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García Carrillo M, Gagnon MA, Blaustein M. Editorial: Current priorities in health research agendas: tensions between public and commercial interests in prioritizing biomedical, social, and environmental aspects of health. Front Med (Lausanne) 2024; 11:1391982. [PMID: 38562373 PMCID: PMC10982506 DOI: 10.3389/fmed.2024.1391982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Affiliation(s)
- Mercedes García Carrillo
- Departamento de Fisiología, Biología Molecular y Celular (DFBMC), Facultad de Ciencias Exactas y Naturales (FCEyN), Instituto de Biociencias, Biotecnología y Biología Traslacional (iB3), Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Marc-André Gagnon
- School of Public Policy and Administration, Carleton University, Ottawa, ON, Canada
| | - Matías Blaustein
- Departamento de Fisiología, Biología Molecular y Celular (DFBMC), Facultad de Ciencias Exactas y Naturales (FCEyN), Instituto de Biociencias, Biotecnología y Biología Traslacional (iB3), Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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Cosgrove L, Patterson EH, Bursztajn HJ. Industry influence on mental health research: depression as a case example. Front Med (Lausanne) 2024; 10:1320304. [PMID: 38322498 PMCID: PMC10845136 DOI: 10.3389/fmed.2023.1320304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/07/2023] [Indexed: 02/08/2024] Open
Abstract
Emotional distress has been rising since before the COVID-19 pandemic and the public is told that depression is a major public health problem. For example, in 2017 depressive disorders were ranked as the third leading cause of "years lost to disability" and the World Health Organization now ranks depression as the single largest contributor to global disability. Although critical appraisals of the epidemiological data raise questions about the accuracy of population-based depression estimates, the dominance of the medical model and the marketing of psychotropics as "magic bullets," have contributed to a dramatic rise in the prescription of psychiatric drugs. Unfortunately, the pharmaceutical industry's influence on psychiatric research and practice has resulted in over-estimates of the effectiveness of psychotropic medications and an under-reporting of harms. This is because the principles that govern commercial entities are incongruent with the principles that guide public health research and interventions. In order to conduct mental health research and develop interventions that are in the public's best interest, we need non-reductionist epistemological and empirical approaches that incorporate a biopsychosocial perspective. Taking depression as a case example, we argue that the socio-political factors associated with emotional distress must be identified and addressed. We describe the harms of industry influence on mental health research and show how the emphasis on "scaling up" the diagnosis and treatment of depression is an insufficient response from a public health perspective. Solutions for reform are offered.
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Affiliation(s)
- Lisa Cosgrove
- Department of Counseling & School Psychology, University of Massachusetts, Boston, MA, United States
| | - Elissa H. Patterson
- Departments of Psychiatry and Neurology, Institute for Healthcare Policy & Innovation, University of Michigan Medical School, Ann Arbor, MI, United States
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Testoni FE, Carrillo MG, Gagnon MA, Rikap C, Blaustein M. Correction: Whose shoulders is health research standing on? Determining the key actors and contents of the prevailing biomedical research agenda. PLoS One 2023; 18:e0296549. [PMID: 38153945 PMCID: PMC10754440 DOI: 10.1371/journal.pone.0296549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0249661.].
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Blaustein M, Garelli FM. What about Health Education? Hegemony, paradigms in tension and alternatives. Front Med (Lausanne) 2023; 10:1289865. [PMID: 38020148 PMCID: PMC10680365 DOI: 10.3389/fmed.2023.1289865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Matías Blaustein
- Instituto de Biociencias, Biotecnología y Biología Traslacional (iB3), Departamento de Fisiología, Biología Molecular y Celular (DFBMC), Facultad de Ciencias Exactas y Naturales (FCEyN), Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Fernando Miguel Garelli
- Grupo de Didáctica de las Ciencias (IFLYSIB-CONICET), La Plata, Argentina
- Departamento de Educación, Universidad Nacional de Luján, Luján, Argentina
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Redman BK. Rebalancing commercial and public interests in prioritizing biomedical, social and environmental aspects of health through defining and managing conflicts of interest. Front Med (Lausanne) 2023; 10:1247258. [PMID: 37809337 PMCID: PMC10556523 DOI: 10.3389/fmed.2023.1247258] [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: 06/25/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Biomedical research is intended to benefit human beings and their health. Toward that end, scientific norms involve examining and criticizing the work of others and prioritizing questions that should be studied. Yet, in areas of health research where industry is active, it has often utilized well-honed strategies aimed at evading scientific standards and at dominating the research agenda, largely through its financial support and lack of transparency of its research practices. These tactics have now been documented to uniformly support industry products. Commercial entities are aided in this pursuit by public policy that has significantly embedded commercial interests and agendas into federal research funding and infrastructure. Therefore, to understand the resulting landscape and its effect on priority in health research agendas, traditional definitions of individual conflicts of interest (COI) and the less well developed institutional COI must be supplemented by a new construct of structural COI, largely operating as intellectual monopolies, in support of industry. These arrangements often result in financial and reputational resources that assure dominance of commercial priorities in research agendas, crowding out any other interests and ignoring justified returns to the public from investment of its tax dollars. There is no sustained attention to mechanisms by which public interests can be heard, normative issues raised, and then balanced with commercial interests which are transparently reported. Focus on research supporting approval of commercial products ignores social and environmental determinants of health. Commercial bias can invalidate regulatory research protections through obscuring valid risk-benefit ratios considered by IRBs.
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Affiliation(s)
- Barbara K. Redman
- Division of Medical Ethics, Grossman School of Medicine, New York University, New York, NY, United States
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Sowerbutts AM, Lal S, Pironi L, Jones D, French C, Riis M, Clamp A, McCracken J, Williamson L, Wheatley C, Johnson B, Burden S. Patients, family members and healthcare professionals' top ten research priorities for adults receiving home parenteral nutrition for malignant or benign disease. Clin Nutr ESPEN 2023; 53:151-158. [PMID: 36657907 DOI: 10.1016/j.clnesp.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/01/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Home parenteral nutrition (HPN) is the primary treatment for chronic intestinal failure (CIF) due to non-malignant disease and is increasingly used in patients with a diagnosis of cancer. This project engaged with patients, family members and healthcare professionals to ascertain what questions they want researched. METHODS This study followed the five-stage process of the James Lind Alliance that involved (1) setting up a steering group, (2) carrying out an initial survey to gather participants' questions, (3) data processing, (4) an interim priority setting survey and (5) final priority setting workshop. Surveys were translated and back translated into Italian, Danish and French. RESULTS The project was delivered by an international steering committee with representation from Denmark, Italy, the United Kingdom and United States consisting of three patients, six healthcare professionals and facilitated by University researchers. For the first survey, 633 questions were submitted by 292 respondents from 12 countries. There were 79 questions removed as out of scope or already in the published literature. Responses were collated into two interim surveys of 41 questions for benign CIF and 13 questions for HPN and cancer. In the second survey, 216 respondents prioritised their top ten questions. The ordering from the cancer and HPN survey was taken as definitive; top priorities were quality of life, survival, when to commence HPN, using HPN with anti-cancer treatments, access barriers, measuring benefit and ethical implications. For CIF with benign disease, 18 questions were discussed in two workshops attended by 13 patients and 7 healthcare professionals. The questions were ranked using a modified nominal group technique; the top research priorities were prevention and treatment of liver disease, improving central infusion lines, oral absorption, avoiding long-term negative consequences, vascular access, side effects, line infections, decreasing stoma output, quality of life and sleep. CONCLUSIONS Priorities identified will assist researchers to focus on research questions important to patients, family members and healthcare professionals.
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Affiliation(s)
| | - Simon Lal
- Salford Royal Foundation Trust, Salford, UK; School of Medical Sciences, University of Manchester, Manchester, UK
| | - Loris Pironi
- Alma Mater Studiorum -University of Bologna, Department of Medical and Surgical Sciences, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Center for Chronic Intestinal Failure - Clinical Nutrition and Metabolism Unit, Italy
| | - Debra Jones
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Chloe French
- School of Health Sciences, University of Manchester, Manchester, UK
| | | | - Andrew Clamp
- School of Medical Sciences, University of Manchester, Manchester, UK; Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Jennifer McCracken
- Richard Wells Rehabilitation Centre, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | | | | | | | - Sorrel Burden
- School of Health Sciences, University of Manchester, Manchester, UK; Salford Royal Foundation Trust, Salford, UK
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Correction: Whose shoulders is health research standing on? Determining the key actors and contents of the prevailing biomedical research agenda. PLoS One 2021; 16:e0260330. [PMID: 34784406 PMCID: PMC8594811 DOI: 10.1371/journal.pone.0260330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Beall RF, Moradpour J, Hollis A. The private versus public contribution to the biomedical literature during the COVID-19, Ebola, H1N1, and Zika public health emergencies. PLoS One 2021; 16:e0258013. [PMID: 34679120 PMCID: PMC8535173 DOI: 10.1371/journal.pone.0258013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/15/2021] [Indexed: 01/03/2023] Open
Abstract
Background The private versus public contribution to developing new health knowledge and interventions is deeply contentious. Proponents of commercial innovation highlight its role in late-stage clinical trials, regulatory approval, and widespread distribution. Proponents of public innovation point out the role of public institutions in forming the foundational knowledge undergirding downstream innovation. The rapidly evolving COVID-19 situation has brought with it uniquely proactive public involvement to characterize, treat, and prevent this novel health treat. How has this affected the share of research by industry and public institutions, particularly compared to the experience of previous pandemics, Ebola, H1N1 and Zika? Methods Using Embase, we categorized all publications for COVID-19, Ebola, H1N1 and Zika as having any author identified as affiliated with industry or not. We placed all disease areas on a common timeline of the number of days since the WHO had declared a Public Health Emergency of International Concern with a six-month lookback window. We plotted the number and proportion of publications over time using a smoothing function and plotted a rolling 30-day cumulative sum to illustrate the variability in publication outputs over time. Results Industry-affiliated articles represented 2% (1,773 articles) of publications over the 14 months observed for COVID-19, 7% (278 articles) over 7.1 years observed for Ebola, 5% (350 articles) over 12.4 years observed for H1N1, and 3% (160 articles) over the 5.7 years observed for Zika. The proportion of industry-affiliated publications built steadily over the time observed, eventually plateauing around 7.5% for Ebola, 5.5% for H1H1, and 3.5% for Zika. In contrast, COVID-19’s proportion oscillated from 1.4% to above 2.7% and then declined again to 1.7%. At this point in the pandemic (i.e., 14 months since the PHEIC), the proportion of industry-affiliated articles had been higher for the other three disease areas; for example, the proportion for H1N1 was twice as high. Conclusions While the industry-affiliated contribution to the biomedical literature for COVID is extraordinary in its absolute number, its proportional share is unprecedentedly low currently. Nevertheless, the world has witnessed one of the most remarkable mobilizations of the biomedical innovation ecosystem in history.
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Affiliation(s)
- Reed F Beall
- Department of Community Health Sciences, Cumming School of Medicine and O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Javad Moradpour
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Aidan Hollis
- Department of Economics, University of Calgary, Calgary, Canada
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