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Cosgrove L, Mintzes B, Bursztajn HJ, D'Ambrozio G, Shaughnessy AF. Industry effects on evidence: a case study of long-acting injectable antipsychotics. Account Res 2024; 31:2-13. [PMID: 35634753 DOI: 10.1080/08989621.2022.2082289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A vigorously debated issue in the psychiatric literature is whether long-acting injectable antipsychotics (LAIs) show clinical benefit over antipsychotics taken orally. In addressing this question, it is critical that systematic reviews incorporate risk of bias assessments of trial data in a robust way and are free of undue industry influence. In this paper, we present a case analysis in which we identify some of the design problems in a recent systematic review on LAIs vs oral formulations. This case illustrates how evidence syntheses that are shaped by commercial interests may undermine patient-centered models of recovery and care. We offer recommendations that address both the bioethical and research design issues that arise in the systematic review process when researchers have financial conflicts of interest.
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Affiliation(s)
- Lisa Cosgrove
- Counseling Psychology Department, Faculty Fellow, Applied Ethics Center, University of Massachusetts-Boston, Boston, Massachusetts, USA
| | - Barbara Mintzes
- School of Pharmacy and Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Harold J Bursztajn
- Co-founder, Program in Psychiatry and the Law @ BIDMC Psychiatry of Harvard Medical School, Cambridge, Massachusetts, USA
| | - Gianna D'Ambrozio
- Counseling Psychology Department, University of Massachusetts-Boston, Boston, Massachusetts, USA
| | - Allen F Shaughnessy
- Department of Family Medicine, Tufts University School of Medicine, Malden, Massachusetts, USA
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2
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Forbes M, Bhowon Y, Mintzes B. Pharmaceutical company payments to Australian doctors reported to Medicines Australia, 2019-22: a cross-sectional analysis. Med J Aust 2024. [PMID: 38623760 DOI: 10.5694/mja2.52284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/20/2023] [Indexed: 04/17/2024]
Affiliation(s)
- Malcolm Forbes
- University Hospital Geelong, Geelong, VIC
- The University of Melbourne, Melbourne, VIC
| | | | - Barbara Mintzes
- Charles Perkins Centre, the University of Sydney, Sydney, NSW
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3
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Mintzes B. Information on medicines: Does independence from industry influence matter? Afr J Prim Health Care Fam Med 2024; 16:e1-e2. [PMID: 38572857 PMCID: PMC11019035 DOI: 10.4102/phcfm.v16i1.4522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 04/05/2024] Open
Abstract
No abstract available.
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Affiliation(s)
- Barbara Mintzes
- School of Pharmacy and Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney.
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4
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Mintzes B. Do regulatory safety warnings on medicines miss the mark? Drug Ther Bull 2024; 62:50. [PMID: 38458656 DOI: 10.1136/dtb.2023.000053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Affiliation(s)
- Barbara Mintzes
- School of Pharmacy and Charles Perkins Centre, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The University of British Columbia School of Population and Public Health, Vancouver, British Columbia, Canada
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5
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Menkes DB, Mintzes B, Macdonald N, Lexchin J. Raising the bar for disclosure of industry payments to doctors. BMJ 2024; 384:e078133. [PMID: 38423552 DOI: 10.1136/bmj-2023-078133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- David B Menkes
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Semaglutide (▼Ozempic solution for injection, ▼Rybelsus tablets-Novo Nordisk) was initially granted market authorisation for the treatment of type 2 diabetes as an adjunct to diet and exercise. In 2021 and 2022, regulatory agencies in the USA and Europe licensed semaglutide (▼Wegovy solution for injection-Novo Nordisk) for the treatment of individuals who are obese, or overweight and who have at least one weight-related comorbidity. Manufacturer-sponsored randomised controlled trials have shown a loss of almost 12% of body weight over a 68-week period, however, once the medication is stopped people regain most of their pretreatment weight. Gastrointestinal adverse events occur commonly with semaglutide, and pancreatitis, diabetic retinopathy and severe allergic reactions have also been reported. Extensive hype in social and general media has resulted in increased demand for semaglutide leading to supply problems across the various licensed products including those used for treatment of diabetes. In the UK, the National Institute for Health and Care Excellence has recommended semaglutide as an option for weight management for a maximum treatment duration of 2 years. Further studies are underway to assess the effect of semaglutide on longer-term health benefits.
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Affiliation(s)
- Joel Lexchin
- School of Health Policy and Management, York University - Keele Campus, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Barbara Mintzes
- School of Pharmacy and Charles Perkins Centre, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The University of British Columbia School of Population and Public Health, Vancouver, British Columbia, Canada
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8
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Patterson T, Beckenkamp PR, Turner J, Gnjidic D, Mintzes B, Bennett C, Bywaters L, Clavisi O, Baysari M, Ferreira M, Ferreira P. Barriers and facilitators to reducing paracetamol use in low back pain: A qualitative study. Musculoskelet Sci Pract 2023; 67:102856. [PMID: 37696066 DOI: 10.1016/j.msksp.2023.102856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/24/2023] [Accepted: 09/04/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Paracetamol is widely used for low back pain (LBP), but research questions its efficacy and safety. Patient education booklets have been explored for promoting deprescribing, but barriers and facilitators specific to LBP deprescribing remain unexamined. OBJECTIVE To identify contextual factors facilitating and obstructing successful deprescribing of paracetamol for LBP after receiving an educational booklet. STUDY DESIGN This study is part of an uncontrolled cohort feasibility study (CEASE NOW) in the community, recruiting from Musculoskeletal Australia and painaustralia. PATIENT SAMPLE Twenty-four participants with acute, sub-acute, or chronic LBP, self-reporting paracetamol consumption, were included. METHODS Thematic content analysis was used to analyze qualitative data on barriers and facilitators. Data were categorized by deprescribing outcomes: i) successful deprescribing, ii) attempted but failed, or iii) no attempt. Semi-structured telephone interviews were conducted within one week after each participant completed the one-month follow-up. RESULTS Successful deprescribing was facilitated by supportive healthcare professionals, willingness, high self-efficacy, fear of future illness, and diverse strategies for deprescribing plans. Barriers included unsupportive healthcare professionals and fear of flare-ups. Participants not attempting deprescribing believed it unnecessary, perceived it as effortful, unquestioningly trusted healthcare professionals, and lacked risk awareness. CONCLUSIONS Support from healthcare professionals, patient willingness, perceived necessity, risk awareness, effort, and varied strategies influence deprescribing outcomes for LBP patients using paracetamol. Addressing these factors is crucial when designing interventions to promote safe and effective deprescribing in LBP management.
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Affiliation(s)
- Thomas Patterson
- The University of Sydney, Sydney Musculoskeletal Health, Faculty of Medicine and Health, Charles Perkins Centre, Susan Wakil Health Building D18, Camperdown, NSW, 2006, Australia.
| | - Paula R Beckenkamp
- The University of Sydney, Sydney Musculoskeletal Health, Faculty of Medicine and Health, Charles Perkins Centre, Susan Wakil Health Building D18, Camperdown, NSW, 2006, Australia
| | - Justin Turner
- University of Montreal, Faculty of Pharmacy, Edouard Montpetit Blvd, Montreal, Quebec, H3T 1J4, Canada
| | - Danijela Gnjidic
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, A15, Science Rd, Camperdown, NSW, 2006, Australia
| | - Barbara Mintzes
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, A15, Science Rd, Camperdown, NSW, 2006, Australia
| | - Carol Bennett
- Painaustralia, Unit 6/42 Geils Ct, Deakin ACT, 2600, Australia
| | - Lisa Bywaters
- Consumer Services for Musculoskeletal Australia, 263-265 Kooyong Rd, Elsternwick, VIC, 3185, Australia
| | - Ornella Clavisi
- Consumer Services for Musculoskeletal Australia, 263-265 Kooyong Rd, Elsternwick, VIC, 3185, Australia
| | - Melissa Baysari
- The University of Sydney, Biomedical Informatics and Digital Health, Faculty of Medicine and Health, Charles Perkins Centre, John Hopkins Drive, Camperdown, NSW, 2006, Australia
| | - Manuela Ferreira
- The University of Sydney, Sydney Musculoskeletal Health and the Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, St Leonards, NSW 2064, Australia
| | - Paulo Ferreira
- The University of Sydney, Sydney Musculoskeletal Health, Faculty of Medicine and Health, Charles Perkins Centre, Susan Wakil Health Building D18, Camperdown, NSW, 2006, Australia
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9
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Mintzes B, Menkes DB. Pharmaceutical company sponsorship of doctors: is gender equity a concern? Med J Aust 2023; 219:261-262. [PMID: 37605943 DOI: 10.5694/mja2.52088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023]
Affiliation(s)
- Barbara Mintzes
- Charles Perkins Centre, the University of Sydney, Sydney, NSW
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Pokorny AMJ, Bero LA, Fox P, Karikios DJ, McEwin EJ, Moynihan R, Mintzes B. Interactions between Australian cancer physicians and the pharmaceutical industry: a qualitative study. BMJ Open 2023; 13:e065719. [PMID: 37236664 DOI: 10.1136/bmjopen-2022-065719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVES To understand how and why Australian cancer physicians interact with the pharmaceutical industry. DESIGN Qualitative study using semistructured interviews, performed by a medical oncologist. Thematic analysis using a combination of deductive and inductive codes. SETTING Given the evidence on industry influences on clinical practice and the importance to the market of oncology drugs, we sought to better understand cancer physicians' experiences. Practising consultant medical oncologists and clinical haematologists from four Australian states were interviewed over Zoom. PARTICIPANTS 16 cancer physicians were interviewed between November 2021 and March 2022, from 37 invited (response rate 43%). Most were medical oncologists (n=12 of 16, 75%) and male (n=9 of 16, 56%). OUTCOME MEASURES The analysis of all interviews was based on grounded theory. Transcripts were coded and then codes formed into themes with supporting quotes. The themes were then placed into categories, used to describe the broad areas into which the themes could be grouped. RESULTS Six themes were identified that fell within two broad categories: cancer physicians' views and experiences of interactions and management of these interactions. Views and experiences included: the transactional nature of relationships, risks of research dependence, ethical challenges and varied attitudes based on interaction type. Management themes included: lack of useful guidance and reduced interactions during the COVID-19 pandemic. These led to an overarching seventh theme, on the desire for a 'middle road'. Cancer physicians identified the transactional nature of industry relationships and felt uncomfortable with several types of interactions, including those with sales representatives. Most wanted less contact with industry, and the forced separation that occurred with the COVID-19 pandemic was generally welcome. CONCLUSIONS Cancer physicians may have difficulty balancing the perceived need to interact with industry in modern cancer care while maintaining distance to minimise conflicts of interest. Further research is needed to assess management strategies in this area.
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Affiliation(s)
- Adrian M J Pokorny
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Lisa A Bero
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Center for Bioethics and Humanities, University of Colorado-Anschutz Medical Campus, Denver, Colorado, USA
| | - Peter Fox
- Central West Cancer Care Centre, Orange Health Service, Orange, New South Wales, Australia
- School of Medicine, Western Sydney University, Orange, New South Wales, Australia
| | - Deme J Karikios
- Department of Medical Oncology, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Eliza J McEwin
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ray Moynihan
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Barbara Mintzes
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Menkes DB, Mintzes B, Lexchin J. Time for New Zealand to ban direct-to-consumer advertising of prescription medicines. N Z Med J 2023; 136:7-9. [PMID: 37167935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- David B Menkes
- The University of Auckland, Waikato Clinical Campus, Hamilton
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12
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Davis C, Wagner AK, Salcher-Konrad M, Scowcroft H, Mintzes B, Pokorny AMJ, Lew J, Naci H. Communication of anticancer drug benefits and related uncertainties to patients and clinicians: document analysis of regulated information on prescription drugs in Europe. BMJ 2023; 380:e073711. [PMID: 36990506 PMCID: PMC10053600 DOI: 10.1136/bmj-2022-073711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To evaluate the frequency with which relevant and accurate information about the benefits and related uncertainties of anticancer drugs are communicated to patients and clinicians in regulated information sources in Europe. DESIGN Document content analysis. SETTING European Medicines Agency. PARTICIPANTS Anticancer drugs granted a first marketing authorisation by the European Medicines Agency, 2017-19. MAIN OUTCOME MEASURES Whether written information on a product addressed patients' commonly asked questions about: who and what the drug is used for; how the drug was studied; types of drug benefit expected; and the extent of weak, uncertain, or missing evidence for drug benefits. Information on drug benefits in written sources for clinicians (summaries of product characteristics), patients (patient information leaflets), and the public (public summaries) was compared with information reported in regulatory assessment documents (European public assessment reports). RESULTS 29 anticancer drugs that received a first marketing authorisation for 32 separate cancer indications in 2017-19 were included. General information about the drug (including information on approved indications and how the drug works) was frequently reported across regulated information sources aimed at both clinicians and patients. Nearly all summaries of product characteristics communicated full information to clinicians about the number and design of the main studies, the control arm (if any), study sample size, and primary measures of drug benefit. None of the patient information leaflets communicated information to patients about how drugs were studied. 31 (97%) summaries of product characteristics and 25 (78%) public summaries contained information about drug benefits that was accurate and consistent with information in regulatory assessment documents. The presence or absence of evidence that a drug extended survival was reported in 23 (72%) summaries of product characteristics and four (13%) public summaries. None of the patient information leaflets communicated information about the drug benefits that patients might expect based on study findings. Scientific concerns about the reliability of evidence on drug benefits, which were raised by European regulatory assessors for almost all drugs in the study sample, were rarely communicated to clinicians, patients, or the public. CONCLUSIONS The findings of this study highlight the need to improve the communication of the benefits and related uncertainties of anticancer drugs in regulated information sources in Europe to support evidence informed decision making by patients and their clinicians.
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Affiliation(s)
- Courtney Davis
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Anita K Wagner
- Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | | - Henry Scowcroft
- Alzheimer's Research UK, Cambridge, UK
- National Cancer Research Institute Bladder and Renal Research Group, London, UK
| | - Barbara Mintzes
- School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Adrian M J Pokorny
- School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
- Alice Springs Hospital, Northern Territory, Australia
| | - Jianhui Lew
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, UK
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13
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Morrow RL, Mintzes B, Gray G, Law MR, Garrison S, Dormuth CR. Public reporting of clinical trial findings as an ethical responsibility to participants: a qualitative study. BMJ Open 2023; 13:e068221. [PMID: 36944466 PMCID: PMC10032397 DOI: 10.1136/bmjopen-2022-068221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVE To understand how the experiences and views of trial participants, trial investigators and others connected to clinical trial research relate to whether researchers have a duty to participants to publicly report research findings. DESIGN Qualitative interview study. SETTING Semistructured interviews held in person or by telephone between March 2019 and April 2021 with participants in the Canadian provinces of Alberta, British Columbia and Ontario. PARTICIPANTS 34 participants, including 10 clinical trial participants, 17 clinical trial investigators, 1 clinical research coordinator, 3 research administrators and 3 research ethics board members. ANALYSIS We conducted a thematic analysis, including qualitative coding of interview transcripts and identification of key themes. MAIN OUTCOME MEASURES Key themes identified through qualitative coding of interview data. RESULTS Most clinical trial participants felt that reporting clinical trial results is important. Accounts of trial participants suggest their contributions are part of a reciprocal relationship involving the expectation that research will advance medical knowledge. Similarly, comments from trial investigators suggest that reporting trial results is part of reciprocity with trial participants and is a necessary part of honouring informed consent. Accounts of trial investigators suggest that when drug trials are not reported, this may undermine informed consent in subsequent trials by withholding information on harms or efficacy relevant to informed decisions on whether to conduct or enroll in future trials of similar drugs. CONCLUSION The views of trial participants, trial investigators and others connected to clinical trial research in Canada suggest that researchers have an obligation to participants to publicly report clinical trial results and that reporting results is necessary for honouring informed consent.
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Affiliation(s)
- Richard L Morrow
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Barbara Mintzes
- Faculty of Pharmacy and Charles Perkins Centre, University of Sydney Faculty of Health Sciences, The University of Sydney, New South Wales, Australia
| | - Garry Gray
- Department of Sociology, University of Victoria, Victoria, British Columbia, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott Garrison
- Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Colin R Dormuth
- Anaesthesiology, Pharmacology, and Therapeutics, Therapeutics Initiative, The University of British Columbia, Vancouver, British Columbia, Canada
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Morrow RL, Mintzes B, Gray G, Law MR, Garrison S, Dormuth CR. Factors relating to nonpublication and publication bias in clinical trials in Canada: A qualitative interview study. Br J Clin Pharmacol 2023; 89:1198-1206. [PMID: 36268743 DOI: 10.1111/bcp.15574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 09/02/2022] [Accepted: 10/11/2022] [Indexed: 11/30/2022] Open
Abstract
AIMS This study aims to understand factors contributing to nonpublication and publication bias in clinical trials in Canada. METHODS Qualitative interviews were conducted between March 2019 and April 2021 with 34 participants from the Canadian provinces of Alberta, British Columbia and Ontario, including 17 clinical trial investigators, 1 clinical research coordinator, 3 research administrators, 3 research ethics board members and 10 clinical trial participants. We conducted a thematic analysis involving coding of interview transcripts and memo-writing to identify key themes. RESULTS Several factors contribute to nonpublication and publication bias in clinical trial research. A core theme was that reporting practices are shaped by incentives within the research system taht favour publication of positive over negative trials. Investigators are discouraged from reporting by experiences or perceptions of difficulty in publishing negative findings but rewarded for publishing positive findings in various ways. Trial investigators more strongly associated positive clinical trials than negative trials with opportunities for industry and nonindustry funding and with academic promotion, bonuses and recognition. Research institutions and ethics boards tended to lack well-resourced, proactive policies and practices to ensure trial findings are reported in registries or journals. CONCLUSION Clinical trial reporting practices in Canada are shaped by incentives favouring reporting of positive over negative trials, such as funding opportunities and academic promotion, bonuses and recognition. Research institutions could help change incentives by adopting performance metrics that emphasize full reporting of results in journals or registries.
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Affiliation(s)
- Richard L Morrow
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Barbara Mintzes
- School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Garry Gray
- Department of Sociology, University of Victoria, Victoria, British Columbia, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott Garrison
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Colin R Dormuth
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
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Mintzes B, Vitry A. Australia to lose agency dedicated to better quality medicine use. Drug Ther Bull 2023; 61:2. [PMID: 36456031 DOI: 10.1136/dtb.2022.000026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Barbara Mintzes
- School of Pharmacy and Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia .,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Agnes Vitry
- Clinical and Health Sciences, University of South Australia Division of Health Sciences, Adelaide, South Australia, Australia
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Patterson T, Turner J, Gnjidic D, Mintzes B, Bennett C, Bywaters L, Clavisi O, Baysari M, Ferreira M, Beckenkamp P, Ferreira P. (C)onsumer focused (E)ducation on p(A)racetamol (S)ide (E)ffects, i(N)adequate (O)utcomes and (W)eaning (CEASE NOW) for individuals with low back pain: results of a feasibility study. BMJ Open 2022; 12:e068164. [PMID: 36424116 PMCID: PMC9693669 DOI: 10.1136/bmjopen-2022-068164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To determine the feasibility of a patient-education booklet to support patients with low back pain (LBP) to reduce paracetamol intake. DESIGN Single group, repeated measures feasibility study. SETTING Community. PARTICIPANTS Adults experiencing LBP of any kind and self-reporting consumption of paracetamol for LBP weekly for at least 1 month were invited to participate. INTERVENTION Participants received a patient-education booklet 1 week after the baseline measures were collected. The intervention was designed to change beliefs, increase knowledge and self-efficacy to deprescribe paracetamol for their LBP and create discussion with a health professional through the mechanisms of motivation, capacity and opportunity. PRIMARY OUTCOME MEASURES Feasibility of recruitment procedures, data collection and acceptability of the intervention. SECONDARY OUTCOME MEASURES Changes in motivation, self-efficacy, opportunity to deprescribe paracetamol for their LBP, paracetamol usage and LBP clinical outcomes at baseline, 1-week and 1-month follow-up. RESULTS A total of 24 participants were recruited into the study within the timeframe of 3 months from study advertisement and all completed the study follow-up. There were no missing data for any outcome measure across all follow-up points, 22 (91.6%) participants were willing to participate in a future randomised control trial (RCT) and over 60% of participants responded positively to questions regarding acceptability of the patient-educational booklet. Overall, at the 1-month follow-up, approximately two thirds (15/24) of participants had an increase in motivation and self-efficacy scores and had discussed or intended to discuss their paracetamol use for LBP with a health professional. CONCLUSIONS The results of this study demonstrate that the patient-education booklet is feasible to implement, and both the intervention and study design were well-received by participants. This study supports the undertaking an RCT to assess the effects of the patient-education booklet on deprescribing paracetamol in people with LBP.
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Affiliation(s)
- Thomas Patterson
- The University of Sydney, Musculoskeletal Research Hub, Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
| | - Justin Turner
- School of Pharmacy, University of Montreal, Montreal, Québec, Canada
| | - Danijela Gnjidic
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Barbara Mintzes
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Carol Bennett
- painaustralia, Deakin, Australian Capital Territory, Australia
| | - Lisa Bywaters
- Musculoskeletal Australia, Elsternwick, Victoria, Australia
| | | | - Melissa Baysari
- The University of Sydney, Discipline of Biomedical Informatics and Digital Health, Medicine and Health, Charles Perkins Centre, Camperdown, New South Wales, Australia
| | - Manuela Ferreira
- The University of Sydney, Institute of Bone and Joint, Kolling Institute, Faculty of Medicine and Health, St Leonards, New South Wales, Australia
| | - Paula Beckenkamp
- The University of Sydney, Musculoskeletal Research Hub, Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
| | - Paulo Ferreira
- The University of Sydney, Musculoskeletal Research Hub, Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
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Mintzes B, Reynolds E, Bahri P, Perry LT, Bhasale AL, Morrow RL, Dormuth CR. How do safety warnings on medicines affect prescribing? Expert Opin Drug Saf 2022; 21:1269-1273. [PMID: 36208037 DOI: 10.1080/14740338.2022.2134342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Many adverse effects of medicines only become known after approval, prompting regulatory agencies to issue post-market safety advisories to inform clinicians and support safer care. Our team evaluated advisories issued by national regulators in Australia, Canada, Denmark, the United Kingdom, and the United States from 2007 to 2016 inclusive, comparing regulators' decisions to warn, effects on prescribing, doctors' awareness and responses to warnings, relevant regulatory policies, and specific case studies. AREAS COVERED Based mainly on our research program and a narrative review, this commentary describes how often regulators issue safety advisories and effects on clinical practice. We found extensive differences in decisions to warn, timing and content of warnings. Monitoring advice is often inadequate. The most systematic estimate suggests an average reduction in prescribing of around 6% compared with settings with no advisory. Interviews with doctors suggest limited awareness, uptake, and at times belief in these warnings. EXPERT OPINION Post-market safety advisories are an important intervention aiming to improve prescribing and use of medicines. However, differing warnings mean that some patients may be exposed to riskier prescribing than others. Better integration of new safety information into clinical practice is needed, as well as improved transparency, independence, and public engagement in regulatory decision-making.
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Affiliation(s)
- Barbara Mintzes
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ellen Reynolds
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Priya Bahri
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands; Pharmacovigilance Office, European Medicines Agency, Amsterdam, the Netherlands
| | - Lucy T Perry
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Alice L Bhasale
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Richard L Morrow
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Colin R Dormuth
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
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Affiliation(s)
- Barbara Mintzes
- School of Pharmacy and Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Colleen Fuller
- Independent Voices for Safe and Effective Drugs, Vancouver, BC, Canada
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Flood L, Mintzes B, Chiu K, Dai Z, Karanges EA, Holman B. Australian Clinical Trial Authors' Declarations of Industry Ties. J Gen Intern Med 2022; 37:3196-3198. [PMID: 35257257 PMCID: PMC9485315 DOI: 10.1007/s11606-022-07466-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/08/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Lorelie Flood
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Barbara Mintzes
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
| | - Kellia Chiu
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Zhaoli Dai
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Emily A Karanges
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Orygen, Melbourne, Australia
| | - Bennett Holman
- Underwood International College, Yonsei University, Incheon, South Korea
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
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20
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Naudet F, Gillibert A, Mintzes B, Braillon A, Cosgrove L. A Mirror-Image Trial or Smoke and Mirrors? Phase 3b Study on Digital Aripiprazole. J Clin Psychiatry 2022; 83. [PMID: 35921513 DOI: 10.4088/jcp.22lr14503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Florian Naudet
- Univ Rennes, CHU Rennes, Inserm, Centre d'Investigation Clinique de Rennes (CIC1414), Service de Pharmacologie Clinique, Institut de Recherche en Santé, Environnement et Travail (Irset), UMR S 1085, EHESP, Rennes, France.,Corresponding author: Florian Naudet, MD, PhD, Clinical Investigation Center (INSERM 1414), University Hospital, 2 rue Henri Le Guilloux, 35000 Rennes, France
| | | | - Barbara Mintzes
- Faculty of Medicine and Health, School of Pharmacy and Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Lisa Cosgrove
- Counseling Psychology Department, Applied Ethics Center, University of Massachusetts-Boston, Boston, Massachusetts
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21
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Kemp-Casey A, Mintzes B, Morrow RL, Dormuth CR, Souverein PC, Roughead EE. Pioglitazone use in Australia and the United Kingdom following drug safety advisories on bladder cancer risk: an interrupted time series study. Pharmacoepidemiol Drug Saf 2022; 31:1039-1045. [PMID: 35790047 PMCID: PMC9546180 DOI: 10.1002/pds.5508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 06/09/2022] [Accepted: 07/01/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE National regulators in Australia and the United Kingdom (UK) issued safety advisories on the association between pioglitazone use and bladder cancer in July 2011. The Australian advisory noted that males were at higher risk of bladder cancer than females, while the UK advisory highlighted a new recommendation, suggest careful consideration in the elderly due to increasing risk with age. This study examined whether these differences in the advisories had different age- and sex-based impacts in each country. METHODS Interrupted time series analysis was used to compare pioglitazone use (prescriptions/100,000 population) in Australia and the UK for the 24 months before and 11 months after the July 2011 safety advisories (study period July 2009-June 2012). Separate models were used to compare use by sex and age group (≥65 years vs. <65 years) in each country. RESULTS Pioglitazone use fell in Australia (17%) and the UK (24%) following the safety advisories. Use of pioglitazone fell more for males (18%) than females (16%) in Australia, and more for females (25%) than males (23%) in the UK; however neither difference was statistically significant (Australia P=0.445, UK P=0.462). Pioglitazone use fell to a similar extent among older people than younger people in the UK (23% vs. 26%, P=0.354), and did not differ between age groups in Australia (both 18%, P=0.772). CONCLUSIONS The results indicate that differences in the Australian and UK safety advisories resulted in substantial reductions in pioglitazone use at the population level in both countries, however, differences by sub-groups were not observed. This article is protected by copyright. All rights reserved.
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22
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Morrow RL, Mintzes B, Souverein PC, Hallgreen CE, Ahmed B, Roughead EE, De Bruin ML, Kristiansen SB, Lexchin J, Kemp-Casey A, Sketris I, Mangin D, Pearson SA, Puil L, Lopert R, Bero L, Gnjidic D, Sarpatwari A, Dormuth CR. Hydroxyzine Initiation Following Drug Safety Advisories on Cardiac Arrhythmias in the UK and Canada: A Longitudinal Cohort Study. Drug Saf 2022; 45:623-638. [PMID: 35438459 PMCID: PMC9189086 DOI: 10.1007/s40264-022-01175-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2022] [Indexed: 12/20/2022]
Abstract
Introduction Regulatory advisories on hydroxyzine and risk of QT prolongation and Torsade de pointes (TdP) were issued in the UK in April 2015 and Canada in June 2016. We hypothesized patients with risk factors for QT prolongation and TdP, compared with those without risk factors, would be less likely to initiate hydroxyzine in the UK and in British Columbia (BC), Canada, following advisories. Methods We conducted a longitudinal study with repeated measures, and evaluated hydroxyzine initiation in a UK cohort and a concurrent BC control cohort (April 2013–March 2016) as well as in a BC advisory cohort (June 2014–May 2017). Results This study included 247,665 patients in the UK cohort, 297,147 patients in the BC control cohort, and 303,653 patients in the BC advisory cohort. Over a 12-month post-advisory period, hydroxyzine initiation decreased by 21% in the UK (rate ratio 0.79, 95% confidence interval 0.66–0.96) relative to the expected level of initiation based on the pre-advisory trend. Hydroxyzine initiation did not change in the BC control cohort or following the Canadian advisory in the BC advisory cohort. The decrease in hydroxyzine initiation in the UK in the 12 months after the advisories was not significantly different for patients with risk factors compared with those without risk factors. Conclusion Hydroxyzine initiation decreased in the UK, but not in BC, in the 12 months following safety advisories. The decrease in hydroxyzine initiation in the UK was not significantly different for patients with versus without risk factors for QT prolongation and TdP. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-022-01175-2.
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Affiliation(s)
- Richard L Morrow
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, 210-1110 Government St., Victoria, BC, V8W 1Y2, Canada.
| | - Barbara Mintzes
- Faculty of Medicine and Health and Charles Perkins Centre, School of Pharmacy, University of Sydney, Sydney, NSW, Australia
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Christine E Hallgreen
- Department of Pharmacy, Faculty of Health and Medical Sciences, Copenhagen Centre for Regulatory Science, University of Copenhagen, Copenhagen, Denmark
| | - Bilal Ahmed
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, 210-1110 Government St., Victoria, BC, V8W 1Y2, Canada
| | - Elizabeth E Roughead
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Marie L De Bruin
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- Department of Pharmacy, Faculty of Health and Medical Sciences, Copenhagen Centre for Regulatory Science, University of Copenhagen, Copenhagen, Denmark
| | - Sarah Brøgger Kristiansen
- Department of Drug Design and Pharmacology, Pharmacovigilance Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Joel Lexchin
- Faculty of Health, York University, Toronto, ON, Canada
| | - Anna Kemp-Casey
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Ingrid Sketris
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Sallie-Anne Pearson
- Faculty of Medicine, Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Lorri Puil
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Ruth Lopert
- Department of Health Policy and Management, George Washington University, Washington, DC, USA
| | - Lisa Bero
- School of Medicine and Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Danijela Gnjidic
- Faculty of Medicine and Health and Charles Perkins Centre, School of Pharmacy, University of Sydney, Sydney, NSW, Australia
| | - Ameet Sarpatwari
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Colin R Dormuth
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, 210-1110 Government St., Victoria, BC, V8W 1Y2, Canada
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23
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Fabbri A, Nejstgaard CH, Grundy Q, Bero L, Dunn AG, Mohammad A, Mintzes B. Association Between Conflicts of Interest and Authors' Positions on Harms of Varenicline: a Cross-Sectional Analysis. J Gen Intern Med 2022; 37:290-297. [PMID: 34037923 PMCID: PMC8811060 DOI: 10.1007/s11606-021-06915-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Few studies have investigated the relationship between industry funding/conflicts of interest and authors' positions in opinion pieces on drug safety. Harmful effects of varenicline, a treatment for smoking cessation, have been highly contested. OBJECTIVE To examine the association between pharmaceutical industry funding/authors' financial conflicts of interest and position on varenicline in opinion articles, especially in relation to the minimization of harms; to assess whether opinion pieces on drug safety issues written by authors with conflicts of interest are more frequently cited in the news or social media. DESIGN Cross-sectional analysis. PARTICIPANTS English language opinion pieces and narrative reviews about varenicline published between May 2006 and February 2019. MAIN MEASURES Odds ratios and 95% confidence intervals; the Mann-Whitney two-sample statistic was used to test for differences in Altmetric scores, a measure of media attention. KEY RESULTS Of the 221 included articles, 30.3% (67) disclosed the funding source and 62.9% (139) disclosed authors' conflicts of interest. Authors of opinion pieces on varenicline who reported financial ties to the pharmaceutical industry (as a conflict of interest or funding source) were more likely to minimise the cardiovascular and psychiatric risk of varenicline compared to those without conflicts of interest or industry funding (OR: 4.00; 95% CI: 1.32 to 12.16 for cardiovascular risk; OR: 8.51; 95% CI: 3.79 to 19.11 for psychiatric risk). These associations persisted in sensitivity analyses. No statistically significant difference in Altmetric score was found between articles with (mean 15.83, median 3) and without (mean 11.90, median 1) conflicts of interest, indicating similar media attention (p-value=0.11). CONCLUSIONS We found that authors with financial ties to drug companies were more likely to publish opinion pieces that minimised harms of varenicline. These results raise questions about journals' editorial policies to accept reviews of treatments from authors with financial relationships with manufacturers.
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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, UK
| | - 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
| | - Quinn Grundy
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.,Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Lisa Bero
- School of Medicine and Colorado School of Public Health, University of Colorado Anschutz Medical Campus, University of Colorado Center for Bioethics and Humanities, Denver, CO, USA
| | - Adam G Dunn
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Annim Mohammad
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Barbara Mintzes
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
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Morrow RL, Mintzes B, Souverein PC, De Bruin ML, Roughead EE, Lexchin J, Kemp-Casey A, Puil L, Sketris I, Mangin D, Hallgreen CE, Pearson SA, Lopert R, Bero L, Ofori-Asenso R, Gnjidic D, Sarpatwari A, Perry LT, Dormuth CR. Influence of drug safety advisories on drug utilisation: an international interrupted time series and meta-analysis. BMJ Qual Saf 2022; 31:179-190. [PMID: 35058332 PMCID: PMC8899478 DOI: 10.1136/bmjqs-2021-013910] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/15/2021] [Indexed: 12/26/2022]
Abstract
Objective To evaluate the association between regulatory drug safety advisories and changes in drug utilisation. Design We conducted controlled, interrupted times series analyses with administrative prescription claims data to estimate changes in drug utilisation following advisories. We used random-effects meta-analysis with inverse-variance weighting to estimate the average postadvisory change in drug utilisation across advisories. Study population We included advisories issued in Canada, Denmark, the UK and the USA during 2009–2015, mainly concerning drugs in common use in primary care. We excluded advisories related to over-the-counter drugs, drug-drug interactions, vaccines, drugs used primarily in hospital and advisories with co-interventions within ±6 months. Main outcome measures Change in drug utilisation, defined as actual versus predicted percentage change in the number of prescriptions (for advisories without dose-related advice), or in the number of defined daily doses (for dose-related advisories), per 100 000 population. Results Among advisories without dose-related advice (n=20), the average change in drug utilisation was −5.83% (95% CI −10.93 to –0.73; p=0.03). Advisories with dose-related advice (n=4) were not associated with a statistically significant change in drug utilisation (−1.93%; 95% CI −17.10 to 13.23; p=0.80). In a post hoc subgroup analysis of advisories without dose-related advice, we observed no statistically significant difference between the change in drug utilisation following advisories with explicit prescribing advice, such as a recommendation to consider the risk of a drug when prescribing, and the change in drug utilisation following advisories without such advice. Conclusions Among safety advisories issued on a wide range of drugs during 2009–2015 in 4 countries (Canada, Denmark, the UK and the USA), the association of advisories with changes in drug utilisation was variable, and the average association was modest.
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Affiliation(s)
- Richard L Morrow
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Barbara Mintzes
- School of Pharmacy, Faculty of Medicine and Health, and Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University Faculty of Science, Utrecht, The Netherlands
| | - Marie L De Bruin
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University Faculty of Science, Utrecht, The Netherlands
| | - Elizabeth Ellen Roughead
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Joel Lexchin
- School of Health Policy & Management, York University, Toronto, Ontario, Canada
| | - Anna Kemp-Casey
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Lorri Puil
- School of Population and Public Health, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Ingrid Sketris
- Dalhousie University, College of Pharmacy, Halifax, Nova Scotia, Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Christine E Hallgreen
- Copenhagen Centre for Regulatory Science, Department of Pharmacy, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Ruth Lopert
- Department of Health Policy and Management, George Washington University, Washington, District of Columbia, USA
| | - Lisa Bero
- School of Medicine and Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Richard Ofori-Asenso
- Copenhagen Centre for Regulatory Science, Department of Pharmacy, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Danijela Gnjidic
- School of Pharmacy, Faculty of Medicine and Health, and Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Ameet Sarpatwari
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lucy T Perry
- School of Pharmacy, Faculty of Medicine and Health, and Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Colin R Dormuth
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
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25
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Morrow RL, Mintzes B, Gray G, Law MR, Garrison S, Dormuth CR. Industry Sponsor Influence in Clinical Trial Reporting in Canada: A Qualitative Interview Study. Clin Ther 2021; 44:374-388. [PMID: 34955232 DOI: 10.1016/j.clinthera.2021.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/06/2021] [Accepted: 11/29/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Approximately 40% of randomized controlled trials are not published, leading to publication bias and less informed clinical decision-making. Qualitative interviews were conducted to understand whether and how industry sponsors of clinical trials of drugs and biologics in Canada influence decisions to report trial results. METHODS Participants eligible for an interview included clinical trial investigators and research coordinators with experience in drug research, research ethics board members with at least 1 year of experience in ethical review of trials, research administrators with knowledge of dissemination of clinical trial findings or relations with trial sponsors, and trial participants who had taken part in a drug trial as an adult in the 5 years before their interview. Semi-structured interviews were held in person or by telephone between March 2019 and April 2021 with participants in Alberta, British Columbia, and Ontario, Canada. Qualitative analysis included coding of interview transcripts and identification of key themes. FINDINGS Interviews were conducted with 34 participants, including 17 clinical trial investigators, 1 clinical research coordinator, 3 research administrators, 3 research ethics board members, and 10 clinical trial participants. Participants involved in the conduct, administration, or ethical review of trials represented a range of medical disciplines. Interview participant accounts indicated that in some cases, industry sponsors influence whether results are reported. A core theme was that companies have a weaker incentive to publish trials with unfavorable findings and trials for products that they have decided not to develop further. Companies may influence reporting in various ways, including stopping trials early and not reporting results of stopped trials, owning and controlling access to data, and negotiating clinical trial agreements in multicenter trials that do not fully protect the ability of investigators to publish. Internal company trials represent an additional source of unpublished trials. More broadly, the research system creates a dependency on funding from industry sponsors that may weaken the ability of researchers and research institutions to negotiate terms with industry sponsors that would fully protect publication rights. IMPLICATIONS Interviews with trial investigators and others connected to trial research indicate that in some cases, industry sponsors of clinical trial research in Canada influence whether results are reported. Policies aiming to bring about full reporting of trials could benefit from considering the commercial incentives of companies and the ways in which industry sponsors may influence clinical trial reporting. Future research could examine the generalizability of these findings to other jurisdictions.
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Affiliation(s)
- Richard L Morrow
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Barbara Mintzes
- Charles Perkins Centre and School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Garry Gray
- Department of Sociology, University of Victoria, Victoria, British Columbia, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott Garrison
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Colin R Dormuth
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
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26
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Mintzes B, Vitry A. 'Drugs to avoid': can we improve prescribing appropriateness? Drug Ther Bull 2021; 59:162. [PMID: 34711643 DOI: 10.1136/dtb.2021.000029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Barbara Mintzes
- Faculty of Medicine and Health, School of Pharmacy and Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia .,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Agnes Vitry
- Clinical and Health Sciences, Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Mintzes B, Bhasale A, Torka M, Lopert R, Pearson SA, Lexchin J, Bero L. A sorry tale of unnecessary secrecy about medicine safety. Intern Med J 2021; 51:1765-1766. [PMID: 34664366 DOI: 10.1111/imj.15513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Barbara Mintzes
- School of Pharmacy and Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alice Bhasale
- School of Pharmacy and Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marc Torka
- Department of Sociology and Social Policy, Faculty of Arts, The University of Sydney, Sydney, New South Wales, Australia
| | - Ruth Lopert
- Faculté de Pharmacie, Université de Strasbourg, Illkirch, France.,Department of Health Policy & Management, George Washington University, Washington, District of Columbia, USA
| | - Sallie-Anne Pearson
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Joel Lexchin
- School of Health Policy & Management, York University, Toronto, Ontario, Canada
| | - Lisa Bero
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
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Abstract
The US Food and Drug Administration (FDA) has approved two drugs for 'hypoactive sexual desire disorder' in women, flibanserin (Addyi) in 2015 and bremelanotide (Vyleesi) in 2019. In this paper we examine the outcome measures and clinical trial data upon which regulatory approval was based. In clinical trials, flibanserin led to an average of only one additional enjoyable sexual experience every two months, bremelanotide to none. Trials for both drugs feature shifts in primary outcomes and a contested indication. A politicised industry-sponsored advocacy campaign and conflicted patient and expert testimony likely influenced flibanserin's approval at its third attempt. Bremelanotide, with even weaker efficacy, capitalised on the regulatory precedent set by the approval of flibanserin. Reconsideration of regulatory decisions to approve these drugs is in order, as well as a broader examination of how future regulatory decisions can better address conflicts of interest and clinically meaningful benefit.
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Affiliation(s)
- Barbara Mintzes
- School of Pharmacy and Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia .,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leonore Tiefer
- Department of Psychiatry, New York School of Medicine, New York, New York, USA
| | - Lisa Cosgrove
- Counseling Psychology Department and Applied Ethics Center, University of Massachusetts Boston, Boston, Massachusetts, USA
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Sharma A, Minh Duc NT, Luu Lam Thang T, Nam NH, Ng SJ, Abbas KS, Huy NT, Marušić A, Paul CL, Kwok J, Karbwang J, de Waure C, Drummond FJ, Kizawa Y, Taal E, Vermeulen J, Lee GHM, Gyedu A, To KG, Verra ML, Jacqz-Aigrain ÉM, Leclercq WKG, Salminen ST, Sherbourne CD, Mintzes B, Lozano S, Tran US, Matsui M, Karamouzian M. A Consensus-Based Checklist for Reporting of Survey Studies (CROSS). J Gen Intern Med 2021; 36:3179-3187. [PMID: 33886027 PMCID: PMC8481359 DOI: 10.1007/s11606-021-06737-1] [Citation(s) in RCA: 467] [Impact Index Per Article: 155.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/17/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Akash Sharma
- University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India.,Online Research Club, Nagasaki, Japan
| | - Nguyen Tran Minh Duc
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Tai Luu Lam Thang
- Online Research Club, Nagasaki, Japan.,Department of Emergency, City's Children Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Hai Nam
- Online Research Club, Nagasaki, Japan.,Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sze Jia Ng
- Online Research Club, Nagasaki, Japan.,Department of Medicine, Crozer Chester Medical Center, Upland, PA, USA
| | - Kirellos Said Abbas
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Nguyen Tien Huy
- Institute of Tropical Medicine (NEKKEN) and School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, 852-8523, Japan.
| | - Ana Marušić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Christine L Paul
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Janette Kwok
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital Hong Kong, Pok Fu Lam, Hong Kong
| | - Juntra Karbwang
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Chiara de Waure
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | | | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University School of Medicine, Hyogo, Japan
| | - Erik Taal
- Department of Psychology, Health & Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Joeri Vermeulen
- Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Department of Health Care, Knowledge Centre Brussels Integrated Care, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium
| | - Gillian H M Lee
- Paediatric Dentistry and Orthodontics, Faculty of Dentistry, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kien Gia To
- Faculty of Public Health, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Martin L Verra
- Department of Physiotherapy, Bern University Hospital, Insel Group, Bern, Switzerland
| | | | - Wouter K G Leclercq
- Department of Surgery, Máxima Medical Center, Veldhoven, Veldhoven, the Netherlands
| | - Simo T Salminen
- Department of Social Psychology, University of Helsinki, Helsinki, Finland
| | | | - Barbara Mintzes
- School of Pharmacy and Charles Perkins Centrey, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sergi Lozano
- School of Economics, University of Barcelona, Barcelona, Spain
| | - Ulrich S Tran
- Department of Cognition, Emotion, and Methods in Psychology, School of Psychology, University of Vienna, Vienna, Austria
| | - Mitsuaki Matsui
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Mohammad Karamouzian
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Abstract
BACKGROUND Each year, the French independent bulletin Prescrire publishes a list of medicines, "Drugs to avoid", that should not be used in clinical practice as their risk-to-benefit ratio is unfavourable. This study assessed the market approval, reimbursement and use of these medicines in Australia. METHODS The approval status of the medicines included in 2019 Prescrire "Drugs to avoid" list was assessed by searching the Australian Register of Therapeutic Goods website. Funding status was assessed on the Pharmaceutical Benefits Scheme (PBS) website, the Australian public insurance system. Use levels were determined by examining governmental reports on prescribing rates including the Australian Statistics on Medicines (ASM) reports, drug use reports released by the Drug Utilisation Sub Committee (DUSC) and PBS statistics. RESULTS Of the 93 medicines included in the Prescrire 2019 "Drug to avoid" list included, 57 (61%) were approved in Australia in 2019 including 9 (16%) that were sold as over-the-counter medicines, 35 (38%) were listed on the PBS, 22 (24%) were registered but not listed on the PBS. Although most of these medicines were used infrequently, 16 (46%) had substantial use despite serious safety concerns. Dipeptidyl peptidase-4 (DPP-4) inhibitors were used by 22% of patients receiving a treatment for diabetes in 2016. More than 50,000 patients received an anti-dementia medicine in 2014, a 19% increase since 2009. Denosumab became the 8th medicine, in terms of total sales, funded by the Australian Government in 2017-2018. CONCLUSIONS Prescrire's assessments provide a reliable external benchmark to assess the current use of medicines in Australia. Sixteen "drugs to avoid", judged to be more harmful than beneficial based on systematic, independent evidence reviews, are in substantial use in Australia. These results raise serious concerns about the awareness of Australian clinicians of medicine safety and efficacy. Medicines safety has become an Australian National Health Priority. Regulatory and reimbursement agencies should review the marketing and funding status of medicines which have not been shown to provide an efficacy and safety at least similar to alternative therapeutic options.
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Affiliation(s)
- Agnes Vitry
- Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.
| | - Barbara Mintzes
- Charles Perkins Centre and School of Pharmacy, University of Sydney, Camperdown, Sydney, Australia
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Lunny C, Ramasubbu C, Puil L, Liu T, Gerrish S, Salzwedel DM, Mintzes B, Wright JM. Over half of clinical practice guidelines use non-systematic methods to inform recommendations: A methods study. PLoS One 2021; 16:e0250356. [PMID: 33886670 PMCID: PMC8062080 DOI: 10.1371/journal.pone.0250356] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/06/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Assessing the process used to synthesize the evidence in clinical practice guidelines enables users to determine the trustworthiness of the recommendations. Clinicians are increasingly dependent on guidelines to keep up with vast quantities of medical literature, and guidelines are followed to avoid malpractice suits. We aimed to assess whether systematic methods were used when synthesizing the evidence for guidelines; and to determine the type of review cited in support of recommendations. METHODS Guidelines published in 2017 and 2018 were retrieved from the TRIP and Epistemonikos databases. We randomly sorted and sequentially screened clinical guidelines on all topics to select the first 50 that met our inclusion criteria. Our primary outcomes were the number of guidelines using either a systematic or non-systematic process to gather, assess, and synthesise evidence; and the numbers of recommendations within guidelines based on different types of evidence synthesis (systematic or non-systematic reviews). If a review was cited, we looked for evidence that it was critically appraised, and recorded which quality assessment tool was used. Finally, we examined the relation between the use of the GRADE approach, systematic review process, and type of funder. RESULTS Of the 50 guidelines, 17 (34%) systematically synthesised the evidence to inform recommendations. These 17 guidelines clearly reported their objectives and eligibility criteria, conducted comprehensive search strategies, and assessed the quality of the studies. Of the 29/50 guidelines that included reviews, 6 (21%) assessed the risk of bias of the review. The quality of primary studies was reported in 30/50 (60%) guidelines. CONCLUSIONS High quality, systematic review products provide the best available evidence to inform guideline recommendations. Using non-systematic methods compromises the validity and reliability of the evidence used to inform guideline recommendations, leading to potentially misleading and untrustworthy results.
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Affiliation(s)
- Carole Lunny
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, Cochrane Hypertension Review Group, Therapeutics Initiative, University of British Columbia, Vancouver, BC, Canada
- * E-mail:
| | - Cynthia Ramasubbu
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, Cochrane Hypertension Review Group, Therapeutics Initiative, University of British Columbia, Vancouver, BC, Canada
| | - Lorri Puil
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, Cochrane Hypertension Review Group, Therapeutics Initiative, University of British Columbia, Vancouver, BC, Canada
| | - Tracy Liu
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, Cochrane Hypertension Review Group, Therapeutics Initiative, University of British Columbia, Vancouver, BC, Canada
| | - Savannah Gerrish
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, Cochrane Hypertension Review Group, Therapeutics Initiative, University of British Columbia, Vancouver, BC, Canada
| | - Douglas M. Salzwedel
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, Cochrane Hypertension Review Group, Therapeutics Initiative, University of British Columbia, Vancouver, BC, Canada
| | - Barbara Mintzes
- Charles Perkins Centre, and School of Pharmacy, The University of Sydney, Camperdown, NSW, Australia
| | - James M. Wright
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, Cochrane Hypertension Review Group, Therapeutics Initiative, University of British Columbia, Vancouver, BC, Canada
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Moore TJ, Morrow RL, Dormuth CR, Mintzes B. US Food and Drug Administration Safety Advisories and Reporting to the Adverse Event Reporting System (FAERS). Pharmaceut Med 2021; 34:135-140. [PMID: 32180152 DOI: 10.1007/s40290-020-00329-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The US Food and Drug Administration (FDA) and other major regulators regularly issue safety advisories about licensed drugs with new adverse effects that have been documented through observational studies, clinical trials, and spontaneously reported adverse drug events. OBJECTIVE To assess the possible effects of a representative group of FDA Drug Safety Communications on the reporting of the specific adverse effect featured in the advisory on new cases reported to the FDA Adverse Event Reporting System (FAERS). METHODS We examined 16 FDA Drug Safety Communications issued from 2010 to 2015 that had not previously been the focus of advisories from regulators in the UK, Canada, or Australia. We compared the reports of the adverse effect in the 8 calendar quarters preceding the advisory and in the 4 quarters following. We measured change in reporting frequency by calculating the event reporting odds ratio (ROR) for the post-warning compared to the pre-warning periods. We defined a credible association of the advisory with increased reporting as a ROR ≥ 2.0 and p value of < 0.05 by Fisher's Exact Test. RESULTS We found statistically significant increased reporting for 4/16 advisories with RORs that ranged from 3.9 to 40.6. Three advisories had smaller but still statistically significant increases that were less than the ROR ≥ 2.0 threshold. For 7 advisories, we found no statistically significant changes in reporting. CONCLUSIONS No consistent pattern or effect was found on spontaneous reporting following these safety advisories. After results were available, we observed that some cases with the largest reporting increase also involved substantial numbers of legal claims. Changes in adverse event reporting following a warning need to be evaluated on a case-by-case basis.
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Affiliation(s)
- Thomas J Moore
- Institute for Safe Medication Practices, 916 Prince Street, Suite 102, Alexandria, VA, 22314, USA.
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, Washington, DC, USA.
| | - Richard L Morrow
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Colin R Dormuth
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Barbara Mintzes
- Faculty of Medicine and Health, University of Sidney Charles Perkins Center and School of Pharmacy, Sydney, Australia
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Mintzes B. Policing the promotion of prescription medicines - the new Medicines Australia Code of Conduct. Aust Prescr 2021; 44:4-5. [PMID: 33664540 PMCID: PMC7900277 DOI: 10.18773/austprescr.2020.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Parker L, Grundy Q, Fabbri A, Mintzes B, Bero L. 'Lines in the sand': an Australian qualitative study of patient group practices to promote independence from pharmaceutical industry funders. BMJ Open 2021; 11:e045140. [PMID: 33563626 PMCID: PMC7875302 DOI: 10.1136/bmjopen-2020-045140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To study how patient groups that accept pharmaceutical industry money perceive and manage the risk of undue influence from their sponsors. DESIGN Empirical ethics approach using a qualitative interview study. SETTING The Australian patient group sector. PARTICIPANTS 27 participants from 23 patient groups, purposively recruited for diversity of group characteristics (degree of pharmaceutical industry funding, health focus, location) and participant role (staff, board members). ANALYSIS Interview data were transcribed and read repeatedly to identify concepts and patterns in the data. These were grouped into conceptual categories that described and explained the findings. We used an inductive analytical approach to identify important themes and concepts in the data. RESULTS Participants in this study described how the patient group sector receives pressure from pharmaceutical company funders to act in ways that prioritise company interests. Groups worked to try and protect their credibility and ability to act in ways of their own choosing using practical rules or 'lines in the sand' about industry funding activities. They were grouped around the dominant topics of: sponsor exclusivity, brand marketing, agenda setting, advocacy and content of group activities. Lines in the sand were largely experience-driven and ethically informed; they varied between groups. There was also variable transparency among groups about financial interactions with pharmaceutical companies. CONCLUSIONS It is important to know about patient group practices around pharmaceutical industry funders as this allows public scrutiny about the adequacy of such practices. Inadequate strategies may mean that funders can influence patient groups activities in ways that do not necessarily prioritise the interests of members. We found that groups differed in their approach, with little independent external guidance to inform responses to commonly encountered types of influence. Inadequate transparency limits the ability of the public to make informed assessments about the risk of bias over the activities of groups that accept industry funding.
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Affiliation(s)
- Lisa Parker
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Quinn Grundy
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Alice Fabbri
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Barbara Mintzes
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Bero
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Hooimeyer A, Bhasale A, Perry L, Fabbri A, Mohammad A, McEwin E, Mintzes B. Regulatory post-market drug safety advisories on cardiac harm: A comparison of four national regulatory agencies. Pharmacol Res Perspect 2020; 8:e00680. [PMID: 33169534 PMCID: PMC7652786 DOI: 10.1002/prp2.680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/17/2020] [Accepted: 09/19/2020] [Indexed: 11/26/2022] Open
Abstract
Information on rare adverse effects is often limited when a medication is initially approved for marketing. Medicines regulators use safety advisories to warn health professionals and consumers about emerging harms. This study aimed to identify characteristics and advice provided in cardiac safety advisories released by regulators in Australia, Canada, the United Kingdom, and the United States. This was a retrospective study of safety advisories about cardiac-related adverse events issued by these four international medicines regulators between 2010 and 2016. A descriptive overview was followed by a more detailed content analysis, focusing on recommended actions for health professionals, including monitoring advice. For the latter, we applied the systematic information for monitoring (SIM) scale to assess adequacy. Over this period, 164 safety advisories about cardiac harms were issued by the four regulators. There were 61 drugs with advisories of cardiac risk, only 9 (14.7%) of which had advisories from all regulators in countries where the drug was approved. The most common adverse events were cardiac arrhythmias (n = 97, 59.1%) and coronary artery disorders (n = 39, 23.8%). The most frequent advice to prescribers was to monitor patients (n = 74, 45.1%), although only 41.2% of these advisories provided detailed advice on how monitoring should occur. We found many differences in the decision to warn and the advice provided. Patient monitoring was most often recommended, but key information such as frequency or thresholds for action was often lacking. Healthcare professionals and consumers need consistent information about rare serious harms so that they can make informed decisions.
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Affiliation(s)
- Ashleigh Hooimeyer
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Alice Bhasale
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Lucy Perry
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Alice Fabbri
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
- Centre for Evidence‐Based Medicine Odense (CEBMO)Odense University Hospital and University of Southern DenmarkOdenseDenmark
| | - Annim Mohammad
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Eliza McEwin
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Barbara Mintzes
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
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Mintzes B, Lexchin J. The "Nuts and Bolts" of Opioid Marketing: Promotional Messages to Family Doctors in Sacramento, Vancouver, Montreal, and Toulouse. J Gen Intern Med 2020; 35:3730-3732. [PMID: 32043257 PMCID: PMC7728976 DOI: 10.1007/s11606-019-05584-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/25/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Barbara Mintzes
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia.
| | - Joel Lexchin
- School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada
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37
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Parker L, Bennett A, Mintzes B, Grundy Q, Fabbri A, Karanges EA, Bero L. "There are ways … drug companies will get into DTC decisions": How Australian drug and therapeutics committees address pharmaceutical industry influence. Br J Clin Pharmacol 2020; 87:2341-2353. [PMID: 33129226 DOI: 10.1111/bcp.14636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/17/2020] [Accepted: 10/23/2020] [Indexed: 12/28/2022] Open
Abstract
AIMS One tool for protecting quality use of medicines in hospitals is a drug and therapeutics committee (DTC) that oversees medicines availability. Pharmaceutical industry marketing to prescribers is associated with less appropriate prescribing and increased costs. There is little data on decision-making practices of DTCs so it is unknown whether or how they might be vulnerable to pharmaceutical industry influence. This project explores DTC decision-making with a focus on how pharmaceutical industry influence on access and use of medicines is identified and managed. METHODS We used a qualitative methodology with individual interviews of 29 participants who were current or recent members of public hospital DTCs across New South Wales, Australia. Participants included medical, pharmacy and nursing staff and 1 citizen. Committees were linked to specific hospitals or regions, and some were affiliated with paediatric, neonatal, rural or mental health services. RESULTS Drug committee processes for oversight of medicines in public hospitals are vulnerable to pharmaceutical industry influence at several points. Applications for formulary additions are sometimes initiated and completed by company representatives. Conflict of interest disclosures among applicants and committee members may be incomplete. In some institutions, medicines are available from pharmaceutical companies without committee review, including through free samples and industry-supported medicines access programmes. Participants noticed the presence and impact of pharmaceutical company marketing activities to local clinicians, resulting in increased prescriber demand for products. CONCLUSION Improved DTC practices and review of hospital policies concerning pharmaceutical marketing activities might preserve the independence of evidence-based decision-making for safe, cost-effective prescribing.
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Affiliation(s)
- Lisa Parker
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine & Health, The University of Sydney, Australia
| | | | - Barbara Mintzes
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine & Health, The University of Sydney, Australia
| | - Quinn Grundy
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine & Health, The University of Sydney, Australia.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada
| | - Alice Fabbri
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine & Health, The University of Sydney, Australia.,Centre for Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, University of Southern Denmark, Denmark
| | - Emily A Karanges
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine & Health, The University of Sydney, Australia.,Centre for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia.,Orygen, Melbourne, Australia
| | - Lisa Bero
- University of Colorado Center for Bioethics and Humanities, School of Medicine and Colorado School of Public Health, University of Colorado Anschutz Medical Campus, USA
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38
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Lau E, Fabbri A, Mintzes B. How do health consumer organisations in Australia manage pharmaceutical industry sponsorship? A cross-sectional study. AUST HEALTH REV 2020; 43:474-480. [PMID: 30021681 DOI: 10.1071/ah17288] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/09/2018] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to investigate how health consumer organisations manage their relationships with the pharmaceutical industry in Australia. Methods We identified 230 health consumer organisations that received pharmaceutical industry support from 2013 to 2016 according to reports published by Medicines Australia, the industry trade association. A random sample of 133 organisations was selected and their websites assessed for financial transparency, policies governing corporate sponsorship and evidence of potential industry influence. Results In all, 130 of the 133 organisations evaluated received industry funding. Of these 130, 68 (52.3%; 95% confidence interval (CI) 43.4-61.1%) disclosed this funding. Nearly all (67; 98.5%) reported the identity of their industry donors, followed by uses (52.9%), amount (13.2%) and proportion of income from industry (4.4%). Less than one-fifth (24/133; 18.0%; 95% CI 11.9-25.6%) had publicly available policies on corporate sponsorship. Six organisations (7.2%; 95% CI 2.7-15.1%) had board members that were currently or previously employed by pharmaceutical companies, and 49 (36.8%; 95% CI 28.6-45.6%) had company logos, web links or advertisements on their websites. Conclusion Industry-funded health consumer organisations in Australia have low transparency when reporting industry funding and few have policies governing corporate sponsorship. Relationships between health consumer organisations and the industry require effective actions to minimise the risks of undue influence. What is known about this topic? Pharmaceutical industry funding of health consumer organisations is common in the US and Europe, yet only a minority of such organisations publicly disclose this funding and have policies regulating their relationships with industry. What does this paper add? Industry-funded health consumer organisations in Australia have inadequate financial transparency and rarely have policies addressing corporate funding. Organisations that have received more industry funding are more likely to report it publicly. What are the implications for practitioners? Robust policies addressing corporate sponsorship and increased transparency are needed to maintain the independence of health consumer organisations. Governments may also consider regulating non-profit organisations to ensure public reporting of funding sources.
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Affiliation(s)
- Edith Lau
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, John Hopkins Drive, Camperdown, NSW 2006, Australia.
| | - Alice Fabbri
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, John Hopkins Drive, Camperdown, NSW 2006, Australia.
| | - Barbara Mintzes
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, John Hopkins Drive, Camperdown, NSW 2006, Australia.
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Lunny C, Salzwedel DM, Mintzes B, Puil L, Liu T, Ramasubbu C, Gerrish S, Wright JM. Reply to Kelly Farrah and David Kaunelis regarding our study "Validation of five search filters for retrieval of clinical practice guidelines produced low precision". J Clin Epidemiol 2020; 133:156-157. [PMID: 33031933 DOI: 10.1016/j.jclinepi.2020.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/22/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Carole Lunny
- Department of Anesthesiology, Pharmacology and Therapeutics, Cochrane Hypertension Review Group, Therapeutics Initiative, Faculty of Medicine, University of British Columbia, 2176 Health Science Mall, Vancouver, BC, Canada, V6T 1Z3.
| | - Douglas M Salzwedel
- Department of Anesthesiology, Pharmacology and Therapeutics, Cochrane Hypertension Review Group, Therapeutics Initiative, Faculty of Medicine, University of British Columbia, 2176 Health Science Mall, Vancouver, BC, Canada, V6T 1Z3
| | - Barbara Mintzes
- The University of Sydney, Charles Perkins Centre, and School of Pharmacy, 6W75, The Hub, Sydney, New South Wales, 2006
| | - Lorri Puil
- Department of Anesthesiology, Pharmacology and Therapeutics, Cochrane Hypertension Review Group, Therapeutics Initiative, Faculty of Medicine, University of British Columbia, 2176 Health Science Mall, Vancouver, BC, Canada, V6T 1Z3
| | - Tracy Liu
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2176 Health Science Mall, Vancouver, BC, Canada, V6T 1Z3
| | - Cynthia Ramasubbu
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2176 Health Science Mall, Vancouver, BC, Canada, V6T 1Z3
| | - Savannah Gerrish
- Department of Anesthesiology, Pharmacology and Therapeutics, Cochrane Hypertension Review Group, Therapeutics Initiative, Faculty of Medicine, University of British Columbia, 2176 Health Science Mall, Vancouver, BC, Canada, V6T 1Z3
| | - James M Wright
- Department of Anesthesiology, Pharmacology and Therapeutics, Cochrane Hypertension Review Group, Therapeutics Initiative, Faculty of Medicine, University of British Columbia, 2176 Health Science Mall, Vancouver, BC, Canada, V6T 1Z3
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Fabbri A, Parker L, Colombo C, Mosconi P, Barbara G, Lau E, Kroeger CM, Lunny C, Salzwedel DM, Mintzes B. Industry funding of patient groups: a systematic review. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patient groups play an important role in health care and policy. Concerns have been raised about the financial ties between the pharmaceutical industry and patient groups, because of potential threats to the groups' independence. We conducted a systematic review to synthesise studies that explored pharmaceutical or medical device industry funding of patient groups.
Methods
We searched Medline, Embase, Web of Science, Scopus and Google Scholar (from inception to January 2018). We included observational studies reporting at least one of the following outcomes: prevalence of industry funding; proportion of industry funded patient groups which disclosed information about this funding; association between industry funding and organisational positions on health and policy issues. We carried out duplicate independent data extraction and assessed study quality.
Results
26 cross-sectional studies were included. Fifteen studies assessed the prevalence of industry funding, which ranged from 20% (12/61) to 83% (86/104). The proportion of patient groups which disclosed funding information on their websites was low (27% [95% CI: 24%-31%]). Few patient groups had formal policies governing corporate sponsorship (range from 2% (2/125) to 64% (175/274)). Among the few studies examining funding status versus organisational position, industry sponsored groups tend to hold positions consistent with sponsors' interests.
Conclusions
We found widespread indications of industry funding of patient groups. Transparency of funding is inadequate and the prevalence of policies governing corporate sponsorship is low. Research on policy impact is still limited. Considering the important role that patient groups play in health, strategies to prevent biases that may favour commercial interests above those of patients need to be implemented.
Key messages
Industry funding of patient groups is common in high income countries. Transparency of funding is inadequate and the prevalence of policies governing corporate sponsorship is low. Considering the important role that patient groups play in health care and policy, strategies to prevent biases that may favour commercial interests above those of patients need to be implemented.
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Affiliation(s)
- A Fabbri
- Centre for Evidence Based Medicine, University of Southern Denmark, Odense, Denmark
- Charles Perkins Centre and School of Pharmacy, The University of Sydney, Sydney, Australia
| | - L Parker
- Charles Perkins Centre and School of Pharmacy, The University of Sydney, Sydney, Australia
| | - C Colombo
- Laboratory of Medical Research on Consumer Involvement, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - P Mosconi
- Laboratory of Medical Research on Consumer Involvement, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - G Barbara
- Gynaecology Unit, IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - E Lau
- Charles Perkins Centre and School of Pharmacy, The University of Sydney, Sydney, Australia
| | - C M Kroeger
- Charles Perkins Centre and School of Pharmacy, The University of Sydney, Sydney, Australia
| | - C Lunny
- Cochrane Hypertension Review Group, University of British Columbia, Vancouver, Canada
| | - D M Salzwedel
- Cochrane Hypertension Review Group, University of British Columbia, Vancouver, Canada
| | - B Mintzes
- Charles Perkins Centre and School of Pharmacy, The University of Sydney, Sydney, Australia
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Perry LT, Bhasale A, Fabbri A, Lexchin J, Puil L, Joarder M, Mintzes B. A descriptive analysis of medicines safety advisories issued by national medicines regulators in Australia, Canada, the United Kingdom and the United States ‐ 2007 to 2016. Pharmacoepidemiol Drug Saf 2020; 29:1054-1063. [DOI: 10.1002/pds.5072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/19/2020] [Accepted: 06/05/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Lucy T. Perry
- School of Pharmacy, Faculty of Medicine and Health, and Charles Perkins Centre University of Sydney Sydney New South Wales Australia
| | - Alice Bhasale
- School of Pharmacy, Faculty of Medicine and Health, and Charles Perkins Centre University of Sydney Sydney New South Wales Australia
| | - Alice Fabbri
- School of Pharmacy, Faculty of Medicine and Health, and Charles Perkins Centre University of Sydney Sydney New South Wales Australia
- Centre for Evidence Based Medicine Odense Odense University Hospital and University of Southern Denmark Odense Denmark
| | - Joel Lexchin
- School of Health Policy & Management, Faculty of Health York University Toronto Ontario Canada
| | - Lorri Puil
- Department of Anaesthesiology, Pharmacology & Therapeutics, Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Maisah Joarder
- School of Pharmacy, Faculty of Medicine and Health, and Charles Perkins Centre University of Sydney Sydney New South Wales Australia
| | - Barbara Mintzes
- School of Pharmacy, Faculty of Medicine and Health, and Charles Perkins Centre University of Sydney Sydney New South Wales Australia
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Affiliation(s)
- Alice Bhasale
- University of Sydney Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, 6W75, The Hub, Charles Perkins Centre D17, University of Sydney, NSW 2006, Australia
| | - Barbara Mintzes
- University of Sydney Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, 6W75, The Hub, Charles Perkins Centre D17, University of Sydney, NSW 2006, Australia
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Ameet Sarpatwari
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
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Fabbri A, O'Keeffe M, Moynihan R, Møllebaek M, Mohammad A, Bhasale A, Puil L, Mintzes B. Media coverage of drug regulatory agencies' safety advisories: A case study of citalopram and denosumab. Br J Clin Pharmacol 2020; 86:1416-1429. [PMID: 32067255 DOI: 10.1111/bcp.14255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/16/2020] [Accepted: 02/01/2020] [Indexed: 11/30/2022] Open
Abstract
AIMS Drug regulators issue safety advisories to warn clinicians and the public about new evidence of harmful effects of medicines. It is unclear how often these messages are covered by the media. Our aim was to analyse the extent of media coverage of two medicines that were subject to safety advisories from 2007 to 2016 in Australia, Canada, the United Kingdom and the United States. METHODS Two medicines widely used to treat mental health or physical conditions were selected: citalopram and denosumab. Media reports were identified by searching LexisNexis and Factiva. Reports were included if they stated at least one health benefit or harm. A content analysis of the reports was conducted. RESULTS In total, 195 media reports on citalopram and 239 on denosumab were included. For citalopram, 43.1% (84/195) of the reports mentioned benefits, 85.6% (167/195) mentioned harms and 9.7% (19/195) mentioned the harm described in the advisories (cardiac arrhythmia). For denosumab, 94.1% (225/239) of the reports mentioned benefits and 39.7% (95/239) mentioned harms. The harms described in the advisories were rarely mentioned: 10.9% (26/239) of the reports mentioned osteonecrosis and ≤5% mentioned any of the other harms (atypical fractures, hypocalcaemia, serious infections and dermatologic reactions). CONCLUSIONS We found limited media coverage of the harms highlighted in safety advisories. Almost two-thirds of the media stories on denosumab did not include any information about harms, despite the many advisories during this time frame. Citalopram coverage covered harms more often but rarely mentioned cardiac arrhythmias. These findings raise questions about how to better ensure that regulatory risk communications reach the general public.
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Affiliation(s)
- Alice Fabbri
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mary O'Keeffe
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ray Moynihan
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mathias Møllebaek
- Copenhagen Centre for Regulatory Science, Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Annim Mohammad
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alice Bhasale
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lorri Puil
- Department of Anaesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - 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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Hanley GE, Miller T, Mintzes B. A Cohort Study of Psychotropic Prescription Drug Use in Pregnancy in British Columbia, Canada from 1997 to 2010. J Womens Health (Larchmt) 2020; 29:1339-1349. [PMID: 32176573 DOI: 10.1089/jwh.2019.8199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background: Psychiatric conditions are relatively common during pregnancy, and many of these conditions are treated with psychotropic medications. In this article, we aim to quantify the rate of pregnancy-related exposures and describe how psychotropic medications are being used in pregnancy. Materials and Methods: We conducted a retrospective cohort study of all pregnancies ending in a live birth in the Canadian province of British Columbia between January 1, 1997 and December 31, 2010. We examined antipsychotic, anxiolytic, antidepressant, and stimulants use during pregnancy. We describe use of these medications across the pregnancy period, in terms of incident and prevalent use in pregnancy and whether women had corresponding diagnoses for mental health conditions. Results: We included 424,307 pregnancies, of whom 7.1% were dispensed a psychotropic medication. The most commonly used psychotropic medications were antidepressants (4.2%) followed by anxiolytics (3.4%). Among psychotropic medication users, the most commonly associated psychiatric diagnosis was major depressive disorder (43.2%) followed by anxiety (15.8%) and adjustment reaction and/or acute stress (15.8%). The majority of antidepressant use was prevalent (continued from preconception period), whereas most anxiolytic use was incident (no prescriptions in the 6 months before conception). Conclusions: The relatively high rate of use of psychotropic drugs in this cohort, and the existence of effective alternative treatments for the commonly treated conditions suggests a need to improve access to nondrug options before and during pregnancy. The finding that fewer women are discontinuing their antidepressants during pregnancy should be further investigated.
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Affiliation(s)
- Gillian E Hanley
- Department of Obstetrics & Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, University of British Columbia, Vancouver, Canada
| | - Tarita Miller
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, Canada
| | - Barbara Mintzes
- Faculty of Pharmacy and Charles Perkins Centre, The University of Sydney, Sydney, Australia
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Mintzes B, Fabbri A, Grundy Q, Spurling GKP, Lexchin J, McKenzie JE, Bero L. Information and promotional strategies by pharmaceutical companies for clinicians. Hippokratia 2020. [DOI: 10.1002/14651858.cd013423.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Barbara Mintzes
- The University of Sydney; Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health; Camperdown, Sydney NSW Australia 2006
| | - Alice Fabbri
- The University of Sydney; Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health; Camperdown, Sydney NSW Australia 2006
| | - Quinn Grundy
- University of Toronto; Lawrence S. Bloomberg Faculty of Nursing; 155 College Street Suite 130 Toronto ON Canada M5T 1P8
| | - Geoffrey KP Spurling
- The University of Queensland; Discipline of General Practice, School of Medicine; Herston Brisbane Queensland Australia 4029
| | - Joel Lexchin
- York University; School of Health Policy and Management; 121 Walmer Rd Toronto ON Canada M5R 2X8
| | - Joanne E McKenzie
- Monash University; School of Public Health & Preventive Medicine; 553 St Kilda Road Melbourne Victoria Australia 3004
| | - Lisa Bero
- The University of Sydney; Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health; Camperdown, Sydney NSW Australia 2006
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Affiliation(s)
- Paula Byrne
- J E Cairnes School of Business and Economics, National University of Ireland Galway, Galway, Ireland
| | - John Cullinan
- J E Cairnes School of Business and Economics, National University of Ireland Galway, Galway, Ireland
| | - Barbara Mintzes
- School of Pharmacy and Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Susan M Smith
- HRB Centre for Primary Care Research and Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
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Fabbri A, Parker L, Colombo C, Mosconi P, Barbara G, Frattaruolo MP, Lau E, Kroeger CM, Lunny C, Salzwedel DM, Mintzes B. Industry funding of patient and health consumer organisations: systematic review with meta-analysis. BMJ 2020; 368:l6925. [PMID: 31969320 PMCID: PMC7190040 DOI: 10.1136/bmj.l6925] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate pharmaceutical or medical device industry funding of patient groups. DESIGN Systematic review with meta-analysis. DATA SOURCES Ovid Medline, Embase, Web of Science, Scopus, and Google Scholar from inception to January 2018; reference lists of eligible studies and experts in the field. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Observational studies including cross sectional, cohort, case-control, interrupted time series, and before-after studies of patient groups reporting at least one of the following outcomes: prevalence of industry funding; proportion of industry funded patient groups that disclosed information about this funding; and association between industry funding and organisational positions on health and policy issues. Studies were included irrespective of language or publication type. REVIEW METHODS Reviewers carried out duplicate independent data extraction and assessment of study quality. An amended version of the checklist for prevalence studies developed by the Joanna Briggs Institute was used to assess study quality. A DerSimonian-Laird estimate of single proportions with Freeman-Tukey arcsine transformation was used for meta-analyses of prevalence. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) was used to assess the quality of the evidence for each outcome. RESULTS 26 cross sectional studies met the inclusion criteria. Of these, 15 studies estimated the prevalence of industry funding, which ranged from 20% (12/61) to 83% (86/104). Among patient organisations that received industry funding, 27% (175/642; 95% confidence interval 24% to 31%) disclosed this information on their websites. In submissions to consultations, two studies showed very different disclosure rates (0% and 91%), which appeared to reflect differences in the relevant government agency's disclosure requirements. Prevalence estimates of organisational policies that govern corporate sponsorship ranged from 2% (2/125) to 64% (175/274). Four studies analysed the relationship between industry funding and organisational positions on a range of highly controversial issues. Industry funded groups generally supported sponsors' interests. CONCLUSION In general, industry funding of patient groups seems to be common, with prevalence estimates ranging from 20% to 83%. Few patient groups have policies that govern corporate sponsorship. Transparency about corporate funding is also inadequate. Among the few studies that examined associations between industry funding and organisational positions, industry funded groups tended to have positions favourable to the sponsor. Patient groups have an important role in advocacy, education, and research, therefore strategies are needed to prevent biases that could favour the interests of sponsors above those of the public. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017079265.
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Affiliation(s)
- Alice Fabbri
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW 2006, Australia
| | - Lisa Parker
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW 2006, Australia
| | - Cinzia Colombo
- Laboratory of Medical Research on Consumer Involvement, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Paola Mosconi
- Laboratory of Medical Research on Consumer Involvement, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Giussy Barbara
- Gynaecology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Pina Frattaruolo
- Gynaecology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Edith Lau
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW 2006, Australia
| | - Cynthia M Kroeger
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW 2006, Australia
| | - Carole Lunny
- Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Douglas M Salzwedel
- Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Barbara Mintzes
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW 2006, Australia
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Lunny C, Ramasubbu C, Gerrish S, Liu T, Salzwedel DM, Puil L, Mintzes B, Wright JJ. Impact and use of reviews and 'overviews of reviews' to inform clinical practice guideline recommendations: protocol for a methods study. BMJ Open 2020; 10:e031442. [PMID: 31964662 PMCID: PMC7044835 DOI: 10.1136/bmjopen-2019-031442] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Guidelines are systematically developed recommendations to assist practitioner and patient decisions about treatments for clinical conditions. High quality and comprehensive systematic reviews and 'overviews of systematic reviews' (overviews) represent the best available evidence. Many guideline developers, such as the WHO and the Australian National Health and Medical Research Council, recommend the use of these research syntheses to underpin guideline recommendations. We aim to evaluate the impact and use of systematic reviews with and without pairwise meta-analysis or network meta-analyses (NMAs) and overviews in clinical practice guideline (CPG) recommendations. METHODS AND ANALYSIS CPGs will be retrieved from Turning Research Into Practice and Epistemonikos (2017-2018). The retrieved citations will be sorted randomly and then screened sequentially by two independent reviewers until 50 CPGs have been identified. We will include CPGs that provide at least two explicit recommendations for the management of any clinical condition. We will assess whether reviews or overviews were cited in a recommendation as part of the development process for guidelines. Data extraction will be done independently by two authors and compared. We will assess the risk of bias by examining how each guideline developed clinical recommendations. We will calculate the number and frequency of citations of reviews with or without pairwise meta-analysis, reviews with NMAs and overviews, and whether they were systematically or non-systematically developed. Results will be described, tabulated and categorised based on review type (reviews or overviews). CPGs reporting the use of the Grading of Recommendations, Assessment, Development and Evaluation approach will be compared with those using a different system, and pharmacological versus non-pharmacological CPGs will be compared. ETHICS AND DISSEMINATION No ethics approval is required. We will present at the Cochrane Colloquium and the Guidelines International Network conference.
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Affiliation(s)
- Carole Lunny
- Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cynthia Ramasubbu
- Faculty of Pharmacy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Savannah Gerrish
- Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tracy Liu
- Faculty of Pharmacy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Douglas M Salzwedel
- Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lorri Puil
- Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Barbara Mintzes
- Faculty of Pharmacy and Charles Perkins Centre, University of Sydney Faculty of Health Sciences, The University of Sydney, New South Wales, Australia
| | - James Jim Wright
- Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Lunny C, Salzwedel DM, Liu T, Ramasubbu C, Gerrish S, Puil L, Mintzes B, Wright JM. Validation of five search filters for retrieval of clinical practice guidelines produced low precision. J Clin Epidemiol 2020; 117:109-116. [DOI: 10.1016/j.jclinepi.2019.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/31/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
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50
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Puil L, Lexchin J, Bero L, Mangin D, Hallgreen CE, Wong GWK, Mintzes B. The impact of post-market regulatory safety advisories on patients, prescribers, and the healthcare system. Hippokratia 2019. [DOI: 10.1002/14651858.cd013510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Lorri Puil
- University of British Columbia; Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine; 2176 Health Sciences Mall Vancouver BC Canada V6T 1Z3
| | - Joel Lexchin
- York University; School of Health Policy and Management; 121 Walmer Rd Toronto ON Canada M5R 2X8
| | - Lisa Bero
- The University of Sydney; Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health; D17, 6th floor, Charles Perkins Centre, , The University of Sydney
- NSW
- 2006 Camperdown, Sydney NSW Australia 2006
| | - Dee Mangin
- McMaster University; Family Medicine; Hamilton Canada
| | - Christine E Hallgreen
- University of Copenhagen; Copenhagen Centre for Regulatory Science (CORS), Department of Pharmacy, Faculty of Health and Medical Sciences; Universitetsparken 2 Copenhagen Denmark 2100
| | - Gavin WK Wong
- University of British Columbia; Centre for Clinical Epidemiology and Evaluation; 828 West 10th Avenue Vancouver British Columbia Canada V5Z 1M9
| | - Barbara Mintzes
- The University of Sydney; Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health; D17, 6th floor, Charles Perkins Centre, , The University of Sydney
- NSW
- 2006 Camperdown, Sydney NSW Australia 2006
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