews conducted by 1 or more authors with conflicts of interest were more likely than those with no conflicted authors to draw favorable conclusions about the investigated intervention.
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Affiliation(s)
| | - Deepika Mannem
- Office of Medical Student Research
- Arkansas College of Osteopathic Medicine, Fort Smith, AR
| | | | - Michael Weaver
- Office of Medical Student Research
- Kansas City University of Medicine and Biosciences, College of Osteopathic Medicine, Joplin, MO
| | - Micah Hartwell
- Office of Medical Student Research
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK
| | - Matt Vassar
- Office of Medical Student Research
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK
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Gomes WJ, Almeida RMS, Petrucci O, Antunes MJ, Albuquerque LC. The 2020 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Management of Patients with Valvular Heart Disease. Should the World Jump In? Braz J Cardiovasc Surg 2021; 36:278-288. [PMID: 34048208 PMCID: PMC8163277 DOI: 10.21470/1678-9741-2021-0953] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Walter J Gomes
- Cardiovascular Surgery Discipline and São Paulo Hospital. Escola Paulista de Medicina. Federal University of São Paulo, São Paulo, Brazil
| | - Rui M S Almeida
- Faculty of Medicine of the University Center Assis Gurgacz, Cascavel, PR, Brazil
| | - Orlando Petrucci
- Faculty of Medical Sciences. State University of Campinas - UNICAMP, Campinas, SP, Brazil
| | | | - Luciano C Albuquerque
- São Lucas Hospital of the Pontifical Catholic University of Porto Alegre, Porto Alegre, RS, Brazil
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Lexchin J, Bero LA, Davis C, Gagnon MA. Achieving greater independence from commercial influence in research. BMJ 2021; 372:n370. [PMID: 33687982 DOI: 10.1136/bmj.n370] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Joel Lexchin
- School of Health Policy and Management, York University, Toronto, ON, Canada
- Department of Family and Community Medicine University of Toronto, Toronto, Canada
- University Health Network, Toronto, Canada
| | - Lisa A Bero
- Center for Bioethics and Humanities, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Courtney Davis
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Marc-Andre Gagnon
- School of Public Policy and Administration, Carleton University, Ottawa, ON, Canada
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Hengartner MP, Amendola S, Kaminski JA, Kindler S, Bschor T, Plöderl M. Suicide risk with selective serotonin reuptake inhibitors and other new-generation antidepressants in adults: a systematic review and meta-analysis of observational studies. J Epidemiol Community Health 2021; 75:jech-2020-214611. [PMID: 33685964 DOI: 10.1136/jech-2020-214611] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 11/25/2020] [Accepted: 02/20/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is ongoing controversy whether antidepressant use alters suicide risk in adults with depression and other treatment indications. METHODS Systematic review of observational studies, searching MEDLINE, PsycINFO, Web of Science, PsycARTICLES and SCOPUS for case-control and cohort studies. We included studies on depression and various indications unspecified (including off-label use) reporting risk of suicide and/or suicide attempt for adult patients using selective serotonin reuptake inhibitors (SSRI) and other new-generation antidepressants relative to non-users. Effects were meta-analytically aggregated with random-effects models, reporting relative risk (RR) estimates with 95% CIs. Publication bias was assessed via funnel-plot asymmetry and trim-and-fill method. Financial conflict of interest (fCOI) was defined present when lead authors' professorship was industry-sponsored, they received industry-payments, or when the study was industry-sponsored. RESULTS We included 27 studies, 19 on depression and 8 on various indications unspecified (n=1.45 million subjects). SSRI were not definitely related to suicide risk (suicide and suicide attempt combined) in depression (RR=1.03, 0.70-1.51) and all indications (RR=1.19, 0.88-1.60). Any new-generation antidepressant was associated with higher suicide risk in depression (RR=1.29, 1.06-1.57) and all indications (RR=1.45, 1.23-1.70). Studies with fCOI reported significantly lower risk estimates than studies without fCOI. Funnel-plots were asymmetrical and imputation of missing studies with trim-and-fill method produced considerably higher risk estimates. CONCLUSIONS Exposure to new-generation antidepressants is associated with higher suicide risk in adult routine-care patients with depression and other treatment indications. Publication bias and fCOI likely contribute to systematic underestimation of risk in the published literature. REGISTRATION Open Science Framework, https://osf.io/eaqwn/.
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Affiliation(s)
- Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Simone Amendola
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Roma, Italy
| | - Jakob A Kaminski
- Department of Psychiatry and Psychotherapy, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Simone Kindler
- Psychotherapist in Private Practice, Winterthur, Switzerland
| | - Tom Bschor
- Department of Psychiatry and Psychotherapy, University Hospital, Technical University of Dresden, Dresden, Germany
| | - Martin Plöderl
- Department of Crisis Intervention and Suicide Prevention, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria
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Johansson V, Norén Selinus E, Kuja-Halkola R, Lundström S, Durbeej N, Anckarsäter H, Lichtenstein P, Hellner C. The Quantified Behavioral Test Failed to Differentiate ADHD in Adolescents With Neurodevelopmental Problems. J Atten Disord 2021; 25:312-321. [PMID: 30024318 DOI: 10.1177/1087054718787034] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The Quantified Behavioral Test (QbTest) is a computerized diagnostic test for ADHD, used in clinical psychiatric care, but its validity may be questioned. We analyzed the QbTest's diagnostic validity and its relation to cognitive ability and psychosocial factors in an adolescent population with a high occurrence of neurodevelopmental disorders. Method: In total, 340 participants aged 15 years, completed the QbTest, along with questionnaires, clinical and intelligence quotient (IQ) assessments. Results: The clinical assessment resulted in 89 (26%) participants with ADHD. Area under curve (AUC) scores indicated a random to poor validity of the QbTest (AUC range = 0.48-0.64). QbTest scores of inattention and impulsivity correlated with IQ. Conclusion: The QbTest was insufficient as a diagnostic test for ADHD, and was not able to differentiate ADHD from other neurodevelopmental conditions. Clinicians should be aware of the dubious discriminating power of the QbTest.
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Affiliation(s)
- Viktoria Johansson
- Karolinska Institutet, Stockholm, Sweden.,Stockholm County Council, Sweden
| | - Eva Norén Selinus
- Karolinska Institutet, Stockholm, Sweden.,Stockholm County Council, Sweden
| | | | | | - Natalie Durbeej
- Karolinska Institutet, Stockholm, Sweden.,Uppsala University, Sweden
| | | | | | - Clara Hellner
- Karolinska Institutet, Stockholm, Sweden.,Stockholm County Council, Sweden
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Lexchin J. Are academia-pharma partnerships essential for novel drug discovery in the time of the COVID-19 pandemic? Expert Opin Drug Discov 2020; 16:475-479. [PMID: 33307875 DOI: 10.1080/17460441.2021.1858794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Joel Lexchin
- Professor Emeritus, School of Health Policy and Management, York University, Toronto, ON, Canada.,Associate Professor, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Emergency Physician, University Health Network, Toronto, ON, Canada
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Sanders MR, Kirby JN, Toumbourou JW, Carey TA, Havighurst SS. Innovation, research integrity, and change: A conflict of interest management framework for program developers. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Matthew R. Sanders
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia,
| | - James N. Kirby
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia,
| | | | - Timothy A. Carey
- Centre for Remote Health, Flinders University, Adelaide, South Australia, Australia,
| | - Sophie S. Havighurst
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia,
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Hakoum MB, Noureldine H, Habib JR, Abou-Jaoude EA, Raslan R, Jouni N, Hasbani DJ, Lopes LC, Guyatt G, Akl EA. Authors of clinical trials seldom reported details when declaring their individual and institutional financial conflicts of interest: a cross-sectional survey. J Clin Epidemiol 2020; 127:49-58. [DOI: 10.1016/j.jclinepi.2020.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 04/25/2020] [Accepted: 05/25/2020] [Indexed: 11/29/2022]
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Indispensable but deceptive evidence-based medicine. DIABETES & METABOLISM 2020; 46:415-422. [DOI: 10.1016/j.diabet.2020.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 12/17/2022]
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Østengaard L, Lundh A, Tjørnhøj-Thomsen T, Abdi S, Gelle MHA, Stewart LA, Boutron I, Hróbjartsson A. Influence and management of conflicts of interest in randomised clinical trials: qualitative interview study. BMJ 2020; 371:m3764. [PMID: 33109515 PMCID: PMC7590918 DOI: 10.1136/bmj.m3764] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To characterise and analyse the experiences of trial researchers of if and how conflicts of interest had unduly influenced clinical trials they had worked on, what management strategies they had used to minimise any potential influence, and their experiences and views on conflicts of interest more generally. DESIGN Qualitative interview study. PARTICIPANTS Trial researchers who had participated in at least 10 clinical trials with methodological or statistical expertise. Researchers differed by geographical location, educational background, and experience with different types of funders. Interviewees were identified by searches on Web of Science and snowball sampling. 52 trial researchers were approached by email; 20 agreed to be interviewed. SETTING Interviews conducted by telephone, recorded, transcribed verbatim, imported to NVivo 12, and analysed by systematic text condensation. Semistructured interviews focused on financial and non-financial conflicts of interest. RESULTS The interviewees had participated in a median of 37.5 trials and were mainly male physicians who had experience with commercial and non-commercial trial funders. Two predefined themes (influence of conflicts of interest and management strategies) and two additional themes (definition and reporting of conflicts of interest) emerged. Examples of perceived influence of conflicts of interest were: choice of inferior comparator, manipulation of the randomisation process, prematurely stopping the trials, fabrication of data, blocking access to data, and spin (eg, overly favourable interpretation of the results). Examples of strategies to manage conflicts of interest were: disclosure procedures, exclusion of the funder from design and analysis, independent committees, contracts ensuring complete access to the data, and no restriction by the funder on analysis and reporting. Interviewees used different definitions or thresholds for what they considered to be conflicts of interest, and they described different criteria for when to report them. Some interviewees considered non-commercial financial conflicts of interest (eg, funding of trials by governmental health agencies with a political agenda) to be equally or more important than commercial financial conflicts of interest (eg, funding by drug and device companies), but more challenging to report and manage. CONCLUSION This study described how trial researchers perceive conflicts of interest unduly influencing clinical trials they had worked on, and the management strategies they used to prevent these influences. The results indicated considerable variability in researchers' understanding of what conflicts of interest are and when they should be reported.
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Affiliation(s)
- Lasse Østengaard
- Centre for Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, Kløvervænget 10, 13th floor, 5000 Odense C, Denmark
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- University Library of Southern Denmark, Odense, Denmark
| | - Andreas Lundh
- Centre for Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, Kløvervænget 10, 13th floor, 5000 Odense C, Denmark
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Infectious Diseases, Hvidovre Hospital, Hvidovre, Denmark
| | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Suhayb Abdi
- Centre for Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, Kløvervænget 10, 13th floor, 5000 Odense C, Denmark
| | - Mustafe H A Gelle
- Centre for Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, Kløvervænget 10, 13th floor, 5000 Odense C, Denmark
| | - Lesley A Stewart
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Isabelle Boutron
- Université de Paris, CRESS, Inserm, INRA, F-75004, Paris, France
| | - Asbjørn Hróbjartsson
- Centre for Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, Kløvervænget 10, 13th floor, 5000 Odense C, Denmark
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Lundh A, Boutron I, Stewart L, Hróbjartsson A. What to do with a clinical trial with conflicts of interest. BMJ Evid Based Med 2020; 25:157-158. [PMID: 31292209 DOI: 10.1136/bmjebm-2019-111230] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Andreas Lundh
- Centre for Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, Odense, Denmark
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Infectious Diseases, Hvidovre Hospital, Hvidovre, Denmark
| | - Isabelle Boutron
- Equipe METHODS, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS-UMR1153) Inserm, Paris, France
- Université Paris Descartes, Paris, France
- Cochrane France, Paris, France
| | - Lesley Stewart
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Asbjorn Hróbjartsson
- Centre for Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, Odense, Denmark
- Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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The Policies for the Disclosure of Funding and Conflict of Interest in Surgery Journals: A Cross-Sectional Survey. World J Surg 2020; 45:97-108. [PMID: 32914281 DOI: 10.1007/s00268-020-05771-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Industry through its funding of research and through its relationships with study authors can influence the results of research. Most journals have policies for reporting funding and disclosing conflict of interest (COI) to mitigate the influence of industry on research. The objective of this study is to assess the policies of surgery journals for the reporting of funding and the disclosure of COI. METHODS We described the prevalence and characteristics of funding and COI policies of journals indexed under "Surgery" in the Journal Citation Reports. We extracted data from publicly available information and through simulation of manuscript submission. RESULTS Of the 186 eligible journals, 171 (92%) had policies for reporting of funding. None of the policies described procedures to deal with non-reporting or underreporting of funding. Of the 186 journals, 183 (99%) had a policy for disclosure of COI. All journals with a COI policy required disclosure of financial interest, while 96 (52%) required the disclosure of non-financial interests. Only 24 (13%) policies described how non-disclosure of COI affects the editorial process, and none described procedures to verify COI disclosure. Of the policies that required disclosing COI, 94 (51%) also required reporting the source of financial COI. CONCLUSIONS Most journals have policies for reporting of funding and disclosure of financial COI. However, many do not have clear policies for disclosing non-financial COI. Major limitations in the policies include the lack of processes for the verification of disclosed interests and for dealing with underreporting of funding and of COI.
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Byberg L, Warensjö Lemming E. Milk Consumption for the Prevention of Fragility Fractures. Nutrients 2020; 12:E2720. [PMID: 32899514 PMCID: PMC7551481 DOI: 10.3390/nu12092720] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 12/17/2022] Open
Abstract
Results indicating that a high milk intake is associated with both higher and lower risks of fragility fractures, or that indicate no association, can all be presented in the same meta-analysis, depending on how it is performed. In this narrative review, we discuss the available studies examining milk intake in relation to fragility fractures, highlight potential problems with meta-analyses of such studies, and discuss potential mechanisms and biases underlying the different results. We conclude that studies examining milk and dairy intakes in relation to fragility fracture risk need to study the different milk products separately. Meta-analyses should consider the doses in the individual studies. Additional studies in populations with a large range of intake of fermented milk are warranted.
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Affiliation(s)
- Liisa Byberg
- Department of Surgical Sciences, Orthopaedics, Uppsala University, SE-751 85 Uppsala, Sweden;
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Staartjes VE, Klukowska AM, Sorba EL, Schröder ML. Conflicts of interest in randomized controlled trials reported in neurosurgical journals. J Neurosurg 2020; 133:855-864. [PMID: 31419788 DOI: 10.3171/2019.5.jns183560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/14/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Randomized controlled trials (RCTs) form the basis of today's evidence-based approach to medicine, and play a critical role in guidelines and the drug and device approval process. Conflicts of interest (COIs) are commonplace in medical research, but little is known about their influence. The authors aimed to evaluate the extent and influence of COIs in recent RCTs published in core neurosurgical journals using a cross-sectional analysis. METHODS Through review of 6 general neurosurgical journals, all interventional RCTs published from January 2009 to January 2019 were identified. Because it is difficult to objectively assess study outcome, the authors opted for a strict rating approach based on the statistical significance of unambiguously reported primary endpoints, and the reported statistical protocol. RESULTS A total of 129 RCTs met the inclusion criteria. During the study period, the Journal of Neurosurgery published the largest number of RCTs (n = 40, 31%). Any potential COI was disclosed by 57%, and a mean of 12% of authors had a personal COI. Nonfinancial industry involvement was reported in 10%, while 31% and 20% received external support and sponsoring, respectively. Study registration was reported by 56%, while 51% of studies were blinded. Registration showed an increasing trend from 17% to 76% (p < 0.001). The median randomized sample size was 92 (interquartile range 50-153), and 8% were designed to investigate noninferiority or equality. Sixty-three RCTs (49%) unambiguously reported a primary endpoint, of which 13% were composite primary endpoints. In 43%, study outcome was positive, which was associated with a noninferiority design (31% vs 3%, p = 0.007) and a composite primary endpoint (46% vs 9%, p = 0.002). Potential COIs were not significantly associated with study positivity (69% vs 59%, p = 0.433). In the multivariate analysis, only a composite primary endpoint remained predictive of a positive study outcome (odds ratio 6.34, 95% confidence interval 1.51-33.61, p = 0.017). CONCLUSIONS This analysis provides an overview of COIs and their potential influence on recent trials published in core neurosurgical journals. Reporting of primary endpoints, study registration, and uniform disclosure of COIs are crucial to ensure the quality of future neurosurgical randomized trials. COIs do not appear to significantly influence the outcome of randomized neurosurgical trials.
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Affiliation(s)
- Victor E Staartjes
- 1Department of Neurosurgery, Bergman Clinics, Amsterdam
- 2Amsterdam UMC, Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- 3Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland; and
| | - Anita M Klukowska
- 1Department of Neurosurgery, Bergman Clinics, Amsterdam
- 4School of Medicine, University of Nottingham, United Kingdom
| | - Elena L Sorba
- 1Department of Neurosurgery, Bergman Clinics, Amsterdam
- 3Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland; and
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Relationships among commercial practices and author conflicts of interest in biomedical publishing. PLoS One 2020; 15:e0236166. [PMID: 32706798 PMCID: PMC7380625 DOI: 10.1371/journal.pone.0236166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/30/2020] [Indexed: 11/29/2022] Open
Abstract
Recently, concerns have been raised over the potential impacts of commercial relationships on editorial practices in biomedical publishing. Specifically, it has been suggested that certain commercial relationships may make editors more open to publishing articles with author conflicts of interest (aCOI). Using a data set of 128,781 articles published in 159 journals, we evaluated the relationships among commercial publishing practices and reported author conflicts of interest. The 159 journals were grouped according to commercial biases (reprint services, advertising revenue, and ownership by a large commercial publishing firm). 30.6% (39,440) of articles were published in journals showing no evidence of evaluated commercial publishing relationships. 33.9% (43,630) were published in journals accepting advertising and reprint fees; 31.7% (40,887) in journals owned by large publishing firms; 1.2% (1,589) in journals accepting reprint fees only; and 2.5% (3,235) in journals accepting only advertising fees. Journals with commercial relationships were more likely to publish articles with aCOI (9.2% (92/1000) vs. 6.4% (64/1000), p = 0.024). In the multivariate analysis, only a journal’s acceptance of reprint fees served as a significant predictor (OR = 2.81 at 95% CI, 1.5 to 8.6). Shared control estimation was used to evaluate the relationships between commercial publishing practices and aCOI frequency in total and by type. BCa-corrected mean difference effect sizes ranged from -1.0 to 6.1, and confirm findings indicating that accepting reprint fees may constitute the most significant commercial bias. The findings indicate that concerns over the influence of industry advertising in medical journals may be overstated, and that accepting fees for reprints may constitute the largest risk of bias for editorial decision-making.
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Elder K, Turner KA, Cosgrove L, Lexchin J, Shnier A, Moore A, Straus S, Thombs BD. Reporting of financial conflicts of interest by Canadian clinical practice guideline producers: a descriptive study. CMAJ 2020; 192:E617-E625. [PMID: 32538799 PMCID: PMC7867217 DOI: 10.1503/cmaj.191737] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The producers of clinical practice guidelines (CPGs) may not disclose industry funding in their CPGs. We reviewed Canadian national CPGs to examine the existence and disclosure of industry-related organizational funding in the CPGs, financial conflicts of interest of committee members and organizational procedures for managing financial conflicts of interest. METHODS For this descriptive study, we searched the asset map of the Strategy for Patient-Oriented Research Evidence Alliance and the CPG Infobase for CPGs published between Jan. 1, 2016, and Nov. 30, 2018. Eligible guidelines had to have a national focus and either a first-line drug recommendation or a screening recommendation leading to drug treatment. One investigator reviewed all CPG titles to exclude those that were clearly ineligible. Two reviewers independently reviewed all remaining guidelines and extracted data. We analyzed the data descriptively. RESULTS We included 21 CPGs: 3 from government-sponsored organizations, 9 from disease or condition interest groups and 9 from medical professional societies. None of the 3 government-sponsored organizations reported industry funding, and none of their committee members disclosed financial conflicts of interest. Among the 18 disease or condition interest groups and medical professional societies, 14 (93%) of the 15 that disclosed funding sources on websites (3 did not disclose) reported organizational funding from industry, but none disclosed this information in the CPGs; 12 (86%) of the 14 with conflict-of-interest disclosure statements in the CPG (4 did not include disclosures) had at least 1 committee member with a financial conflict (mean proportion of committee members with a conflict 56%); and for all 8 CPGs with identifiable chairs or cochairs (chairs or cochairs not reported for 10) at least 1 of these people had a financial conflict of interest. None of the guidelines described a plan to manage organizational financial conflicts of interest. INTERPRETATION Canadian CPGs are vulnerable to industry influence through funding of producers of guidelines and through the financial conflicts of interest of committee members. The CPG producers that receive industry funding should disclose organizational financial conflicts in the CPGs, should engage independent oversight committees and should restrict voting on recommendations to guideline panelists who have no financial conflicts.
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Affiliation(s)
- Katharine Elder
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Kimberly A Turner
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Lisa Cosgrove
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Joel Lexchin
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Adrienne Shnier
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Ainsley Moore
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Sharon Straus
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Brett D Thombs
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.
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Gomes WJ, Albuquerque LC, Jatene FB, Leal JCF, Rocha EAV, Almeida RMS. The transfiguration of the EXCEL trial: exceeding ethical and moral boundaries. Eur J Cardiothorac Surg 2020; 58:30-34. [DOI: 10.1093/ejcts/ezaa121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Walter J Gomes
- Cardiovascular Surgery Discipline, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Luciano C Albuquerque
- Sao Lucas Hospital of the Pontifical Catholic University of Porto Alegre, Porto Alegre, RS, Brazil
| | - Fabio B Jatene
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Joao Carlos F Leal
- Faculty of Medicine of São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brazil
| | - Eduardo A V Rocha
- Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Rui M S Almeida
- Faculty of Medicine of the University Center Assis Gurgacz, Cascavel, PR, Brazil
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Turner K, Carboni-Jiménez A, Benea C, Elder K, Levis B, Boruff J, Roseman M, Bero L, Lexchin J, Turner EH, Benedetti A, Thombs BD. Reporting of drug trial funding sources and author financial conflicts of interest in Cochrane and non-Cochrane meta-analyses: a cross-sectional study. BMJ Open 2020; 10:e035633. [PMID: 32398334 PMCID: PMC7229983 DOI: 10.1136/bmjopen-2019-035633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To (1) investigate the extent to which recently published meta-analyses report trial funding, author-industry financial ties and author-industry employment from included randomised controlled trials (RCTs), comparing Cochrane and non-Cochrane meta-analyses; (2) examine characteristics of meta-analyses independently associated with reporting funding sources of included RCTs; and (3) compare reporting among recently published Cochrane meta-analyses to Cochrane reviews published in 2010. DESIGN Review of consecutive sample of recently published meta-analyses. DATA SOURCES MEDLINE database via PubMed searched on 19 October 2018. ELIGIBILITY CRITERIA FOR SELECTING ARTICLES We selected the 250 most recent meta-analyses listed in PubMed that included a documented search of at least one database, statistically combined results from ≥2 RCTs and evaluated the effects of a drug or class of drugs. RESULTS 90 of 107 (84%) Cochrane meta-analyses reported funding sources for some or all included trials compared with 21 of 143 (15%) non-Cochrane meta-analyses, a difference of 69% (95% CI 59% to 77%). Percent reporting was also higher for Cochrane meta-analyses compared with non-Cochrane meta-analyses for trial author-industry financial ties (44% versus 1%; 95% CI for difference 33% to 52%) and employment (17% versus 1%; 95% CI for difference 9% to 24%). In multivariable analysis, compared with Cochrane meta-analyses, the odds ratio (OR) for reporting trial funding was ≤0.11 for all other journal category and impact factor combinations. Compared with Cochrane reviews from 2010, reporting of funding sources of included RCTs among recently published Cochrane meta-analyses improved by 54% (95% CI 42% to 63%), and reporting of trial author-industry financial ties and employment improved by 37% (95% CI 26% to 47%) and 10% (95% CI 2% to 19%). CONCLUSIONS Reporting of trial funding sources, trial author-industry financial ties and trial author-industry employment in Cochrane meta-analyses has improved since 2010 and is higher than in non-Cochrane meta-analyses.
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Affiliation(s)
- Kimberly Turner
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
| | - Andrea Carboni-Jiménez
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
| | - Carla Benea
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
| | - Katharine Elder
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
| | - Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
| | - Jill Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Quebec, Canada
| | - Michelle Roseman
- Kingsway Medical Centre Family Health Organization, Toronto, Ontario, Canada
| | - Lisa Bero
- Charles Perkins Centre/Pharmacy, University of Sydney, Camperdown, New South Wales, Australia
| | - Joel Lexchin
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Erick H Turner
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- McGill University, Montreal, Quebec, Canada
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Rocha RV, Elbatarny M, Tam DY, Fremes SE. Commentary: Coronary artery bypass surgery and percutaneous coronary intervention: Optimal revascularization for the younger patient. J Thorac Cardiovasc Surg 2020; 163:657-658. [PMID: 32505453 DOI: 10.1016/j.jtcvs.2020.04.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/11/2020] [Accepted: 04/13/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Rodolfo V Rocha
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Malak Elbatarny
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Derrick Y Tam
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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