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Lexchin J. Conflicts of Interest of Canadian Medical School Deans: A Cross-Sectional Study. Healthc Policy 2024; 19:70-80. [PMID: 39229664 PMCID: PMC11411646 DOI: 10.12927/hcpol.2024.27349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024] Open
Abstract
Background Medical school deans wield considerable influence over research, clinical and educational missions at their institutions. This study investigates conflict of interest (COI) of Canadian medical school deans. Method The websites of all 17 Canadian medical schools were searched for any mention of relationships between deans and pharmaceutical or medical device companies. Results No COIs were discovered for 11 of the deans. Six had COIs, including participating in research funded by pharmaceutical companies and received consulting and speaker fees. Discussion A minority of deans had COIs with healthcare industry companies. Whether deans' COIs affect policies at the medical schools they lead should be the subject of further investigation.
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Affiliation(s)
- Joel Lexchin
- Professor Emeritus, School of Health Policy and Management, York University, Associate Professor, Faculty of Medicine, University of Toronto, Toronto, ON
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2
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Bavarian R, Ngo TG, Schatman ME, Kulich RJ. The Lyceum for Pain Education: Providing Accessible Education on Chronic Pain and Headaches to a Global Audience. J Pain Res 2024; 17:1503-1507. [PMID: 38623277 PMCID: PMC11017117 DOI: 10.2147/jpr.s470973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 04/09/2024] [Indexed: 04/17/2024] Open
Affiliation(s)
- Roxanne Bavarian
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, MA, USA
| | | | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, & Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
| | - Ronald J Kulich
- Orofacial Pain Center, Tufts University School of Dental Medicine, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine/Department of Psychiatry Massachusetts General Hospital, Boston, MA, USA
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3
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Hooimeyer A, Lines T, Mirzaei J, Pande P, Ganeshamoorthy S, Fabbri A, Parker L, Dunn AG, Mintzes B. Conflict of interest policies at Australian medical schools. Intern Med J 2024; 54:62-73. [PMID: 37255333 DOI: 10.1111/imj.16148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/28/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Pharmaceutical industry exposure is widespread during medical training and may affect education and clinical decision-making. Medical faculties' conflict of interest (COI) policies help to limit this exposure and protect students against commercial influence. AIMS Our aim was to investigate the prevalence, content and strength of COI policies at Australian medical schools and changes since a previous assessment conducted in 2009. METHODS We identified policies by searching medical school and host university websites in January 2021, and contacted deans to identify any missed policies. We applied a modified version of a scorecard developed in previous studies to examine the content of COI policies. All data were coded in duplicate. COI policies were rated on a scale from 0 (no policy) to 2 (strong policy) across 11 items per medical school. Oversight mechanisms and sanctions were also assessed, and current policies were compared with the 2009 study. RESULTS Of 155 potentially relevant policies, 153 were university-wide and two were specific to medical schools. No policies covered sales representatives, on-site sponsored education or free samples. Oversight of consultancies had improved substantially, with 76% of schools requiring preapproval. Disclosure policies, while usually present, were weak, with no public disclosure required. CONCLUSION We found little indication that Australian medical students are protected from commercial influence on medical education, and there has been limited COI policy development within the past decade. More attention is needed to ensure the independence of medical education in Australia.
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Affiliation(s)
- Ashleigh Hooimeyer
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Janet Mirzaei
- School of Medicine, University of Notre Dame Sydney, Sydney, New South Wales, Australia
| | - Preshita Pande
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Sylviya Ganeshamoorthy
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Alice Fabbri
- Department for Health, University of Bath, Bath, United Kingdom
| | - Lisa Parker
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Adam G Dunn
- Biomedical Informatics and Digital Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Barbara Mintzes
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Eisenkraft Klein D, Lexchin J, Sud A, Bavli I. Pharmaceutical company responses to Canadian opioid advertising restrictions: A framing analysis. PLoS One 2023; 18:e0287861. [PMID: 37384735 PMCID: PMC10310031 DOI: 10.1371/journal.pone.0287861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 06/14/2023] [Indexed: 07/01/2023] Open
Abstract
The pharmaceutical industry's promotion of opioids in North America has been well-documented. Yet despite the clear consequences of improperly classifying pharmaceutical company messaging and frequently permissive approaches that allow the pharmaceutical industry to self-regulate its own advertising, there has been scarce investigation to date of how pharmaceutical industry stakeholders interpret definitions of "advertising." This study explores how variations of "marketing" and "advertising" are strategically framed by the different actors involved in the manufacturing and distribution of pharmaceutical opioids. We employed a framing analysis of industry responses to Health Canada's letter to Canadian manufacturers and distributors of opioids requesting their commitment to voluntarily cease all marketing and advertising of opioids to health care professionals. Our findings highlight companies' continuing efforts to frame their messaging as "information" and "education" rather than "advertising" in ways that serve their interests. This study also calls attention to the industry's continual efforts to promote self-regulation and internal codes of conduct within a highly permissive federal regulatory framework with little concern for violations or serious consequences. While this framing often occurring out of public sight, this study highlights the subtle means through which the industry attempts to frame their promotion strategies away from "marketing". These framing strategies have significant consequences for the pharmaceutical industry's capacity to influence healthcare professionals, patients, and the general public.
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Affiliation(s)
| | - Joel Lexchin
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Abhimanyu Sud
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Humber River Hospital, Toronto, Ontario, Canada
| | - Itai Bavli
- Department of the History of Science, Faculty of Arts and Sciences, Harvard University, Cambridge, Massachusetts, United States of America
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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5
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Pappin J, Bavli I, Herder M. On what basis did Health Canada approve OxyContin in 1996?: A retrospective analysis of regulatory data. Clin Trials 2022; 19:584-590. [PMID: 35924783 PMCID: PMC9523806 DOI: 10.1177/17407745221108436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The marketing and sale of oxycodone (OxyContin) by Purdue Pharma has commanded a great deal of legal and policy attention due to the drug’s central role in the ongoing overdose crisis. However, little is known about the basis for OxyContin’s approval by regulators, such as Health Canada in 1996. Taking advantage of a recently created online database containing information pertaining to the safety and effectiveness of drugs, we conducted a retrospective analysis of Purdue Pharma’s submission to Health Canada, including both published and unpublished clinical trials. None of the trials sponsored by Purdue Pharma sought to meaningfully assess the risks of misuse or addiction associated with OxyContin. The trials were short in duration (maximum length was 24 days) and only assessed safety and efficacy of a 12-h dosing interval. Also, the two trial reports that explicitly mentioned (but did not formally evaluate) the risk of misuse were not published, making it unclear how Health Canada concluded that there was no risk of misuse. In our view, these findings underscore the need for transparency of not only of clinical trial data, but also the regulator’s interpretation of such data, which is currently lacking in Canada. Furthermore, they call into question why Health Canada’s role in precipitating the overdose crisis has not received greater scrutiny, including in the context of recent litigation surrounding OxyContin.
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Affiliation(s)
- Jessie Pappin
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Itai Bavli
- Department of the History of Science, Faculty of Arts and Sciences, Harvard University, Cambridge, MA, USA.,School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Matthew Herder
- Health Law Institute, Schulich School of Law, Dalhousie University, Halifax, NS, Canada.,Department of Pharmacology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
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Sud A, Strang M, Buchman DZ, Spithoff S, Upshur REG, Webster F, Grundy Q. How the Suboxone Education Programme presented as a solution to risks in the Canadian opioid crisis: a critical discourse analysis. BMJ Open 2022; 12:e059561. [PMID: 35820738 PMCID: PMC9277368 DOI: 10.1136/bmjopen-2021-059561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Pharmaceutical industry involvement in medical education, research and clinical practice can lead to conflicts of interest. Within this context, this study examined how the 'Suboxone Education Programme', developed and delivered by a pharmaceutical company as part of a federally regulated risk management program, was presented as a solution to various kinds of risks relating to opioid use in public documents from medical institutions across Canada. SETTING These documents were issued during the Canadian opioid crisis, a time when the involvement of industry in health policy was being widely questioned given industry's role in driving the overprescribing of opioid analgesics and contributing to population-level harms. DESIGN A critical discourse analysis of 69 documents collected between July 2020 and May 2021 referencing the Suboxone Education Program spanning 13 years (2007-2021) from medical, nursing and pharmacy institutions sourced from every Canadian province and territory. Discursive themes were identified through iterative and duplicate analyses using a semistructured data extraction instrument. RESULTS Documents characterised the Programme as addressing iatrogenic risks from overprescribing opioid analgesics, environmental risks from a toxic street drug supply and pharmacological risks relating to the dominant therapeutic alternative of methadone. The programme was identified as being able to address these risks by providing mechanisms to surveil healthcare professionals and to facilitate the prescribing of Suboxone. Medical institutions legitimised the Suboxone Education Programme by lending their regulatory, epidemiological and professional authority. CONCLUSIONS Addressing risk is considered as a central, moral responsibility of contemporary healthcare services. In this case, moral imperatives to address opioid crisis-related risks overrode other ethical concerns regarding conflicts of interest between industry and public welfare. Failing to address these conflicts potentially imperils efforts of mitigating population health harms by propagating an important driving force of the opioid crisis.
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Affiliation(s)
- Abhimanyu Sud
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Bridgepoint Collaboratory for Research and Innovation, Sinai Health System, Toronto, Ontario, Canada
| | - Matthew Strang
- Department of Sociology, York University, Toronto, Ontario, Canada
| | - Daniel Z Buchman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Bioethics Program, University Health Network, Toronto, Ontario, Canada
| | - Sheryl Spithoff
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Ross E G Upshur
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Bridgepoint Collaboratory for Research and Innovation, Sinai Health System, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Fiona Webster
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Quinn Grundy
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Permissive regulation: A critical review of the regulatory history of buprenorphine formulations in Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 105:103749. [DOI: 10.1016/j.drugpo.2022.103749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/20/2022]
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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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Humphreys K, Shover CL, Andrews CM, Bohnert ASB, Brandeau ML, Caulkins JP, Chen JH, Cuéllar MF, Hurd YL, Juurlink DN, Koh HK, Krebs EE, Lembke A, Mackey SC, Larrimore Ouellette L, Suffoletto B, Timko C. Responding to the opioid crisis in North America and beyond: recommendations of the Stanford-Lancet Commission. Lancet 2022; 399:555-604. [PMID: 35122753 PMCID: PMC9261968 DOI: 10.1016/s0140-6736(21)02252-2] [Citation(s) in RCA: 190] [Impact Index Per Article: 95.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/01/2021] [Accepted: 10/06/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Keith Humphreys
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
| | - Chelsea L Shover
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Christina M Andrews
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Amy S B Bohnert
- Department of Psychiatry and Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA; Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Margaret L Brandeau
- Department of Management Science and Engineering, Huang Engineering Center, Stanford University, Stanford, CA USA
| | | | - Jonathan H Chen
- Stanford Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, USA; Division of Hospital Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Yasmin L Hurd
- Addiction Institute, Icahn School of Medicine, New York, NY, USA
| | - David N Juurlink
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Howard K Koh
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Erin E Krebs
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Center for Care Delivery and Outcomes Research, Veterans Affairs Minneapolis Health Care System, Minneapolis, MN, USA
| | - Anna Lembke
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Brian Suffoletto
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Christine Timko
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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Makhinson M, Seshia SS, Young GB, Smith PA, Stobart K, Guha IN. The iatrogenic opioid crisis: An example of 'institutional corruption of pharmaceuticals'? J Eval Clin Pract 2021; 27:1033-1043. [PMID: 33760335 DOI: 10.1111/jep.13566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 11/28/2022]
Abstract
RATIONALE Prescribed opioids are major contributors to the international public health opioid crisis. Such widespread iatrogenic harms usually result from collective decision failures of healthcare organizations rather than solely of individual organizations or professionals. Findings from a system-wide safety analysis of the iatrogenic opioid crisis that includes roles of pertinent healthcare organizations may help avoid or mitigate similar future iatrogenic consequences. In this retrospective exploratory study, we report such an analysis. METHODS The study population encompassed the entire age spectrum and included those in whom opioids prescribed for chronic pain (unrelated to malignancy) were associated with death or morbidity. Root cause analysis, incorporating recent suggestions for improvement, was used to identify possible contributory factors from the literature. Based on their mandated roles and potential influences to prevent or mitigate the iatrogenic crisis, relevant organizations were grouped and stratified from most to least influential. RESULTS The analysis identified a chain of multiple interrelated causal factors within and between organizations. The most influential organizations were pharmaceutical, political, and drug regulatory; next: experts and their related societies, and publications. Less influential: accreditation, professional licensing and regulatory, academic and healthcare funding bodies. Collectively, their views and decisions influenced prescribing practices of frontline healthcare professionals and advocacy groups. Financial associations between pharmaceutical and most other organizations/groups were common. Ultimately, patients were adversely affected. There was a complex association with psychosocial variables. LIMITATIONS The analysis suggests associations not causality. CONCLUSION The iatrogenic crisis has multiple intricately linked roots. The major catalyst: pervasive pharma-linked financial conflicts of interest (CoIs) involving most other healthcare organizations. These extensive financial CoIs were likely triggers for a cascade of erroneous decisions and actions that adversely affected patients. The actions and decisions of pharma ranged from unethical to illegal. The iatrogenic opioid crisis may exemplify 'institutional corruption of pharmaceuticals'.
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Affiliation(s)
- Michael Makhinson
- Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine at the University of California, Los Angeles, California, USA.,Department of Psychiatry, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Shashi S Seshia
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Gordon Bryan Young
- Clinical Neurological Sciences and Medicine (Critical Care), Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada.,Grey Bruce Health Services, Owen Sound, Ontario, Canada
| | - Preston A Smith
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kent Stobart
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Indra Neil Guha
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
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Grundy Q, Mazzarello S, Brennenstuhl S, Karanges EA. A comparison of educational events for physicians and nurses in Australia sponsored by opioid manufacturers. PLoS One 2021; 16:e0248238. [PMID: 33735203 PMCID: PMC7971255 DOI: 10.1371/journal.pone.0248238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 02/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Educational activities for physicians sponsored by opioid manufacturers are implicated in the over- and mis-prescribing of opioids. However, the implications of promotion to nurses are poorly understood. Nurses play a key role in assessing pain, addressing the determinants of pain, and administering opioid medications. We sought to understand the nature and content of pain-related educational events sponsored by opioid manufacturers and to compare events targeting physicians and nurses. METHODS We conducted a cross sectional, descriptive analysis of pharmaceutical company reports detailing 116,845 sponsored educational events attended by health professionals from 2011 to 2015 in Australia. We included events that were sponsored by manufacturers of prescription opioid analgesics and were pain related. We compared event characteristics across three attendee groups: (a) physicians only; (b) at least one nurse in attendance; and (c) nurses only. We coded the unstructured data using iteratively generated keywords for variables related to location, format, and content focus. RESULTS We identified 3,411 pain-related events sponsored by 3 companies: bioCSL/CSL (n = 15), Janssen (n = 134); and Mundipharma (n = 3,262). Pain-related events were most often multidisciplinary, including at least one nurse (1,964/3,411; 58%); 38% (1,281/3,411) included physicians only, and 5% (166/3,411) nurses only. The majority of events were held in clinical settings (61%) and 43% took the form of a journal club. Chronic pain was the most common event topic (26%) followed by cancer pain and palliative care (18%), and then generic or unspecified references to pain (15%); nearly a third (32%) of event descriptions contained insufficient information to determine the content focus. Nurse-only events were less frequently held in clinical settings (32%; p < .001) and more frequently were product launches (17%; p < .001) and a significantly larger proportion focused on cancer or palliative care (33%; p < .001), generic pain topics (27%; p < .001), and geriatrics (25%; p < .001) than physician-only or multidisciplinary events. DISCUSSION Opioid promotion via sponsored educational events extends beyond physicians to multidisciplinary teams and specifically, nurses. Despite lack of evidence that opioids improve outcomes for long-term chronic non-cancer pain, hundreds of sponsored educational events focused on chronic pain. Regulators should consider the validity of distinguishing between pharmaceutical companies' "promotional" and "non-promotional" activities.
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Affiliation(s)
- Quinn Grundy
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- Faculty of Medicine and Health, Sydney Pharmacy School, The University of Sydney, Sydney, Australia
- * E-mail:
| | - Sasha Mazzarello
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Emily A. Karanges
- Faculty of Medicine and Health, Sydney Pharmacy School, The University of Sydney, Sydney, Australia
- Faculty of Medicine, Dentistry and Health, Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Orygen, Melbourne, Australia
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Kruger JM, Chowers I. The ethical advantages of video conferencing in medical education. MEDICAL EDUCATION ONLINE 2020; 25:1787310. [PMID: 32615906 PMCID: PMC7482868 DOI: 10.1080/10872981.2020.1787310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Joshua M. Kruger
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
- The Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Itay Chowers
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
- The Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
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13
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Bavli I, Steel D. Inductive Risk and OxyContin: The Ethics of Evidence and Post-Market Surveillance of Pharmaceuticals in Canada. Public Health Ethics 2020. [DOI: 10.1093/phe/phaa031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
The argument from inductive risk claims that judgments about the moral severity of errors are relevant to decisions about what should count as sufficient evidence for accepting claims. While this idea has been explored in connection with evidence required for the approval of pharmaceuticals, the role of inductive risk in the post-approval process has been largely neglected. In this article, we examine the ethics of inductive risk in connection with revisions to the product monograph for OxyContin in Canada, which understates the risks of addiction and abuse associated with this drug. Using the concept of inductive risk, we consider what evidence should have been sufficient for Health Canada (HC) to revise the product monograph for OxyContin. Given the stakes involved, we argue that a less strict standard of evidence would have been appropriate, yet HC in fact took the opposite course, insisting upon a higher standard of evidence than it normally requires. In addition to providing a novel perspective on the opioid crisis in Canada, this article contributes to existing philosophical work by demonstrating that inductive risks in the post-approval stage are important and linked to pre-approval inductive risks.
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Affiliation(s)
- Itai Bavli
- Interdisciplinary Studies Graduate Program and the W. Maurice Young Centre for Applied Ethics (School of Population and Public Health), the University of British Columbia and Harvard Department of the History of Science
| | - Daniel Steel
- W. Maurice Young Centre for Applied Ethics (School of Population and Public Health), The University of British Columbia
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14
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Bavli I. Industry influence and Health Canada's responsibility: lessons from the opioid epidemic in Canada. Addiction 2020; 115:1605-1606. [PMID: 31845436 DOI: 10.1111/add.14929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Itai Bavli
- W. Maurice Young Centre for Applied Ethics, the University of British Columbia, Vancouver, BC, Canada
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15
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Effective Treatments for Pain in the Older Patient. Anesth Analg 2020. [DOI: 10.1213/ane.0000000000004685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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King C, Curran J, Devanagondi S, Balach T, Conti Mica M. Targeted Intervention to Increase Awareness of Opioid Overprescribing Significantly Reduces Narcotic Prescribing Within an Academic Orthopaedic Practice. JOURNAL OF SURGICAL EDUCATION 2020; 77:413-421. [PMID: 31587957 DOI: 10.1016/j.jsurg.2019.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 06/07/2019] [Accepted: 09/11/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the impact of a targeted intervention focused on increasing awareness of opioid overprescribing within an academic orthopaedic practice. DESIGN Retrospective prescribing data was collected through an electronic chart review. A single time point, a departmental grand rounds titled "Opioid Use, Misuse, & Abuse in Orthopaedics," was conducted on February 8, 2017. Opioid prescribing data was analyzed for the year preceding and year immediately following this targeted intervention. Narcotics were standardized using milligram morphine equivalents (MME) for comparison, and patients were categorized as opioid naive or non-naive based on whether an opioid prescription was written within 90 days prior to surgery. A segmented time series regression model was utilized to determine statistical significance of the educational intervention. SETTING Academic Medical Center. PARTICIPANTS All patients undergoing orthopaedic procedures at our institution between January 2016 and March 2018. RESULTS A total of 5882 patients underwent orthopaedic procedures at our institution during the study period. Of these, 2887 were in the year preceding and 2995 were in the year immediately following the targeted intervention to increase awareness of opioid overprescribing. The interve.ntion was associated with an acute decrease of 167 mean MME from 780 to 613 in opioid naive (p = 0.028) and 154 mean MME from 1,015 to 861 in opioid non-naive patients (p = 0.010). The intervention was also associated with a favorable change in the overall mean MME prescribing trend over time in both naive (p = 0.011) and non-naive (p = 0.064) patients. CONCLUSIONS This study demonstrates decreased opioid prescribing within an academic orthopaedic department after a targeted intervention focused on raising the awareness of opioid overprescribing. Ongoing provider education and awareness are critical parts of any plan to continue curtail opioid overprescribing among surgeons.
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Affiliation(s)
- Connor King
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, Illinois.
| | - John Curran
- University of Chicago Pritzker, School of Medicine, Chicago, Illinois
| | - Shwetha Devanagondi
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, Illinois
| | - Tessa Balach
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, Illinois
| | - Megan Conti Mica
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, Illinois
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Akl EA, Khamis AM. The intersections of industry with the health research enterprise. Health Res Policy Syst 2019; 17:53. [PMID: 31142343 PMCID: PMC6542139 DOI: 10.1186/s12961-019-0457-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 04/30/2019] [Indexed: 01/05/2023] Open
Abstract
There is increased awareness of the negative impact of large multinational corporations - the 'industry' - on public health. These corporations have established different types of relationships with a number of actors in the field of health research. This Commentary explores the different types of relationships between the industry and the actors of health research, how they intersect with the different research steps, and how these relationships allow the industry to exert influence. The types of relationships discussed consist of funding of research, direct relationships with the actors of research (namely advocacy groups, funding agencies, experts, professional organisations, regulatory agencies and health practitioners), and the influencing research standards. The potentially influenced research steps either precede the research (i.e. the prioritisation of research question), relate to it directly (i.e. its planning, conduct, reporting, dissemination and evaluation), or build on it (i.e. regulatory approval, integration into guidelines and adoption into practice). In conclusion, the industry has successfully fostered relationships with almost every actor of the health research enterprise and is using these relationships to influence the different steps of health research. The degree of influence the industry is having on health research calls for more work on managing the relationships discussed herein.
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Affiliation(s)
- Elie A. Akl
- Department of Internal Medicine, American University of Beirut Medical Center, P.O. Box: 11-0236, Riad-El-Solh Beirut, Beirut, 1107 2020 Lebanon
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario Canada
| | - Assem M. Khamis
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
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Rhéaume C, Labrecque M, Moisan N, Rioux J, Tardieux É, Diallo FB, Lussier MT, Lessard A, Grad R, Pluye P. Drug samples in family medicine teaching units: a cross-sectional descriptive study: Part 1: drug sample management policies and the relationship between the pharmaceutical industry and residents in Quebec. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:e531-e539. [PMID: 30541819 PMCID: PMC6371883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To determine the existence and the level of health care professional (HCP) knowledge of local policies regarding drug sample use and the relationship between residents and the pharmaceutical industry in academic primary health care settings. DESIGN Descriptive cross-sectional survey. Health care providers were invited to complete a self-administered questionnaire on drug sample use between February and December 2013. Managers of drug samples were also asked to complete a specific questionnaire on drug sample management and policies and an inventory log sheet. Data about the existence of written policies were validated with health and social services centre (HSCC) directors or pharmacy departments and family medicine teaching unit (FMTU) directors between February and June 2014. SETTING All 42 FMTUs in Quebec. PARTICIPANTS All HCPs in the FMTUs authorized to hand out drug samples (practising physicians, residents, pharmacists, and nurses). Dispensers were defined as those who reported using drug samples. Managers were defined as HCPs or staff members who managed drug samples. MAIN OUTCOME MEASURES Existence of written policies on drug sample use in HSCCs and FMTUs; whether FMTUs applied the HSCC policies if they existed; whether dispensers were aware of the existence of the policies; and whether policies on the relationships between residents and pharmaceutical companies existed. RESULTS Among the 42 FMTUs, 33 (79%) kept drug samples. Of these, 30% (10 of 33) did not have policies about drug samples in the FMTU or in the HSCC. A total of 67% (579 of 859) of HCPs from these FMTUs reported using drug samples. Most dispensers did not know if a policy existed in their FMTU (n = 297; 51%) or their HSCC (n = 420; 73%). Eleven (26%) of the 42 FMTU directors reported having a policy regarding relationships between residents and the pharmaceutical industry. Most drug sample dispensers were not aware whether such a policy existed (n = 310; 54%). CONCLUSION Many FMTUs did not have policies regarding drug samples or relationships between residents and the pharmaceutical industry. Variation in use and management of drug samples and the lack of knowledge of HCPs about the existence of policies point to the need to implement uniform policies in all FMTUs in Quebec.
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Affiliation(s)
- Caroline Rhéaume
- Clinical researcher in the Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec and in the Department of Family Medicine and Emergency Medicine at Laval University in Quebec
| | - Michel Labrecque
- Professor Emeritus in the Department of Family Medicine and Emergency Medicine at Laval University
| | - Nadine Moisan
- Pharmacist, a clinical teacher, and Professor in the Department of Family Medicine and Emergency Medicine at Laval University
| | - Jacky Rioux
- Research assistant in the Department of Family Medicine Emergency Medicine at Laval University at the time of the study
| | - Émilie Tardieux
- Research assistant in the Department of Family Medicine Emergency Medicine at Laval University at the time of the study
| | - Fatoumata Binta Diallo
- Research coordinator in the Équipe de recherche en soins de première ligne of the Centre intégré de santé et de services sociaux de Laval and at the Cité de la Santé Family Medicine Teaching Unit.
| | - Marie-Thérèse Lussier
- Full Professor in the Department of Family Medicine and Emergency Medicine at the University of Montreal in Quebec, a member of the Équipe de recherche en soins de première ligne du Centre intégré de santé et de services sociaux de Laval, Director of the University of Montreal Primary Care Research Network, Regional Network Director for the Canadian Primary Care Sentinel Surveillance Network in Quebec, and a teacher and practising physician at the Cité de la Santé Family Medicine Teaching Unit
| | - Andréa Lessard
- Clinical scientist in the Department of Family Medicine and Emergency Medicine at the University of Sherbrooke in Quebec and at the Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean in Quebec
| | - Roland Grad
- Family physician in the Herzl Family Practice Centre in Montreal and Associate Professor in the Department of Family Medicine at McGill University
| | - Pierre Pluye
- Associate Professor in the Department of Family Medicine at McGill University
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Reid L. Scientism in Medical Education and the Improvement of Medical Care: Opioids, Competencies, and Social Accountability. HEALTH CARE ANALYSIS 2018; 26:155-170. [PMID: 28986710 DOI: 10.1007/s10728-017-0351-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Scientism in medical education distracts educators from focusing on the content of learning; it focuses attention instead on individual achievement and validity in its measurement. I analyze the specific form that scientism takes in medicine and in medical education. The competencies movement attempts to challenge old "scientistic" views of the role of physicians, but in the end it has invited medical educators to focus on validity in the measurement of individual performance for attitudes and skills that medicine resists conceptualizing as objective. Academic medicine should focus its efforts instead on quality and relevance of care. The social accountability movement proposes to shift the focus of academic medicine to the goal of high quality and relevant care in the context of community service and partnership with the institutions that together with medicine create and cope with health and with health deficits. I make the case for this agenda through a discussion of the linked histories of the opioid prescribing crisis and the professionalism movement.
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Affiliation(s)
- Lynette Reid
- Department of Bioethics, Dalhousie University, PO Box 15000, Halifax, NS, B3H 4R2, Canada.
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20
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Green JC, Aziz T, Joseph J, Ravanam A, Shahab S, Straus L. YouTube Enhanced Case Teaching in Health Management and Policy. HEALTH PROFESSIONS EDUCATION 2018. [DOI: 10.1016/j.hpe.2017.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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21
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Kofi LS, Sud A, Buchman DZ. Ethics at the Intersection of Chronic Pain and Substance Use. DEVELOPMENTS IN NEUROETHICS AND BIOETHICS 2018. [DOI: 10.1016/bs.dnb.2018.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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22
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Summers A, Ruderman C, Leung FH, Slater M. Examining patterns in medication documentation of trade and generic names in an academic family practice training centre. BMC MEDICAL EDUCATION 2017; 17:175. [PMID: 28938883 PMCID: PMC5610475 DOI: 10.1186/s12909-017-1015-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 09/18/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Studies in the United States have shown that physicians commonly use brand names when documenting medications in an outpatient setting. However, the prevalence of prescribing and documenting brand name medication has not been assessed in a clinical teaching environment. The purpose of this study was to describe the use of generic versus brand names for a select number of pharmaceutical products in clinical documentation in a large, urban academic family practice centre. METHODS A retrospective chart review of the electronic medical records of the St. Michael's Hospital Academic Family Health Team (SMHAFHT). Data for twenty commonly prescribed medications were collected from the Cumulative Patient Profile as of August 1, 2014. Each medication name was classified as generic or trade. Associations between documentation patterns and physician characteristics were assessed. RESULTS Among 9763 patients prescribed any of the twenty medications of interest, 45% of patient charts contained trade nomenclature exclusively. 32% of charts contained only generic nomenclature, and 23% contained a mix of generic and trade nomenclature. There was large variation in use of generic nomenclature amongst physicians, ranging from 19% to 93%. CONCLUSIONS Trade names in clinical documentation, which likely reflect prescribing habits, continue to be used abundantly in the academic setting. This may become part of the informal curriculum, potentially facilitating undue bias in trainees. Further study is needed to determine characteristics which influence use of generic or trade nomenclature and the impact of this trend on trainees' clinical knowledge and decision-making.
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Affiliation(s)
- Alexander Summers
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON Canada
| | - Carly Ruderman
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON Canada
| | - Fok-Han Leung
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON Canada
| | - Morgan Slater
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON Canada
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23
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Webster F, Bremner S, Oosenbrug E, Durant S, McCartney CJ, Katz J. From Opiophobia to Overprescribing: A Critical Scoping Review of Medical Education Training for Chronic Pain. PAIN MEDICINE (MALDEN, MASS.) 2017; 18:1467-1475. [PMID: 28371881 PMCID: PMC5914373 DOI: 10.1093/pm/pnw352] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Chronic pain is a significant health problem strongly associated with a wide range of physical and mental health problems, including addiction. The widespread prevalence of pain and the increasing rate of opioid prescriptions have led to a focus on how physicians are educated about chronic pain. This critical scoping review describes the current literature in this important area, identifying gaps and suggesting avenues for further research starting from patients' standpoint. METHODS A search of the ERIC, MEDLINE, and Social Sciences Abstracts databases, as well as 10 journals related to medical education, was conducted to identify studies of the training of medical students, residents, and fellows in chronic noncancer pain. RESULTS The database and hand-searches identified 545 articles; of these, 39 articles met inclusion criteria and underwent full review. Findings were classified into four inter-related themes. We found that managing chronic pain has been described as stressful by trainees, but few studies have investigated implications for their well-being or ability to provide empathetic care. Even fewer studies have investigated how educational strategies impact patient care. We also note that the literature generally focuses on opioids and gives less attention to education in nonpharmacological approaches as well as nonopioid medications. DISCUSSION The findings highlight significant discrepancies between the prevalence of chronic pain in society and the low priority assigned to educating future physicians about the complexities of pain and the social context of those afflicted. This suggests the need for better pain education as well as attention to the "hidden curriculum."
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Affiliation(s)
- Fiona Webster
- Institute of Health Policy Management and Evaluation and Wilson Centre for Education Research, University of Toronto, Toronto, ON, Canada
| | - Samantha Bremner
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Eric Oosenbrug
- Department of Psychology, York University, Toronto, ON, Canada
| | - Steve Durant
- Institute of Health Policy Management and Evaluation and Wilson Centre for Education Research, University of Toronto, Toronto, ON, Canada
| | | | - Joel Katz
- Department of Anesthesiology, University of Ottawa, Ottawa, ON, Canada
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24
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Busse JW, Juurlink D, Guyatt GH. Addressing the limitations of the CDC guideline for prescribing opioids for chronic noncancer pain. CMAJ 2016; 188:1210-1211. [PMID: 27873754 DOI: 10.1503/cmaj.161023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Jason W Busse
- Michael G. DeGroote Institute for Pain Research and Care (Busse), Department of Anesthesia (Busse), and Department of Clinical Epidemiology and Biostatistics (Busse, Guyatt), McMaster University, Hamilton, Ont.; Departments of Medicine and Paediatrics (Juurlink), University of Toronto, Toronto, Ont.
| | - David Juurlink
- Michael G. DeGroote Institute for Pain Research and Care (Busse), Department of Anesthesia (Busse), and Department of Clinical Epidemiology and Biostatistics (Busse, Guyatt), McMaster University, Hamilton, Ont.; Departments of Medicine and Paediatrics (Juurlink), University of Toronto, Toronto, Ont
| | - Gordon H Guyatt
- Michael G. DeGroote Institute for Pain Research and Care (Busse), Department of Anesthesia (Busse), and Department of Clinical Epidemiology and Biostatistics (Busse, Guyatt), McMaster University, Hamilton, Ont.; Departments of Medicine and Paediatrics (Juurlink), University of Toronto, Toronto, Ont
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25
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Does brief chronic pain management education change opioid prescribing rates? A pragmatic trial in Australian early-career general practitioners. Pain 2016; 158:278-288. [DOI: 10.1097/j.pain.0000000000000755] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Finestone HM, Juurlink DN, Power B, Gomes T, Pimlott N. Opioid prescribing is a surrogate for inadequate pain management resources. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2016; 62:465-468. [PMID: 27302997 PMCID: PMC4907548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Hillel M Finestone
- Director of Stroke Rehabilitation Research at the Élisabeth Bruyère Hospital in Ottawa, Ont, and Professor in the Division of Physical Medicine and Rehabilitation in the Department of Medicine at the University of Ottawa.
| | - David N Juurlink
- Head of the Division of Clinical Pharmacology and Toxicology at Sunnybrook Health Sciences Centre in Toronto, Ont, and Eaton Scholar and Professor in the Department of Medicine, the Department of Paediatrics, and the Institute of Health Policy, Management and Evaluation at the University of Toronto
| | - Barry Power
- Pharmacist with the Rideau Family Health Team in Ottawa
| | - Tara Gomes
- Scientist in the Li Ka Shing Knowledge Institute of St Michael's Hospital and with the Institute for Clinical and Evaluative Sciences and Assistant Professor in the Institute of Health Policy, Management and Evaluation and the Leslie Dan Faculty of Pharmacy at the University of Toronto
| | - Nicholas Pimlott
- Associate Professor in the Department of Family and Community Medicine at the University of Toronto and Scientific Editor of Canadian Family Physician
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27
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Finestone HM, Juurlink DN, Power B, Gomes T, Pimlott N. [La prescription d'opioïdes: un substitut au manque de ressources en contrôle de la douleur]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2016; 62:e287-e290. [PMID: 27303017 PMCID: PMC4907568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Hillel M Finestone
- Directeur de la recherche en réadaptation après un AVC à l'Hôpital Élisabeth-Bruyère à Ottawa, en Ontario, et professeur à la Division de la médecine physique et réadaptation du Département de médecine de l'Université d'Ottawa.
| | - David N Juurlink
- Directeur de la Division de pharmacologie clinique et de toxicologie au Centre des sciences de la santé Sunnybrook à Toronto, en Ontario, boursier Eaton et professeur au Département de médecine, au Département de pédiatrie et à l'Institute of Health Policy, Management and Evaluation de l'Université de Toronto
| | - Barry Power
- Pharmacien au sein de l'Équipe de santé familiale Rideau à Ottawa
| | - Tara Gomes
- Scientifique au Li Ka Shing Knowledge Institute de l'Hôpital St Michael et auprès de l'Institute for Clinical and Evaluative Sciences, de même que professeure adjointe à l'Institute of Health Policy, Management and Evaluation et à la Faculté de pharmacie Leslie Dan de l'Université de Toronto
| | - Nicholas Pimlott
- Professeur agrégé au Département de médecine familiale et communautaire de l'Université de Toronto et rédacteur scientifique du Médecin de famille canadien
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28
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The prescription opioid epidemic: an overview for anesthesiologists. Can J Anaesth 2015; 63:61-8. [DOI: 10.1007/s12630-015-0520-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 06/23/2015] [Accepted: 10/15/2015] [Indexed: 02/03/2023] Open
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29
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Spithoff S. Industry involvement in continuing medical education: time to say no. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2014; 60:694-703. [PMID: 25122806 PMCID: PMC4131951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Sheryl Spithoff
- Family physician and addiction medicine physician at Women's College Hospital in Toronto, Ont.
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30
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Rintoul AC, Dobbin M. Prescription opioid deaths: we need to treat sick populations, not just sick individuals. Addiction 2014; 109:185-6. [PMID: 24422612 DOI: 10.1111/add.12343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Angela C Rintoul
- School of Public Health and Preventive Medicine, Monash University, 3rd Floor Burnet Building, Alfred Hospital, Melbourne, Vic., 3004, Australia.
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