Key opinion leaders - a critical perspective

Enormous progress has been made in the field of rheumatology in the past several decades, historically led by publicly funded academic innovators but in more recent times with much greater involvement of the pharmaceutical industry. This shift in resources has created a complex new model for reinvestment in the medical community in which the vast majority of private funds are redirected towards influencing the prescription behaviour of practitioners through 'key opinion leaders', with the main purpose of enhancing and perpetuating profit rather than innovation and critical thinking, and often at the expense of partnerships with scientists (that is, basic and translational researchers) and academic collaborations. This new episteme brings multiple opportunities to rethink approaches to sustaining long-term critical research in the field, ultimately maximizing the return on investment: scientific knowledge for the benefit of patients and society. Central to such strategies should be the rebalancing of academia-industry partnerships towards academic research and the involvement of 'innovation and knowledge leaders', rather than mostly key opinion leaders.

Gender inequality in leadership and academic rank in academic reproductive endocrinology programs

PURPOSE

To identify gender differences in leadership and academic rank within academic reproductive endocrinology (REI) programs with fellowships in the USA.

METHODS

Official institutional websites of the 2017-2018 American Board of Obstetrics and Gynecology (ABOG)-accredited reproductive endocrinology fellowship programs were reviewed, and gender representation at each leadership position and academic rank (Division and Fellowship Director and Full, Associate, and Assistant Professor) was recorded. Univariate comparisons were performed using Chi-square tests, with significance at p < 0.05.

RESULTS

Among 49 ABOG-accredited reproductive endocrinology programs, 263 faculty were identified, 129 (49.0%) male and 134 (51.0%) female. Division directors were 69.3% male and 30.7% female (p = 0.006). Similarly, fellowship directors were 65.3% male and 34.6% female (p = 0.03). Full professors (n = 101) were more frequently male (70.3% vs. 29.7%, p < 0.001). There was no difference in gender among associate professors (n = 60, 51.7% male vs. 48.3% female, p = 0.79), while significantly more assistant professors were female than male (n = 102, 73.6% vs. 26.4%, p < 0.001).

CONCLUSION

While a majority of residents in obstetrics and gynecology and half of reproductive endocrinology academic faculty are female, women are still underrepresented among leadership positions and full professors in academic reproductive endocrinology programs with fellowship programs.

[Scientific and Academic Integrity in Portugal: A National Enterprise]

N/a.

LeRoy Walters's Legacy of Bioethics in Genetics and Biotechnology Policy

LeRoy Walters was at the center of public debate about emerging biological technologies, even as "biotechnology" began to take root. He chaired advisory panels on human gene therapy, the human genome project, and patenting DNA for the congressional Office of Technology Assessment. He chaired the subcommittee on Human Gene Therapy for NIH's Recombinant DNA Advisory Committee. He was also a regular advisor to Congress, the executive branch, and academics concerned about policy governing emerging biotechnologies. In large part due to Prof. Walters, the Kennedy Institute of Ethics was one of the primary sources of talent in bioethics, including staff who populated policy and science agencies dealing with reproductive and genetic technologies, such as NIH and OTA. His legacy lies not only in his writings, but in those people, documents, and discussions that guided biotechnology policy in the United States for three decades.

An audit to evaluate an institute's lead researchers' knowledge of trial registries and to investigate adherence to data transparency issues in an Italian research institute registry

BACKGROUND

Clinical trial registries have been a priority topic in the past few years in promoting data transparency and accountability. In this context, in 2011, the IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri" set up a registry to collect data on all studies in which the institute's researchers are involved. In this study we present a self-audit in order to detect the lead researchers' general knowledge on registries, the completeness and quality of the randomized controlled trial (RCT) data inputted in an Italian research institute's registry, and the researchers' adherence to both registration requirements and the institute transparency goal, aiming to improve standards and leading to greater awareness of the issues involved.

METHODS

A questionnaire-based audit was conducted. To interview researchers we included questions ranging from general knowledge on registries (e.g., what are the aims of registries?) to questions about their knowledge of the Mario Negri's registry, questions on selected trials and registration, included information on the protocol, and the results.

RESULTS

The audit sample covers 12 of the 47 RCTs at the institute's Milan branch, representing all the possible lead researchers responsible for RCTs at the institute. The researchers have more than a basic knowledge of trial registries and their aims. All the researchers reported that they know of the ClinicalTrials.gov registry and most of them reported that they frequently use it; however, only a few know about the World Health Organization's registry platform (International Clinical Trials Registry Platform). The most cited registry aims reported were increased transparency and reduced publication bias. Of the studies registered in the institute's registry, 92% had at least one data item missing in the registry record. Concerning trial registration in the international registries, all 12 respondents said their trial had been registered and specified the registry name, but often they had not inputted the associated trial ID code in the corresponding field of the institute's registry. Concerning two important issues on data transparency and ethical standards, namely registration timing and result reporting, 11 stated that their trial was registered before starting recruitment, and for five of six closed trials they stated that their results have been already published-for one trial within 1 year after its completion.

CONCLUSIONS

Researchers should guarantee correct reporting of trials and their data as a rule of great ethical value. Institutional self-audits should be performed periodically in order to improve clinical trial disclosure.

Last name analysis of mobility, gender imbalance, and nepotism across academic systems

In biology, last names have been used as proxy for genetic relatedness in pioneering studies of neutral theory and human migrations. More recently, analyzing the last name distribution of Italian academics has raised the suspicion of nepotism, with faculty hiring their relatives for academic posts. Here, we analyze three large datasets containing the last names of all academics in Italy, researchers from France, and those working at top public institutions in the United States. Through simple randomizations, we show that the US academic system is geographically well-mixed, whereas Italian academics tend to work in their native region. By contrasting maiden and married names, we can detect academic couples in France. Finally, we detect the signature of nepotism in the Italian system, with a declining trend. The claim that our tests detect nepotism as opposed to other effects is supported by the fact that we obtain different results for the researchers hired after 2010, when an antinepotism law was in effect.

Trustworthy Research Institutions: The Challenging Case of Studying the Genetics of Intelligence

It is simple enough to claim that academic research institutions ought to be trustworthy. Building the culture and taking the steps necessary to earn and preserve institutional trust are, however, complex processes. The experience motivating this special report--a request for the Center for Talented Youth at Johns Hopkins University to collaborate on research regarding the genetics of intelligence--illustrates how ensuring institutional trustworthiness can be in tension with a commitment to fostering research. In this essay, we explore the historical context for biomedical research institutions like Johns Hopkins that have worked to build local community trust. In so doing, we consider how the example under focus in this special report can lead to greater consideration of how research institutions balance fostering trust with their other commitments.

Obligations and Concerns of an Organization Like the Center for Talented Youth

There is another set of entities that needs to be brought into the conversation about the ethical, legal, and social implications of scientific conduct. This widely varied group includes not-for-profit educational, academic, public-service, and philanthropic organizations other than the type mentioned above as well as for-profit businesses. Despite their major differences, these organizations may all be in a position to make decisions, directly or indirectly, about the conduct of scientific research. And those decisions may have a significant impact on the parties normally involved in thinking and talking about obligations and concerns-the researchers, the subjects, and the general public. Yet there are few if any conceptual frameworks to help organizations address the ethical, legal, and social issues related to conducting scientific research. There are also few resources to help organizations find and develop the expertise required to make responsible decisions or communicate those decisions in ways that could support and advance the ethical conduct of research. In what follows, we try to identify and explore the duties, rights, and interests of one such organization, the Center for Talented Youth at Johns Hopkins University, when asked to play a supporting role in research on the genetics of intelligence. As central agents in this case, we hope to demonstrate why organizations like CTY cannot be neglected in the broader effort to ensure trustworthy research into the genetics of intelligence.

[Patients' associations and clinical research--academic and industrial]

The notion of "health democracy" was introduced as a core principle into the French health law in 2002. Accordingly, stronger individual rights were recognized to patients and, at the same time, patients' representatives have progressively served at all levels of the governance of health system. In clinical research, it is mandatory since 2004 that institutional review board include patient representatives (I). Patient associationsplay a role in clinical research in financing and/or helping to organize clinical trials. In addition, associations play a role in protecting patients from abusive research--as well as from being possibly not solicited as a subject in trials that could open access to medical innovation. There is no question that, with the support of associations, a patient with HIV or myopathy--eligible but who was not solicited--will obtain to participate in a trial of his or her choice (II). If the role of patients' association in health democracy has become both unquestionable and important, it is nevertheless limited. Patients may be disadvantaged if no combative association is committed on their disease. Patients' associations' role is no substitute to that of the State and the law-only able to devote equitable rights to individuals (III).

Detecting and (not) dealing with plagiarism in an engineering paper: beyond CrossCheck-a case study

In papers in areas such as engineering and the physical sciences, figures, tables and formulae are the basic elements to communicate the authors' core ideas, workings and results. As a computational text-matching tool, CrossCheck cannot work on these non-textual elements to detect plagiarism. Consequently, when comparing engineering or physical sciences papers, CrossCheck may return a low similarity index even when plagiarism has in fact taken place. A case of demonstrated plagiarism involving engineering papers with a low similarity index is discussed, and editor's experiences and suggestions are given on how to tackle this problem. The case shows a lack of understanding of plagiarism by some authors or editors, and illustrates the difficulty of getting some editors and publishers to take appropriate action. Consequently, authors, journal editors, and reviewers, as well as research institutions all are duty-bound not only to recognize the differences between ethical and unethical behavior in order to protect a healthy research environment, and also to maintain consistent ethical publishing standards.

Metrics-based assessments of research: incentives for 'institutional plagiarism'?

The issue of plagiarism--claiming credit for work that is not one's own, rightly, continues to cause concern in the academic community. An analysis is presented that shows the effects that may arise from metrics-based assessments of research, when credit for an author's outputs (chiefly publications) is given to an institution that did not support the research but which subsequently employs the author. The incentives for what is termed here "institutional plagiarism" are demonstrated with reference to the UK Research Assessment Exercise in which submitting units of assessment are shown in some instances to derive around twice the credit for papers produced elsewhere by new recruits, compared to papers produced 'in-house'.

Biodefence and the production of knowledge: rethinking the problem

Biodefence, broadly understood as efforts to prevent or mitigate the damage of a bioterrorist attack, raises a number of ethical issues, from the allocation of scarce biomedical research and public health funds, to the use of coercion in quarantine and other containment measures in the event of an outbreak. In response to the US bioterrorist attacks following September 11, significant US policy decisions were made to spur scientific enquiry in the name of biodefence. These decisions led to a number of critical institutional changes within the US federal government agencies governing scientific research. Subsequent science policy discussions have focused largely on 'the dual use problem': how to preserve the openness of scientific research while preventing research undertaken for the prevention or mitigation of biological threats from third parties. We join others in shifting the ethical debate over biodefence away from a simple framing of the problem as one of dual use, by demonstrating how a dual use framing distorts the debate about bioterrorism and truncates discussion of the moral issues. We offer an alternative framing rooted in social epistemology and institutional design theory, arguing that the ethical and policy debates regarding 'dual use' biomedical research ought to be reframed as a larger optimisation problem across a plurality of values including, among others: (1) the production of scientific knowledge; (2) the protection of human and animal subjects; (3) the promotion and protection of public health (national and global); (4) freedom of scientific enquiry; and (5) the constraint of government power.

Adapting standards: ethical oversight of participant-led health research

As participant-led health research increases, Effy Vayena and and John Tasioulas examine what ethical questions are raised, and what types of standards need to be developed for appropriate ethical oversight for participant-led research projects.

Measuring nepotism through shared last names: the case of Italian Academia

Nepotistic practices are detrimental for academia. Here I show how disciplines with a high likelihood of nepotism can be detected using standard statistical techniques based on shared last names among professors. As an example, I analyze the set of all 61,340 Italian academics. I find that nepotism is prominent in Italy, with particular disciplinary sectors being detected as especially problematic. Out of 28 disciplines, 9 – accounting for more than half of Italian professors – display a significant paucity of last names. Moreover, in most disciplines a clear north-south trend emerges, with likelihood of nepotism increasing with latitude. Even accounting for the geographic clustering of last names, I find that for many disciplines the probability of name-sharing is boosted when professors work in the same institution or sub-discipline. Using these techniques policy makers can target cuts and funding in order to promote fair practices.

Committee on Child Abuse and Neglect. Protecting children from sexual abuse by health care providers

Sexual abuse or exploitation of children is never acceptable. Such behavior by health care providers is particularly concerning because of the trust that children and their families place on adults in the health care profession. The American Academy of Pediatrics strongly endorses the social and moral prohibition against sexual abuse or exploitation of children by health care providers. The academy opposes any such sexual abuse or exploitation by providers, particularly by the academy's members. Health care providers should be trained to recognize and abide by appropriate provider-patient boundaries. Medical institutions should screen staff members for a history of child abuse issues, train them to respect and maintain appropriate boundaries, and establish policies and procedures to receive and investigate concerns about patient abuse. Each person has a responsibility to ensure the safety of children in health care settings and to scrupulously follow appropriate legal and ethical reporting and investigation procedures.

Maternal-fetal intervention and fetal care centers

The past 2 decades have yielded profound advances in the fields of prenatal diagnosis and fetal intervention. Although fetal interventions are driven by a beneficence-based motivation to improve fetal and neonatal outcomes, advancement in fetal therapies raises ethical issues surrounding maternal autonomy and decision-making, concepts of innovation versus research, and organizational aspects within institutions in the development of fetal care centers. To safeguard the interests of both the pregnant woman and the fetus, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics make recommendations regarding informed consent, the role of research subject advocates and other independent advocates, the availability of support services, the multidisciplinary nature of fetal intervention teams, the oversight of centers, and the need to accumulate maternal and fetal outcome data.

Profits and plagiarism: the case of medical ghostwriting

This paper focuses on medical ghostwriting in the United States. I argue that medical ghostwriting often involves plagiarism and, in those cases, can be treated as an act of research misconduct by both the federal government and research institutions. I also propose several anti-ghostwriting measures, including: 1) journals should implement guarantor policies so that researchers may be better held accountable for their work; 2) research institutions and the federal government should explicitly prohibit medical ghostwriting and outline appropriate penalties; and 3) a publicly available database should be created to record researchers' ethics violations.

The California stem cell initiative: persuasion, politics, and public science

The California Institute for Regenerative Medicine (CIRM) was created by a California ballot initiative to make stem cell research a constitutional right, in response to Bush administration restrictions on stem cell research. The initiative created a taxpayer-funded, multibillion-dollar institution, intended to advance public health by developing cures and treatments for diabetes, cancer, paralysis, and other conditions. The initiative has been highly controversial among stakeholders and watchdog groups concerned with organizational transparency, accountability, and the ethics of stem cell research. We interviewed major stakeholders-both supporters and opponents-and analyzed documents and meeting notes. We found that the CIRM has overcome start-up challenges, been selectively influenced by criticism, and adhered to its core mission.

"A good personal scientific relationship": Philip Morris scientists and the Chulabhorn Research Institute, Bangkok

BACKGROUND

This paper examines the efforts of consultants affiliated with Philip Morris (PM), the world's leading transnational tobacco corporation, to influence scientific research and training in Thailand via the Chulabhorn Research Institute (CRI). A leading Southeast Asian institute for environmental health science, the CRI is headed by Professor Dr. Her Royal Highness Princess Chulabhorn, the daughter of the King of Thailand, and it has assumed international significance via its designation as a World Health Organization (WHO) Collaborating Centre in December 2005.

METHODS AND FINDINGS

This paper analyses previously confidential tobacco industry documents that were made publicly available following litigation in the United States. PM documents reveal that ostensibly independent overseas scientists, now identified as industry consultants, were able to gain access to the Thai scientific community. Most significantly, PM scientist Roger Walk has established close connections with the CRI. Documents indicate that Walk was able to use such links to influence the study and teaching of environmental toxicology in the institute and to develop relations with key officials and local scientists so as to advance the interests of PM within Thailand and across Asia. While sensitivities surrounding royal patronage of the CRI make public criticism extremely difficult, indications of ongoing involvement by tobacco industry consultants suggest the need for detailed scrutiny of such relationships.

CONCLUSIONS

The establishment of close links with the CRI advances industry strategies to influence scientific research and debate around tobacco and health, particularly regarding secondhand smoke, to link with academic institutions, and to build relationships with national elites. Such strategies assume particular significance in the national and regional contexts presented here amid the globalisation of the tobacco pandemic. From an international perspective, particular concern is raised by the CRI's recently awarded status as a WHO Collaborating Centre. Since the network of WHO Collaborating Centres rests on the principle of "using national institutions for international purposes," the documents presented below suggest that more rigorous safeguards are required to ensure that such use advances public health goals rather than the objectives of transnational corporations.

Should we consider a boycott of Israeli academic institutions? No

Tony Blair's appointment as Middle East peace envoy is intended to invigorate the peace process. Tom Hickey thinks boycotting universities might encourage the Israeli government to reach a settlement, but Michael Baum believes collaboration is a more effective way forward

Should we consider a boycott of Israeli academic institutions? Yes

Tony Blair's appointment as Middle East peace envoy is intended to invigorate the peace process. Tom Hickey thinks boycotting universities might encourage the Israeli government to reach a settlement, but Michael Baum believes collaboration is a more effective way forward

Responsible oversight of human stem cell research: the California Institute for Regenerative Medicine's medical and ethical standards

California voters recently approved $3 billion over 10 years for public funding of stem cell research through the California Institute for Regenerative Medicine (CIRM). Geoffrey Lomax and colleagues discuss the principles that guided the CIRM regulations.

Neuropathological research at the "Deutsche Forschungsanstalt fuer Psychiatrie" (German Institute for Psychiatric Research) in Munich (Kaiser-Wilhelm-Institute). Scientific utilization of children's organs from the "Kinderfachabteilungen" (Children's Special Departments) at Bavarian State Hospitals

During National Socialism, the politically motivated interest in psychiatric genetic research lead to the founding of research departments specialized in pathological-anatomical brain research, the two Kaiser Wilhelm-Institutes (KWI) in Berlin and Munich. The latter was indirectly provided with brain material by Bavarian State Hospitals, to three of which "Kinderfachabteilungen" (Special Pediatric Units) were affiliated. As children became victims of the systematically conducted child "euthanasia" in these Special Pediatric Units, this paper will address the question whether and to which extent the organs from victims of child "euthanasia" were used for (neuro-) pathological research at the KWI in Munich. By means of case studies and medical histories (with focus on the situation in Kaufbeuren-Irsee), I will argue that pediatric departments on a regular base delivered slide preparations, that the child "euthanasia" conduced in these departments systematically contributed to neuropathological research and that slide preparations from victims of child "euthanasia" were used in scientific publications after 1945.

Wickedness or folly? The ethics of NICE's decisions

A rebuttal is provided to each of the arguments adduced by John Harris, an Editor-in-Chief of the Journal of Medical Ethics, in two editorials in the journal in support of the view that National Institute for Health and Clinical Excellence's procedures and methods for making recommendations about healthcare procedures for use in the National Health Service in England and Wales are the product of "wickedness or folly or more likely both", "ethically illiterate as well as socially divisive", responsible for the "perversion of science as well as of morality" and are "contrary to basic morality and contrary to human rights".

Self inflicted harm--NICE in ethical self destruct mode?

Some very bad old arguments need removing from NICE's latest report