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Murayama A. Pharmaceutical industry-sponsored meals are associated with increased prescriptions and Medicare spending for dupilumab among dermatologists in the United States. J Eval Clin Pract 2024; 30:435-439. [PMID: 38149692 DOI: 10.1111/jep.13956] [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: 08/07/2023] [Accepted: 12/07/2023] [Indexed: 12/28/2023]
Abstract
RATIONALE Healthcare industry sometimes make large marketing payments to physicians. Previous studies have demonstrated that there are significant associations between industry marketing practices and physicians' prescribing behaviours in several specialties. Given the current increasing introduction of many novel biologics for atopic dermatitis and increasing payments to dermatologists, the industry payments to dermatologists for atopic dermatitis drugs could be associated with their prescribing patterns in the United States. AIMS AND OBJECTIVES This study aims to evaluate association between dermatologists' dupilumab prescription behaviours and manufacturer's sponsored meal payments to dermatologists in the United States. METHOD Using the Centers for Medicare and Medicaid Services and the Open Payments Database, this cross-sectional analysis evaluated associations between manufacturer's sponsored meal payments to dermatologists related to dupilumab and dermatologists' dupilumab prescriptions between 2017 and 2021. Associations were evaluated using logistic generalised estimating equations (GEE) and negative binomial regression GEE models at individual dermatologist level. RESULTS Among 2852 dermatologists prescribing dupilumab, 74.5% received meal payments amounting to $1,083,919 between 2017 and 2021. Dermatologists receiving meal payments were more likely to prescribe dupilumab (odds ratio 1.50, 95% confidence interval [CI]: 1.37-1.65). There were also consistent dose-response associations between meal payments and total claims as well as Medicare spending. Dermatologists who received 1, 2-5, 6-10, and 11-15 meal payments per year reported 1.13 (95% CI: 1.03-1.24, p < 0.05), 1.35 (95% CI: 1.24-1.46, p < 0.001), 1.64 (95% CI: 1.48-1.82, p < 0.001), and 2.10 (95% CI: 1.78-2.47, p < 0.001) times more dupilumab-related claims in the year when they received the payments than those who did not receive the payments, respectively. CONCLUSION This study found that significant associations between industry-sponsored meal payments and increased dupilumab prescriptions, shedding light on the potential influence of financial relationships on clinical practice. The findings call for heightened awareness among dermatologists, patients, and policymakers regarding the impact of these relationships on healthcare expenditures and decision-making in the United States. Future research is warranted to further explore these associations longitudinally.
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Affiliation(s)
- Anju Murayama
- School of Medicine, Tohoku University, Sendai City, Miyagi, Japan
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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2
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Junger N, Hirsch O. Ethics of Nudging in the COVID-19 Crisis and the Necessary Return to the Principles of Shared Decision Making: A Critical Review. Cureus 2024; 16:e57960. [PMID: 38601812 PMCID: PMC11005480 DOI: 10.7759/cureus.57960] [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] [Accepted: 04/09/2024] [Indexed: 04/12/2024] Open
Abstract
Nudging, a controversial technique for modifying people's behavior in a predictable way, is claimed to preserve freedom of choice while simultaneously influencing it. Nudging had been largely confined to situations such as promoting healthy eating choices but has been employed in the coronavirus disease 2019 (COVID-19) crisis in a shift towards measures that involve significantly less choice, such as shoves and behavioral prods. Shared decision making (SDM), a method for direct involvement and autonomy, is an alternative approach to communicate risk. Predominantly peer-reviewed scientific publications from standard literature databases like PubMed, PsycInfo, and Psyndex were evaluated in a narrative review. The so-called fear nudges, as well as the dissemination of strongly emotionalizing or moralizing messages can lead to intense psycho-physical stress. The use of these nudges by specialized units during the COVID-19 pandemic generated a societal atmosphere of fear that precipitated a deterioration of the mental and physical health of the population. Major recommendations of the German COVID-19 Snapshot Monitoring (COSMO) study, which are based on elements of nudging and coercive measures, do not comply with ethical principles, basic psychological principles, or evidence-based data. SDM was misused in the COVID-19 crisis, which helped to achieve one-sided goals of governments. The emphasis on utilitarian thinking is criticized and the unethical behavior of decision makers is explained by both using the concept of moral disengagement and the maturity level of coping strategies. There should be a return to an open-ended, democratic, and pluralistic scientific debate without using nudges. It is therefore necessary to return to the origins of SDM.
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Affiliation(s)
- Nancy Junger
- Psychology, Independent Researcher, Tübingen, DEU
| | - Oliver Hirsch
- Psychology, FOM University of Applied Sciences, Siegen, DEU
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3
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Heston TF. Critical Gaps in Medical Research Reporting by Online News Media. Cureus 2024; 16:e57457. [PMID: 38699087 PMCID: PMC11064879 DOI: 10.7759/cureus.57457] [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] [Accepted: 04/02/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND The integrity of medical research reporting in online news publications is crucial for informed healthcare decisions and public health discourse. However, omissions, lack of transparency, and the rapid spread of misinformation on digital and social media platforms can lead to an incomplete or inaccurate understanding of research findings. This study aims to analyze the fidelity of online news in reporting medical research findings, focusing on conflicts of interest, study limitations, statistical data, and research conclusions. METHODS Fifty randomized controlled trials published in major medical journals and their corresponding news reports were evaluated for the inclusion of conflicts of interest, study limitations, and inferential statistics in the news reports. The alignment of conclusions was evaluated. A binomial test with a Bonferroni correction was used to assess the inclusion rate of these variables against a 90% threshold. RESULTS Conflicts of interest were reported in 10 (20%) of news reports, study limitations in 14 (28%), and inferential statistics in 19 (38%). These rates were significantly lower than the 90% threshold (p<0.001). Research conclusions aligned in 43 (86%) cases, which was not significantly different from 90% (p=0.230). Misaligned conclusions resulted from overstating claims. CONCLUSION Significant gaps exist in the reporting of critical contextual information in medical news articles. Adopting a structured reporting format could enhance the quality and transparency of medical research communication. Collaboration among journalists, news organizations, and medical researchers is crucial for establishing and promoting best practices, fostering informed public discourse, and better health outcomes.
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Affiliation(s)
- Thomas F Heston
- Medical Education and Clinical Sciences, Washington State University, Spokane, USA
- Family Medicine, University of Washington, Spokane, USA
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4
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Boesen K, Gøtzsche PC, Ioannidis JPA. Requesting conflicts of interest declarations from the European Medicines Agency: 3-year follow-up status. Epidemiol Psychiatr Sci 2024; 33:e17. [PMID: 38529624 PMCID: PMC11022247 DOI: 10.1017/s2045796024000179] [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: 11/15/2023] [Revised: 02/02/2024] [Accepted: 02/12/2024] [Indexed: 03/27/2024] Open
Abstract
AIMS We have previously described the European Medicines Agency's (EMA) and the US Food and Drug Administration's guidelines, each for a specific psychiatric indication, on how to design pivotal drug trials used in new drug applications. Here, we report on our efforts over 3 years to retrieve conflicts of interest declarations from EMA. We wanted to assess potential internal industry influence judged as the proportion of guideline committee members with industry conflicts of interest. METHODS We submitted Freedom of Information requests in February 2020 to access EMA's lists of committee members (and their declared conflicts of interest) involved in drafting the 13 'Clinical efficacy and safety' guidelines available on EMA's website pertaining to psychiatric indications. In our request, we did not specify the exact EMA committees. Here, we describe the received documents and report the proportion of members with industry interests (i.e. defined as any financial industry relationship). It is a follow-up paper to our first report (http://doi.org/10.1017/S2045796021000147). RESULTS After 2 years and 9 months (November 2022), the EMA sent us member lists and corresponding conflicts of interest declarations from the Committee for Medicinal Products for Human use (CHMP) from 2012, 2013 and 2017. These member lists pertained to 3 of the 13 requested guidelines (schizophrenia, depression and autism spectrum disorder). The 10 remaining guidelines were published before 2011 and EMA stated that they needed to require permission from their expert members (with unknown retrieval rate) and foresaw excessive workload and long wait. Therefore, we withdrew our request. The CHMPs from 2012, 2013 and 2017 had from 34 to 36 members; 39%-44% declared any interests and we judged 14%-18% as having industry interests. For the schizophrenia guideline, we identified two members with industry interests to companies who submitted feedback on the guideline. We did not receive declarations from the Central Nervous System (CNS) Working Party, the CHMP appointed expert group responsible for drafting and incorporating feedback into the guidelines. CONCLUSIONS After almost 3 years, we received information, which only partly addressed our request. We recommend EMA to improve transparency by publishing the author names and their corresponding conflicts of interest declarations directly in the 'Clinical efficacy and safety' guidelines and to not remove conflicts of interest declarations after 1 year from their website to reduce the risk of stealth corporate influence during the development of these influential guidelines.
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Affiliation(s)
- K. Boesen
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | | | - J. P. A. Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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5
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Yadav S. Enhancing Research Integrity and Publication Ethics: An Analysis of the Latest International Committee of Medical Journal Editors Recommendations. Cureus 2024; 16:e56193. [PMID: 38618347 PMCID: PMC11016133 DOI: 10.7759/cureus.56193] [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] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
In the ever-evolving landscape of biomedical research and publishing, the International Committee of Medical Journal Editors recommendations serve as a critical framework for maintaining ethical standards. By providing a framework that adapts to technological advancements, the International Committee of Medical Journal Editors recommendations actively shape responsible and transparent practices, ensuring the integrity of scientific inquiry and fostering global collaboration in the ever-evolving landscape of medical publishing. This editorial delves into key aspects of the latest changes in the International Committee of Medical Journal Editors recommendations, focusing on authorship, conflict of interest disclosure, data sharing and reproducibility, medical publishing and carbon emissions, the use of artificial intelligence, and the challenges posed by predatory journals within the realm of open access. It emphasizes the importance of new recommendations, which represent a beacon of ethical guidance in the ever-evolving domain of biomedical research and publishing.
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Affiliation(s)
- Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
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6
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Adams PJ, Gregan MJ. Moral jeopardy, conflicts of interest and the integrity of public health research. Int J Epidemiol 2024; 53:dyae023. [PMID: 38374718 PMCID: PMC10877091 DOI: 10.1093/ije/dyae023] [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: 09/11/2023] [Accepted: 01/29/2024] [Indexed: 02/21/2024] Open
Affiliation(s)
- Peter J Adams
- Centre for Addiction Research, School of Population Health, The University of Auckland, Auckland, Aotearoa New Zealand
| | - Melissa-Jade Gregan
- Centre for Addiction Research, School of Population Health, The University of Auckland, Auckland, Aotearoa New Zealand
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Murayama A, Kugo H, Kamamoto S. Evaluation of non-research and research industry payments to pediatric hematologist/oncologists in the United States between 2013 and 2021. Leuk Lymphoma 2024:1-9. [PMID: 38349842 DOI: 10.1080/10428194.2024.2317344] [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: 06/21/2023] [Accepted: 02/06/2024] [Indexed: 02/15/2024]
Abstract
Financial interactions between healthcare industry and pediatric hematologist/oncologists (PHOs) could be conflicts of interest. Nevertheless, little is known about financial relationships between healthcare industry and PHOs. This cross-sectional analysis of the Open Payments Database examined general and research payments to PHOs from healthcare industry in the United States between 2013 and 2021. Payments to the PHOs were analyzed descriptively. Trends in payments were assessed using generalized estimating equation models. Of 2784 PHOs, 2142 (76.9%) PHOs received payments totaling $187.3 million from the healthcare industry between 2013 and 2021. Approximately, $46.3 million (24.8%) were general payments and $137.7 million (73.5%) were funding for research where PHOs served as principal investigators (associated research funding). Both general payments and associated research funding considerably increased between 2014 and 2019. The number of PHOs receiving general payments and associated research funding annually increased by 2.2% (95% CI: 1.2-3.3%, p < .001) and 5.0% (95% CI: 3.3-6.8%, p < .001) between 2014 and 2019, respectively.
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Affiliation(s)
- Anju Murayama
- School of Medicine, Tohoku University, Sendai City, Japan
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Hinari Kugo
- School of Medicine, Tohoku University, Sendai City, Japan
| | - Sae Kamamoto
- Hamamatsu University School of Medicine, Hamamatsu, Japan
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8
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Cosgrove L, Patterson EH, Bursztajn HJ. Industry influence on mental health research: depression as a case example. Front Med (Lausanne) 2024; 10:1320304. [PMID: 38322498 PMCID: PMC10845136 DOI: 10.3389/fmed.2023.1320304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/07/2023] [Indexed: 02/08/2024] Open
Abstract
Emotional distress has been rising since before the COVID-19 pandemic and the public is told that depression is a major public health problem. For example, in 2017 depressive disorders were ranked as the third leading cause of "years lost to disability" and the World Health Organization now ranks depression as the single largest contributor to global disability. Although critical appraisals of the epidemiological data raise questions about the accuracy of population-based depression estimates, the dominance of the medical model and the marketing of psychotropics as "magic bullets," have contributed to a dramatic rise in the prescription of psychiatric drugs. Unfortunately, the pharmaceutical industry's influence on psychiatric research and practice has resulted in over-estimates of the effectiveness of psychotropic medications and an under-reporting of harms. This is because the principles that govern commercial entities are incongruent with the principles that guide public health research and interventions. In order to conduct mental health research and develop interventions that are in the public's best interest, we need non-reductionist epistemological and empirical approaches that incorporate a biopsychosocial perspective. Taking depression as a case example, we argue that the socio-political factors associated with emotional distress must be identified and addressed. We describe the harms of industry influence on mental health research and show how the emphasis on "scaling up" the diagnosis and treatment of depression is an insufficient response from a public health perspective. Solutions for reform are offered.
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Affiliation(s)
- Lisa Cosgrove
- Department of Counseling & School Psychology, University of Massachusetts, Boston, MA, United States
| | - Elissa H. Patterson
- Departments of Psychiatry and Neurology, Institute for Healthcare Policy & Innovation, University of Michigan Medical School, Ann Arbor, MI, United States
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9
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Weller S, McCredden JE. Understanding the public voices and researchers speaking into the 5G narrative. Front Public Health 2024; 11:1339513. [PMID: 38283297 PMCID: PMC10820716 DOI: 10.3389/fpubh.2023.1339513] [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] [Received: 11/16/2023] [Accepted: 12/26/2023] [Indexed: 01/30/2024] Open
Abstract
The many different voices speaking into the current narrative surrounding the health effects of 5G technologies necessitate an exploration of the background of the various published author-spokespersons and their potential motives. This has been attempted recently by de Vocht and Albers. However, that opinion piece used a narrow investigative lens, resulting in an undermining of both the rationality of the concerned general public and the motives of specific researchers. At the same time, biases, conflicts of interest, and flaws found in "independent" reviews were not considered. To address these oversights, an evidence-based appraisal of public opinion and the scientific caliber of authors involved in the 5G health discussion is warranted. Subsequently, this review article presents an analysis of the available Australian data representing public voices, while also conducting a broader investigation of the level of expertise of recent author-spokespersons based on their experience as scientists, particularly in the area of health effects of radiofrequency electromagnetic fields. This review thus attempts to more clearly illustrate for the reader the caliber and motives of the voices speaking into the 5G narrative. The article concludes with a set of questions that need to be answered to enable scientists to advise policy makers more effectively on matters of 5G and public health.
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Affiliation(s)
- Steven Weller
- Centre for Environmental and Population Health, School of Medicine and Dentistry, Griffith University, Brisbane, QLD, Australia
- Oceania Radiofrequency Scientific Advisory Association Inc. (ORSAA), Scarborough, QLD, Australia
| | - Julie E. McCredden
- Oceania Radiofrequency Scientific Advisory Association Inc. (ORSAA), Scarborough, QLD, Australia
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10
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Nadra AD. Navigating tensions between public and commercial interests: a case study of open source biosensors for detecting water contaminants in Argentina. Front Med (Lausanne) 2024; 11:1268950. [PMID: 38283621 PMCID: PMC10810021 DOI: 10.3389/fmed.2024.1268950] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Affiliation(s)
- Alejandro D. Nadra
- Departamento de Fisiología, Biología Molecular y Celular, Facultad de Ciencias Exactas y Naturales, Instituto de Biociencias, Biotecnología y Biología Traslacional, Consejo Nacional de Investigaciones Científicas y Técnicas, Universidad de Buenos Aires, Buenos Aires, Argentina
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11
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Murayama A. Industry-sponsored meal payments are associated with prescriptions and Medicare expenditures on brand-name colchicine in the United States. Int J Rheum Dis 2024; 27:e14962. [PMID: 37923570 DOI: 10.1111/1756-185x.14962] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/11/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
AIM To investigate the association between industry-sponsored meal payments and the prescribing patterns of brand-name colchicines, namely Colcrys and Mitigare, among Medicare beneficiaries in the United States from 2014 to 2021. METHODS This cross-sectional study utilized data from the Open Payments Database and Medicare Part D covering the years 2014 to 2021. The study included 54 836 physicians who submitted more than 10 colchicine claims. Exposure was defined as the receipt of one or more industry-sponsored meals from the manufacturers of Colcrys or Mitigare. The primary outcomes included the likelihood of prescribing Colcrys and Mitigare, as well as the associated number of claims and Medicare expenditures. RESULTS Among 54 836 eligible physicians, 44.9% received meal payments from the Colcrys manufacturer, and 8.0% from the Mitigare manufacturer, over the eight-year study period. The average meal payment value was $14.9 for Colcrys and $15.1 for Mitigare. The receipt of meal payments was significantly associated with an increased likelihood of prescribing Colcrys (odds ratio: 1.24 [95% CI: 1.21-1.27], p < .001) and Mitigare (odds ratio: 3.54 [95% CI: 2.98-4.20], p < .001). Each additional meal payment corresponded with a significant increase in Medicare expenditures: $55.4 (95% CI: $48.3-$62.5, p < .001) for Colcrys and $153.7 (95% CI: $17.7-$289.6, p = .03) for Mitigare. These associations remained consistent across different specialties and genders. CONCLUSION This study reveals that receipt of meal payments from manufacturers of brand-name colchicine was significantly associated with an increased rate of prescriptions for these brand-name drugs, leading to higher Medicare expenditures in the United States.
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Affiliation(s)
- Anju Murayama
- School of Medicine, Tohoku University, Sendai City, Japan
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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12
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Yamamoto N, Ozaki A, Taito S, Ariie T, Someko H, Saito H, Tanimoto T, Kataoka Y. Association between Conflicts of Interest Disclosure and Quality of Clinical Practice Guidelines in Japan: A Meta-Epidemiological Study. J Pers Med 2023; 13:1722. [PMID: 38138949 PMCID: PMC10744963 DOI: 10.3390/jpm13121722] [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: 11/20/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
Accurate disclosure of financial conflicts of interest (COI) among clinical practice guideline (CPG) developers is critical to ensure the quality of CPGs. However, there is limited evidence on the impact of underreporting COIs on the quality of CPGs. This study aimed to examine the proportion of underreported COI disclosures in the development of Japanese CPGs and to estimate the association between underreported COIs and CPG quality using the Appraisal of Guidelines for Research & Evaluation (AGREE) II. Twenty-three Japanese CPGs published in 2019 and their 1114 developers were included in the study. The results show that underreporting of COIs occurred in 52% of the included CPGs and 8% of all CPG developers. Underreporting COI disclosures was negatively associated with low-quality CPG (Odds ratio [OR], 0.57; 95% confidence interval [CI]: 0.11, 3.04). On the other hand, CPGs that had more than 13% of CPG developers with voting rights on recommendation decisions and underreporting of COI disclosures were positively associated with low quality (OR, 1.78; 95% CI: 0.25, 12.45). For individual CPG developers with voting rights for recommendation decisions, the presence of a COI was positively associated with low quality (OR, 1.11; 95% CI: 0.71, 1.75). This study demonstrates that the involvement and underreporting of COIs did not seriously distort the CPG development process. However, the COI-related factors of CPG developers with voting rights for recommendation decisions may be associated with low CPG quality.
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Affiliation(s)
- Norio Yamamoto
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan
| | - Akihiko Ozaki
- Medical Governance Research Institute, Tokyo 113-8510, Japan
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Fukushima 972-8322, Japan
| | - Shunsuke Taito
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima 734-0037, Japan
| | - Takashi Ariie
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan
- Department of Physical Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, Fukuoka 286-8686, Japan
| | - Hidehiro Someko
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan
- Department of General Internal Medicine, Asahi General Hospital, Chiba 289-2511, Japan
| | - Hiroaki Saito
- Department of Internal Medicine, Soma Central Hospital, Fukushima 975-0033, Japan
| | - Tetsuya Tanimoto
- Department of Internal Medicine, Navitas Clinic, Tokyo 160-0022, Japan
| | - Yuki Kataoka
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto 616-8147, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto 606-8501, Japan
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Murayama A. Industry Payments to Pediatricians in the United States Between 2013 and 2021. Clin Pediatr (Phila) 2023:99228231218850. [PMID: 38102791 DOI: 10.1177/00099228231218850] [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: 12/17/2023]
Abstract
Financial relationships between physicians and the health care industry sometimes lead to conflicts of interest and need to be properly managed. Using the Open Payments Database between 2013 and 2021, this cross-sectional analysis examined the industry payments made to physicians whose primary specialty was pediatrics. Descriptive analyses were performed for the payment data overall and other pediatrician demographics. Of 99 764 eligible pediatricians, 59 984 (60.1%) received a total of $297 million (12.8%) in general and $2 billion in research payments over the 9 years. Median 9-year per-physician payments were $288 (interquartile range [IQR]: $88-$958) in general and $65 343 (IQR: $16 763-$255 208) in research payments. Male pediatricians were 1.06 (95% CI: 1.05-1.09, P < .001) and 1.56 (95% CI: 1.49-1.65, P < .001) times more likely to receive general and associated research payments than female pediatricians, respectively. The number of pediatricians receiving general payments annually decreased by 1.5% (95% CI: -1.7% to -1.4%, P < .001).
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Affiliation(s)
- Anju Murayama
- Tohoku University School of Medicine, Sendai, Japan
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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14
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Murayama A. Nine-Year Analysis of Industry Payments to Geriatricians in the United States Between 2014 and 2022. J Am Med Dir Assoc 2023:104840. [PMID: 37918817 DOI: 10.1016/j.jamda.2023.09.025] [Citation(s) in RCA: 1] [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: 05/12/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES Financial interactions between physicians and the health care industry might create potential conflicts of interest among physicians. However, little is known about the financial relationships between geriatricians and the health care industry. This study aimed to explore the whole picture of geriatricians-industry financial relationships in the United States. DESIGN Cross-sectional analysis using the Open Payments Database from 2014 to 2022. SETTING AND PARTICIPANTS All geriatricians and geriatric psychiatrists in the United States, identified from the National Plan and Provider Enumeration System database. METHODS This study assessed the extent of geriatrician-industry financial relationships in the United States, using the 2014-2022 Open Payments Database. Descriptive analysis was performed on the payment data. Payment trends were examined by interrupted time series analysis with generalized estimating equation models. RESULTS Of 6688 physicians specializing in geriatric medicine or geriatric psychiatry, 4089 (61.1%) received 1 or more payments from the health care industry, totaling $249.6 million between 2014 and 2022. Even though 61.5% to 80.2% of geriatricians did not receive general payments each year, 4078 geriatricians (61.0%) received 1 or more general payments during the 9-year period. Median annual per-geriatrician general payment ranged from $116 to $199 in inflation-adjusted value. The top 1% and 5% of geriatricians received 62.4% ($18.2 million) and 82.2% ($24.0 million) of overall general payments, respectively; 88.3% of all industry payments were distributed for research purposes, but only 1.4% and 2.6% of all geriatricians received direct and associated research payments, respectively. The number of geriatricians receiving payments significantly decreased by 4.2% (95% CI, -4.8 to -3.6; P < .001) in general payments and 4.8% (95% CI, -9.8 to -0.6; P = .03) in associated research between 2014 and 2019. CONCLUSIONS AND IMPLICATIONS More than 60% of geriatricians received at least 1 payment between 2014 and 2022. Although most payments were made for research purposes, both general and research payments have been concentrated on the small number of geriatricians.
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Affiliation(s)
- Anju Murayama
- School of Medicine, Tohoku University, Sendai City, Miyagi, Japan; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Teixeira da Silva JA, Daly T. Editors and Authors of Medical Journals Should Be Mindful of the New ICMJE Disclosure Form and Updated Policies. JMA J 2023; 6:520-522. [PMID: 37941696 PMCID: PMC10628250 DOI: 10.31662/jmaj.2023-0088] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/10/2023] [Indexed: 11/10/2023] Open
Abstract
The International Committee of Medical Journal Editors (ICMJE) recommendations are used by medical journals worldwide to guide editors and authors regarding "best practices" related to the intersection between research and publishing. In this opinion paper, we bring two discussion points to the attention of readers and users of the ICMJE recommendations. The first pertains to journals' use of the old conflicts of interest form, replaced in 2021 with a new disclosure form. The second relates to inconsistent or outdated policies in journals' instructions for authors mismatching the current ICMJE recommendations. The ICMJE does not monitor how journals use or apply the ICMJE recommendations. Thus, the editors must be mindful of updates and changes relevant to the authors. Furthermore, authors should carefully examine journals before submission to ensure that journals use updated forms and policies and should be mindful of submitting to non-ICMJE-recommendations-conforming journals despite claiming to follow them.
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Affiliation(s)
| | - Timothy Daly
- Bioethics Program, FLACSO Argentina, Buenos Aires, Argentina
- Science Norms Democracy UMR 8011, Sorbonne Université, Paris, France
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16
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Murayama A. Financial Conflicts of Interest Among the Authors of the Clinical Practice Guidelines for Rheumatoid Arthritis in Japan. Cureus 2023; 15:e46650. [PMID: 37937008 PMCID: PMC10627577 DOI: 10.7759/cureus.46650] [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] [Accepted: 10/07/2023] [Indexed: 11/09/2023] Open
Abstract
Objective To assess the financial relationships between pharmaceutical companies and authors of the 2020 Japan College of Rheumatology Clinical Practice Guidelines (CPG) for the Management of Rheumatoid Arthritis and to evaluate the quality of evidence supporting the guideline recommendations. Methods This retrospective study evaluated financial relationships between all 27 authors of the CPG and pharmaceutical companies in Japan. Personal payments from pharmaceutical companies to these authors between 2016 and 2020 were extracted from publicly disclosed databases for each pharmaceutical company. The quality of the evidence supporting the CPG recommendations was also assessed. Results All 27 authors received personal payments from pharmaceutical companies, totaling $3,683,048 over five years. The median and mean payments per author were $101,624 and $136,409, respectively. Speaking compensations accounted for more than 80% of all personal payments. More than 77.8% (21 authors), 66.7% (18 authors), and 51.9% (14 authors) received more than $10,000, $50,000, and $100,000 in total payments over the five years, respectively. Nevertheless, these financial relationships between the CPG authors and pharmaceutical companies were not disclosed. More than 81.8% of the CPG recommendations were supported by low- or very-low-quality evidence. Of the strong recommendations, 66.7% were supported by low- or very-low-quality evidence. Conclusion Even though all CPG authors received substantial amounts of personal payments from pharmaceutical companies, these conflicts of interest (COIs) were not disclosed in the CPG. These findings underscore the urgent need for policy interventions to enhance transparency, integrity, and reliability in the development of CPGs in Japan.
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Affiliation(s)
- Anju Murayama
- School of Medicine, Tohoku University, Sendai, JPN
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
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Kaneda Y, Ozaki A, Hashimoto T, Suzuki Y, Saito H, Tanimoto T, Yamashita E, Jakovljevic M. Characteristics of Top-Searched Individuals in Japan's Yen for Docs Conflicts of Interest Database During the COVID-19 Pandemic. Cureus 2023; 15:e47264. [PMID: 38021906 PMCID: PMC10655768 DOI: 10.7759/cureus.47264] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Transparency in healthcare has led to increased public disclosure of doctors' conflicts of interest, with the "Yen for Docs Database" in Japan emerging as a pivotal source. Nevertheless, there remains ambiguity regarding the backgrounds and influence of highly-searched persons, especially during the COVID-19 pandemic. The primary objective of this study was to examine if the database was utilized for its intended purpose in 2021, a year marked by the introduction of vaccines and treatments, the addition of new COVID-19-related data, and the frequent appearances of expert statements in various media outlets. Methods We conducted a descriptive analysis on the 10 most frequently searched individuals in the "Yen for Docs Database" between August 27 and September 23, 2021, and determined the amount of money they received from pharmaceutical companies and other organizations over the four-year period between 2016 and 2019. To characterize frequently searched individuals' academic profiles and appearances in the mass media, we identified their h-index and affiliation, their activity on Twitter, and the number of TV appearances. Results There were 72,904 searches during the study period, with the top person accounting for 4,905 of those searches. All top 10 were male, mostly affiliated with universities and specialists in infectious diseases or related fields. Their median number of COVID-19 articles was five, and the median h-index was 34. Four of these top 10 had Twitter accounts, with followers ranging from 12,000 to 195,000. The median amount received from pharmaceutical entities over four years was $154,930, ranging from $809 to $705,502. Conclusions In the Yen for Docs Database, a significant portion of searches during the COVID-19 pandemic was concentrated on a selected group of healthcare professionals with considerable payments over the years, and they exhibited prominent academic and media profiles. These observations highlight the need for more transparent conflicts of interest disclosure among physicians with public visibility.
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Affiliation(s)
| | - Akihiko Ozaki
- Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Fukushima, JPN
- Public Health, Medical Governance Research Institute, Tokyo, JPN
| | | | - Yosuke Suzuki
- Public Health, Medical Governance Research Institute, Tokyo, JPN
| | | | | | - Erika Yamashita
- Heart Care, Medical Governance Research Institute, Tokyo, JPN
| | - Mihajlo Jakovljevic
- Comparative Economic Studies, Hosei University, Tokyo, JPN
- Global Health Economics and Policy, University of Kragujevac, Kragujevac, SRB
- Advanced Manufacturing Technologies, Peter the Great St. Petersburg Polytechnic University, St. Petersburg, RUS
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18
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Harrison RA, Majd NK, Johnson MO, Urbauer DL, Puduvalli V, Khasraw M. Characterization of industry relationships in oncology. Cancer 2023; 129:2848-2855. [PMID: 37227811 DOI: 10.1002/cncr.34852] [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: 01/27/2023] [Revised: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Collaborative relationships between academic oncology and industry (pharmaceutical, biotechnology, "omic," and medical device companies) are essential for therapeutic development in oncology; however, limited research on engagement in and perceptions of these relationships has been done. METHODS Survey questions were developed to evaluate relationships between academic oncology and industry. An electronic survey was delivered to 1000 randomly selected members of the American Society of Clinical Oncology, a professional organization for oncologists, eliciting respondents' views around oncology-industry collaborations. The responses were analyzed according to prespecified plans. RESULTS There were 225 survey respondents. Most were from the United States (70.0%), worked at an academic institution (60.1%), worked in medical oncology (81.2%), and had an active relationship with industry (85.8%). One quarter (26.7%) of respondents reported difficulty establishing a relationship with industry collaborators, and most respondents (75%) did not report having had mentorship in developing these relationships. The majority (85.3%) of respondents considered these collaborations important to their careers. Respondents generally thought that scientific integrity was preserved (92%), and most respondents (95%) had little concern over the quality of the collaborative product. Many (60%) shared concerns over potential conflict of interest if an individual with a compensated relationship promoted an industry product for clinical care/research, yet most respondents (67%) stated these relationships did not shape their interactions with patients. CONCLUSIONS This study provides novel data characterizing the nature of collaborative relationships between clinicians, researchers, and industry in oncology. Although respondents considered these collaborations an important part of clinical and academic oncology, formal education or mentorship around these relationships was rare. Conflicting findings around conflict of interest highlight the importance of more dedicated research in this area. PLAIN LANGUAGE SUMMARY Business enterprises in health care play a central role in cancer research and care, driving the development of new medical testing, drugs, and devices. Effective working relationships among clinicians, researchers, and these industry partners can promote innovative research and enhance patient care. Study of these collaborations has been limited to date. Through distribution of a questionnaire to cancer clinicians and researchers, we found that most participants consider these relationships valuable, though they find establishing such relationships challenging partly because of gaps in educational programs in this area. Our findings also highlight the need for further policy around the potential bias these relationships can introduce.
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Affiliation(s)
- Rebecca A Harrison
- Division of Neurology, BC Cancer, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Nazanin K Majd
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Margaret O Johnson
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Diana L Urbauer
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vinay Puduvalli
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mustafa Khasraw
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
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19
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Gramma R, Hanganu B, Arnaut O, Ioan BG. Potential Conflicts of Interest Arising from Dualism of Loyalty Imposed on Employees of Medical Institutions-Findings and Tools for Ethics Management. Medicina (Kaunas) 2023; 59:1598. [PMID: 37763717 PMCID: PMC10536397 DOI: 10.3390/medicina59091598] [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] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023]
Abstract
Background and Objective: Doctors should have full loyalty to their patients, while patients should be able to trust that physicians will act only in their best interests. However, doctors may be faced with situations where they must choose between the patient's interests and those of a third party. This article presents the results of a study that aimed to identify situations of duality in the decision-making process of medical workers, which can compromise their ethical behavior. Materials and Methods: A cross-sectional study was carried out on a sample of 1070 participants, employed in 120 healthcare facilities in the Republic of Moldova. An online questionnaire was completed anonymously. Descriptive statistics for discrete data were performed by estimating absolute and relative frequencies. To perform the multivariate analysis, the logistic regression was applied. Results: A large number (74.4%) of respondents admitted that they had faced situations of conflicts of interest. Every third respondent (35.3%) had experienced ethical dilemmas when access to expensive treatments should be ensured. Every fourth respondent experienced a conflict between the patient's interests and those of the institution (26.1%) or the insurance company (23.3%). As age increases, the probability of reporting the dilemma decreases. Physicians reported such dilemmas almost 3 times more often than nurses. A low rate of staff sought support when faced with dilemmas. Half of the respondents (50.6%) preferred to discuss the problem only with a colleague, and 40.1% preferred to find solutions without anyone's help. There were significant gaps within organizations in terms of the ethical dimension of the decision-making process. Conclusions: Managers should adopt clear institutional policies and tools to identify and prevent situations of dual loyalty. Ethical support should be offered to employees facing such situations. The need to promote an institutional climate based on trust and openness becomes evident.
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Affiliation(s)
- Rodica Gramma
- Doctoral School, State University of Medicine and Pharmacy Nicolae Testemițanu, 2004 Chisinau, Moldova; (R.G.); (O.A.)
| | - Bianca Hanganu
- 3rd Medical Sciences Department, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Oleg Arnaut
- Doctoral School, State University of Medicine and Pharmacy Nicolae Testemițanu, 2004 Chisinau, Moldova; (R.G.); (O.A.)
| | - Beatrice Gabriela Ioan
- 3rd Medical Sciences Department, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania;
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20
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Correa R, Miragaya J, Cohen DA, Hoang TD, Jasim S, Lieb DC, Weber SL, Bird MD, Stec C. Protocol for Development of American Association of Clinical Endocrinology Clinical Practice Guidelines and Consensus Statements: Summary of Methodology, Process, and Policy - 2023 Update. Endocr Pract 2023; 29:341-348. [PMID: 37150580 DOI: 10.1016/j.eprac.2023.01.012] [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: 12/15/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE This 2023 updated protocol summarizes the American Association of Clinical Endocrinology's (AACE's) new framework for the development of clinical practice guidelines and other guidance documents that includes changes to methodology, processes, and policies. METHODS AACE has critically reviewed its development processes for guidance documents over the last several years against the National Academy of Medicine Standards for Developing Trustworthy Clinical Practice Guidelines and the Council of Medical Specialty Societies Principles for Development of Specialty Society Clinical Guidelines to determine areas for improvement. RESULTS The new AACE framework for development of guidance documents incorporates many changes, including a revised conflicts of interest (COI) policy; strengthened commitment to collection of disclosures and management of relevant COI during development; open calls to membership for authors; new requirements for authors; new diversity, equity, and inclusion (DEI) policy; new empanelment process that incorporates consideration of DEI; and adoption of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to increase the quality of evidence assessment and standardize recommendation grades and statements, among other improvements. CONCLUSIONS AACE has revised its policies and adopted a completely new methodology for guideline development in support of the mission to elevate the practice of clinical endocrinology to improve patient care. With the use of an evidence-based medicine framework and by continually assessing and improving its processes for development of guidance, AACE strives to deliver trustworthy, unbiased, and up-to-date information that ensures clinician and patient confidence in AACE content. Further, AACE hopes that these enhancements foster a more collaborative approach to development and increase engagement with the worldwide medical community to improve global health.
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Affiliation(s)
- Ricardo Correa
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - David A Cohen
- Division of Endocrinology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Thanh D Hoang
- Division of Endocrinology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Sina Jasim
- Division of Endocrinology, Metabolism and Lipid Research, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - David C Lieb
- Division of Endocrine and Metabolic Conditions, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia
| | - Sandra L Weber
- University of South Carolina School of Medicine-Greenville, Prisma Health System, Greenville, South Carolina
| | - Melanie D Bird
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
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21
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Kraak VI. Perspective: Examining Conflicts of Interest for Professional Service within the 2020 Dietary Guidelines Advisory Committee. Adv Nutr 2023; 14:432-437. [PMID: 36997092 PMCID: PMC10201810 DOI: 10.1016/j.advnut.2023.03.009] [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] [Received: 11/01/2022] [Revised: 02/06/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023] Open
Abstract
Judgments and integrity uphold professionalism. Failure to manage professional conflicts of interest (COIs) may undermine trust in an individual, practitioner, or institution. This perspective article examines standards for nutrition researchers and practitioners to manage COIs for the Dietary Guidelines for Americans (DGA) process. Thereafter, this article analyzes a study published by Mialon et al. that raised concerns about the expert advisory committee selection process and management of COIs for 20 professionals appointed by the Department of Health and Human Services (HHS) and the USDA, who served on a federal government advisory committee to review evidence for the Dietary Guidelines Advisory Committee (DGAC) 2020 scientific report. The analysis found that Mialon et al. enumerated COIs for each DGAC member with industry, removed from the original context, which prevented readers from assessing the COI risk. Moreover, the USDA ethics office concluded that "the 20 committee members were in full compliance with the federal ethics rules applicable to special government employees." I conclude that Mialon et al. could use institutional mechanisms to encourage the USDA and HHS to strengthen future COI policies and procedures, aligned with the 2022 National Academies of Sciences, Engineering and Medicine report recommendations to improve the DGA 2025 to 2030 process.
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Affiliation(s)
- Vivica I Kraak
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University (Virginia Tech), Blacksburg, VA, United States.
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22
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Gabriel JM, Desai SP. "The Warmth of His Continuing Interest": Henry K. Beecher, the Bioethics Revolution, and Pharmaceutical Industry Funding of Academic Medical Science in Cold War America. J Hist Med Allied Sci 2023; 78:191-208. [PMID: 36866432 DOI: 10.1093/jhmas/jrad011] [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] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
This paper examines anesthesiologist Henry K. Beecher's funding relationship with pharmaceutical manufacturer Edward Mallinckrodt, Jr. Beecher is a familiar figure to both medical ethicists and historians of medicine for his role in the bioethics revolution of the 1960s and 1970s. In particular, his 1966 article "Ethics and Clinical Research" is widely considered a turning point in the post-World War II debate about informed consent. We argue that Beecher's scientific interests should be understood in the context of his funding relationship with Mallinckrodt and that this relationship shaped the direction of his work in important ways. We also argue that Beecher's views on research ethics reflected his assumption that collaboration with industry was a normal part of how academic science is conducted. In the conclusion of the paper we suggest that Beecher's failure to consider his relationship with Mallinckrodt as worthy of ethical deliberation has important lessons for academic researchers who collaborate with industry today.
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23
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Birnkrant DJ, Black JB, Carter JC. "A Process-Based Approach to Conflicts of Interest". Pediatr Pulmonol 2023; 58:1627-1630. [PMID: 36988406 DOI: 10.1002/ppul.26391] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/30/2023] [Accepted: 03/12/2023] [Indexed: 03/30/2023]
Affiliation(s)
- David J Birnkrant
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Pediatrics, MetroHealth System, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Jane B Black
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - John C Carter
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Pediatrics, MetroHealth System, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, MetroHealth System, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Nesrallah S, Klepp KI, Budin-Ljøsne I, Luszczynska A, Brinsden H, Rutter H, Bergstrøm E, Singh S, Debelian M, Bouillon C, Katanasho MB. Youth engagement in research and policy: The CO-CREATE framework to optimize power balance and mitigate risks of conflicts of interest. Obes Rev 2023; 24 Suppl 1:e13549. [PMID: 36633924 DOI: 10.1111/obr.13549] [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] [Received: 09/18/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 01/13/2023]
Abstract
Including youth in the co-creation of policies that affect them has proven to be particularly impactful in public health. Using youth participatory action research methods, the CO-CREATE project engages European youth 16-18 years old in the co-creation of obesity prevention policies. To discuss the feasibility and implications of the policy, youth are invited to engage in an intergenerational dialogue. Given the youth-adult dynamic and policy discussion, conflicts of interests (COIs) can arise and impact the quality of the dialogue. COI frameworks are a tool that can help identify, mitigate, and address COIs. This paper presents a novel framework to mitigate COIs in intergenerational policy dialogues, with a focus on power imbalance. Following a series of youth consultations, interviews, and examination of existing frameworks, our findings suggest that safe, participatory, and empowering dialogues can take place if appropriate measures are integrated into all phases of a dialogue. The selection of stakeholders, use of accessible language, and youth moderation are all factors that can impact COI risks. Measures that promote mutual empowerment, such as equal representation of youth and adults, were deemed important. This framework provides a roadmap to ensure that youth participation in the formulation of policies is safe and empowering.
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Affiliation(s)
| | - Knut-Inge Klepp
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Isabelle Budin-Ljøsne
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Aleksandra Luszczynska
- CARE-BEH Center for Applied Research on Health Behavior and Health, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | | | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Elin Bergstrøm
- Centre for Development and the Environment, University of Oslo, Oslo, Norway
| | - Sudhvir Singh
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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McCredden JE, Weller S, Leach V. The assumption of safety is being used to justify the rollout of 5G technologies. Front Public Health 2023; 11:1058454. [PMID: 36815158 PMCID: PMC9940636 DOI: 10.3389/fpubh.2023.1058454] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/03/2023] [Indexed: 01/27/2023] Open
Affiliation(s)
- Julie E. McCredden
- Oceania Radiofrequency Scientific Advisory Association Inc. (ORSAA), Scarborough, QLD, Australia
| | - Steven Weller
- Oceania Radiofrequency Scientific Advisory Association Inc. (ORSAA), Scarborough, QLD, Australia,Centre for Environmental and Population Health, School of Medicine and Dentistry, Griffith University, Brisbane, QLD, Australia
| | - Victor Leach
- Oceania Radiofrequency Scientific Advisory Association Inc. (ORSAA), Scarborough, QLD, Australia,*Correspondence: Victor Leach ✉
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26
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Murayama A, Kamamoto S, Murata N, Yamasaki R, Yamada K, Yamashita E, Saito H, Tanimoto T, Ozaki A. Evaluation of financial conflicts of interest and quality of evidence in Japanese gastroenterology clinical practice guidelines. J Gastroenterol Hepatol 2022; 38:565-573. [PMID: 36518089 DOI: 10.1111/jgh.16089] [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] [Received: 04/26/2022] [Revised: 11/02/2022] [Accepted: 12/11/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Clinical practice guidelines assist healthcare professionals in providing evidence-based care. However, pharmaceutical companies' financial interests often influence guideline content. This study aimed to elucidate the magnitude of financial ties among Japanese gastroenterology guideline authors and the pharmaceutical industry. METHODS Using pharmaceutical company disclosed payment data, we evaluated financial conflicts of interest (COI) among Japanese Society of Gastroenterology guideline authors between 2016 and 2021. Additionally, we assessed the evidence quality supporting guideline recommendations and associations with financial COI. Finally, we evaluated author COI management during guideline development against global standards. RESULTS Overall, 88.2% (231/262) of guideline authors received a median of $12 968 (interquartile range [IQR]: $1839-$70 374) in payments between 2016 and 2019 for lectures, writings, and consulting. Chairpersons received significantly higher payments (median: $86 444 [IQR: $15 455-$165 679]). Notably, 41 (15.6%) authors had undeclared payments exceeding declaration requirements. Low or very low-quality evidence supported 41.0% of recommendations. There was a negative association between the median 4-year payment per author and the proportion of recommendations based on low-quality evidence (odds ratio: 0.966 [95% confidence interval [95% CI]: 0.945-0.987], P = 0.002) and positive association with moderate-quality evidence (odds ratio: 1.018 [95% CI: 1.011-1.025], P < 0.001). Still, the Japanese Society of Gastroenterology guideline development process remains less transparent, with insufficient COI policies relative to global standards. CONCLUSION There were extensive financial COI between pharmaceutical companies and guideline authors, and more than 40% of recommendations were based on low-quality evidence. More rigorous and transparent COI policies for guideline development adhering to global standards are warranted.
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Affiliation(s)
- Anju Murayama
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,School of Medicine, Tohoku University, Sendai, Miyagi, Japan
| | - Sae Kamamoto
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Faculty of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Nanami Murata
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Faculty of Medicine, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Ryota Yamasaki
- Faculty of Medicine, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Kohki Yamada
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Osaka University School of Medicine, Osaka, Japan
| | - Erika Yamashita
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - Hiroaki Saito
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Tetsuya Tanimoto
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Department of Internal Medicine, Navitas Clinic, Tachikawa, Tokyo, Japan
| | - Akihiko Ozaki
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
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Staley K, Park J. Statistical significance and conflicts of interest: Response to Mayo (2022). Conserv Biol 2022; 36:e13985. [PMID: 35979706 DOI: 10.1111/cobi.13985] [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] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Kent Staley
- Department of Philosophy, Saint Louis University, St. Louis, Missouri, USA
| | - John Park
- Department of Radiation Oncology, Kansas City VA Medical Center, Kansas City, Missouri, USA
- Department of Radiology, University of Missouri-Kansas City, Kansas City, Missouri, USA
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28
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Mialon M, Bertscher A, Bero L, Vandevijvere S. Proposed methods for evaluating efforts made by governments to prevent and mitigate corporate influence and conflicts of interest in public health policy. HRB Open Res 2022; 5:41. [PMID: 37496747 PMCID: PMC10366553 DOI: 10.12688/hrbopenres.13553.2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 07/28/2023] Open
Abstract
Background: There is evidence that corporations try to delay, weaken, and avoid the adoption of measures that would protect and improve population health. This is particularly true and problematic for health harming industries, such as those producing ultra-processed foods, alcohol, and cigarettes. Financial conflicts of interest (COI) are also problematic in policy-making because they may compromise decision-makers' loyalty and independent judgment. Public opinion is in favor of preventing and mitigating that influence from corporations and COI on public health policy. A scoping review recently identified twenty-three mechanisms that could be adopted with that purpose and which principally cover: i) transparency and disclosure; ii) identification, monitoring, and education; iii) management; iv) prohibition of interactions with the industry and/or COI. There is, however, limited knowledge on the adoption of such mechanisms by governments. We therefore propose new methods for evaluating that progress at the country level. Methods and expected results: The proposed evaluation comprises five steps: 1) Gathering information about the national context; 2) Gathering evidence on the implementation of mechanisms by national governments; 3) Verification of step 2 by government officials and policy experts and local public health experts; 4) Identification and prioritization of actions in a workshop; 5) Supporting the translation of findings into policy actions. Conclusions: The evaluation of progress made by governments in their implementation of mechanisms for preventing and mitigating the influence of corporations and COI in public health policy could help countries systematize their efforts, benchmark their progress internationally, and give perspective on particular weaknesses, approaches, and investment gaps needed for change. We will implement and validate our methods in Ireland, as a first case-study.
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Affiliation(s)
- Mélissa Mialon
- Trinity Business School, Trinity College Dublin, Dublin, D02 H308, Ireland
| | - Adam Bertscher
- Tobacco Control Research Group, Department of Health, University of Bath, Bath, BA2 7AY, UK
| | - Lisa Bero
- Center for Bioethics and Humanities, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, 80045, USA
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29
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Murayama A, Kamamoto S, Saito H, Yamada K, Bhandari D, Shoji I, Mamada H, Kawashima M, Yamashita E, Kusumi E, Sawano T, Sapkota B, Tanimoto T, Ozaki A. Pharmaceutical Payments to Japanese Board-Certified Infectious Disease Specialists: A Four-Year Retrospective Analysis of Payments from 92 Pharmaceutical Companies between 2016 and 2019. Int J Environ Res Public Health 2022; 19:ijerph19127417. [PMID: 35742661 PMCID: PMC9223711 DOI: 10.3390/ijerph19127417] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/31/2022] [Accepted: 06/14/2022] [Indexed: 01/30/2023]
Abstract
Backgrounds: Conflict of interest with pharmaceutical companies is one of the most concerned issues in infectious diseases. However, there is a lack of whole picture of detailed payments in Japan. Methods: This retrospective study assessed financial relationships between pharmaceutical companies and all infectious disease specialists board-certified by the Japanese Association for Infectious Disease, using publicly disclosed payment data from 92 major pharmaceutical companies. Descriptive analyses were conducted for the payments. Payment trends were examined by the generalized estimating equations. Results: Of 1614 board-certified infection disease specialists, 1055 (65.4%) received a total of $17,784,070 payments, corresponding to 21,680 contracts between 2016 and 2019. The mean ± SD and median (interquartile range: IQR) were $16,857 ± $45,010 and $3183 ($938–$11,250) in payments. All board executive members of Japanese Association of Infectious Disease received higher payments averaging $163,792. There were no significant changes in payments per specialist (annual change rate: −1.4% [95% CI: −4.7–2.3%], p = 0.48) and prevalence of specialists with payments (annual change rate: −1.4% [95% CI: −3.1–0.2%], p = 0.093) over the four years. Conclusion: There were substantial financial relationships between pharmaceutical companies and board-certified infectious disease specialists in Japan. Furthermore, high ranked specialists such as those in the executive board had stronger financial ties with the companies.
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Affiliation(s)
- Anju Murayama
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
- School of Medicine, Tohoku University, Sendai City 980-8577, Miyagi, Japan
- Correspondence: ; Tel.: +81-90-6321-6996
| | - Sae Kamamoto
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
- School of Medicine, Hamamatsu University, Hamamatsu City 431-2102, Shizuoka, Japan
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kosei Hospital, Sendai City 980-0873, Miyagi, Japan;
| | - Kohki Yamada
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
| | - Divya Bhandari
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
| | - Iori Shoji
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
| | - Hanano Mamada
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
| | - Moe Kawashima
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
| | - Erika Yamashita
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
| | - Eiji Kusumi
- Navitas Clinic Shinjuku, Shinjuku-ku 160-0022, Tokyo, Japan;
| | - Toyoaki Sawano
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki City 972-8322, Fukushima, Japan;
| | - Binaya Sapkota
- Nobel College Faculty of Health Sciences, Pokhara University, Kathmandu 33700, Nepal;
| | - Tetsuya Tanimoto
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
- Department of Internal Medicine, Navitas Clinic, Tachikawa City 160-0022, Tokyo, Japan
| | - Akihiko Ozaki
- Medical Governance Research Institute, Minato-ku 108-0074, Tokyo, Japan; (S.K.); (K.Y.); (D.B.); (I.S.); (H.M.); (M.K.); (E.Y.); (T.T.); (A.O.)
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki City 972-8322, Fukushima, Japan
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Ozaki A, Murayama A, Harada K, Saito H, Sawano T, Tanimoto T, Ozieranski P. How Do Institutional Conflicts of Interest Between Pharmaceutical Companies and the Healthcare Sector Become Corrupt? A Case Study of Scholarship Donations Between Department of Clinical Anesthesiology, Mie University, and Ono Pharmaceutical in Japan. Front Public Health 2022; 9:762637. [PMID: 35047471 PMCID: PMC8761953 DOI: 10.3389/fpubh.2021.762637] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Institutional conflicts of interest (ICOIs) with pharmaceutical companies can bias internal operation of healthcare organizations. Naturally, a scholarship donation—which is a donation scheme unique to Japan, provided to healthcare organizations and their subunits to encourage educational and academic activities related to the development of new drugs—fall into the ICOI category. While anecdotal evidence exists that scholarship donations have been used as bribes by pharmaceutical companies, there has been little case study research that would illuminate the workings of this “gray area” mechanism. From this perspective, we offer an in-depth analysis of a recent scandal involving the Department of Clinical Anesthesiology, Mie University and Ono Pharmaceutical, where a scholarship donation was used by a pharmaceutical company to increase the prescription of one of its key drugs at a hospital department. Available evidence also suggests that a professor based within the department originally requested a scholarship donation from the company, which became an initial trigger of the scandal. We argue that by scrutinizing scholarship donations we can gain insight into problems specific to ICOIs between the pharmaceutical companies and the healthcare sector in Japan. In addition, scholarship donations can be understood as a form of “gifts” which have been found to underpin certain forms of pharmaceutical companies' promotional activities in Japan but also in other countries. We conclude by highlighting potential institutional remedies, which may alleviate ICOIs and corrupt behavior affecting the healthcare sector.
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Affiliation(s)
- Akihiko Ozaki
- Medical Governance Research Institute, Tokyo, Japan.,Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | | | - Kayo Harada
- Medical Governance Research Institute, Tokyo, Japan
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kosei Hospital, Sendai, Japan
| | - Toyoaki Sawano
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | | | - Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Bath, United Kingdom
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31
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Ranpariya VK, Fathy R, Chu B, Wang S, Lipoff JB. Patterns of Promotional Content by Dermatology Influencers on TikTok. JMIR Dermatol 2022; 5:e34935. [PMID: 37632857 PMCID: PMC10501523 DOI: 10.2196/34935] [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: 11/14/2021] [Revised: 02/07/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Varun K Ranpariya
- Rutgers Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, United States
| | - Ramie Fathy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Brian Chu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Sonia Wang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jules B Lipoff
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
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32
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Ranpariya V, Lipoff JB. Direct-to-consumer teledermatology's limitations may be addressed with greater in-person care synergy. J Am Acad Dermatol 2022:S0190-9622(22)00009-3. [PMID: 34998960 DOI: 10.1016/j.jaad.2021.12.047] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/23/2022]
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33
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Ozieranski P, Pitter JG, Rickard E, Mulinari S, Csanadi M. A 'patient-industry complex'? Investigating the financial dependency of UK patient organisations on drug company funding. Sociol Health Illn 2022; 44:188-210. [PMID: 34874566 DOI: 10.1111/1467-9566.13409] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 06/13/2023]
Abstract
We examined the minimum extent of dependency of UK patient organisations on pharmaceutical industry funding using drug company disclosure reports and patient organisation financial accounts from 2012 to 2016. We used linear regression to explain the overall share of industry funding ('general dependency') and top donor funding ('company-specific dependency') in organisations' income. Predictors included patient organisations' goal; having members and volunteers; geographical scope of activity; headquarter location; expenditure/income ratio; and disease area. The prevalent low levels of general dependency (IQR, 0.1%-6.0%) and company-specific dependency (IQR, 0.1%-4.3%) made a widespread capture of patient organisations unlikely, though only if one excludes the possibility of significant payment under-reporting. However, organisations with considerably higher dependency than others might be more prone to co-optation by industry. Of the 398 organisations, 18 (4.5%) and 8 (2.0%) had general and company-specific financial dependency over 50%, respectively. However, the shares of outliers exceeding the third quartile plus 1.5 times IQR were 51 (12.8%) and 56 (14.1%) for each dependency type. Certain characteristics including activity profile (advocacy) or indicating limited access to resources (remote location) made organisations vulnerable to developing financial dependency. Future research should examine both financial and non-financial links between the two sides and their impact on patient organisations' activity.
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Affiliation(s)
- Piotr Ozieranski
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | | | - Emily Rickard
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Shai Mulinari
- Department of Sociology, Lund University, Lund, Sweden
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34
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Adams PJ, Rychert M, Wilkins C. How does the influence of the cannabis industry differ from that of alcohol and tobacco? Addiction 2021; 116:2951-2952. [PMID: 34327753 DOI: 10.1111/add.15637] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Peter J Adams
- Centre for Addiction Research, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Marta Rychert
- Social and Health Outcomes Research and Evaluation (SHORE), SHORE and Whaariki Research Centre, College of Health, Massey University, Auckland, New Zealand
| | - Chris Wilkins
- Social and Health Outcomes Research and Evaluation (SHORE), SHORE and Whaariki Research Centre, College of Health, Massey University, Auckland, New Zealand
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35
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Adams PJ, Rychert M, Wilkins C. Policy influence and the legalized cannabis industry: learnings from other addictive consumption industries. Addiction 2021; 116:2939-2946. [PMID: 33739486 DOI: 10.1111/add.15483] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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] [Received: 08/06/2020] [Revised: 10/13/2020] [Accepted: 03/02/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM New Zealand has recently legalized medicinal cannabis and has explored the possibility of legalizing large-scale recreational cannabis supply. In the process, concerns have emerged regarding whether corporations involved in the large-scale production and sale of legalized cannabis will invest in tactics of influence with policymakers and the public. This paper aimed to examine the various ways a legalized cannabis industry could seek to influence governments and the public in the New Zealand reform context. METHOD Based on the study of industry tactics with alcohol, tobacco and gambling, we applied a three-chain model of industry influence that breaks tactics into the 'public good', 'knowledge' and 'political' chains. RESULTS Exploratory analysis of the nascent cannabis industry's activity in New Zealand provided signs of industry influence strategies related to all three chains. The medicinal cannabis industry has associated the establishment of a legal cannabis sector with regional economic development and employment, supported lobbying for recreational law reform, funded NGOs involved in lobbying for law reform, established research partnerships with universities, invited ex-politicians on advisory boards, and participated in government public sector partnerships. CONCLUSION There is emerging evidence that the legal cannabis industry is using strategies to influence the regulatory environment in New Zealand.
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Affiliation(s)
- Peter J Adams
- Centre for Addiction Research, School of Population Health, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Marta Rychert
- Social and Health Outcomes Research and Evaluation (SHORE), SHORE and Whaariki Research Centre, College of Health, Massey University, P.O. Box 6137, Wellesley Street, Auckland, New Zealand
| | - Chris Wilkins
- Social and Health Outcomes Research and Evaluation (SHORE), SHORE and Whaariki Research Centre, College of Health, Massey University, P.O. Box 6137, Wellesley Street, Auckland, New Zealand
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36
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Wenger D, Nowlin R, Johnson AL, Anderson M, Weaver M, Hartwell M, Vassar M. Evaluation of Industry Relationships Among Authors of Systematic Reviews and Meta-analyses Regarding Ménières Disease. Ann Otol Rhinol Laryngol 2021; 131:1004-1012. [PMID: 34636251 DOI: 10.1177/00034894211051822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To quantify the presence of conflicts of interest (COI) in SRs and MAs of Ménières disease treatment and identify any related secondary characteristics of these articles. METHODS A search was conducted on May 28, 2020 to search MEDLINE and Embase databases for SRs or MAs pertaining to Ménières disease published between September 1, 2016 and June 2, 2020. A risk of bias assessment was performed using the Cochrane Collaboration risk of bias assessment criteria. RESULTS A total of 13 systematic reviews conducted by 49 authors met the inclusion criteria. Of the 49 authors, 7 (14.3%) were found to have some form of COI. Of these 7 authors, 1 (14.3%) completely disclosed all COI within the SR, 1 (14.3%) disclosed one or more COI but were found to have an additional undisclosed COI, and 5 (71.4%) were found to have only undisclosed COI. One of 2 industry funded SRs (50%) had a high risk of bias, and 1 (50%) of the non-industry sponsored SRs were found to have a high risk of bias. CONCLUSIONS Overall authors of SRs pertaining to Ménières disease appear to be properly disclosing COI at higher rates than other fields of medicine; however, further room for improvement has been noted.
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Affiliation(s)
- David Wenger
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Ross Nowlin
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Austin L Johnson
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Michael Anderson
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Michael Weaver
- Kansas City University of Medicine and Biosciences, Joplin, MO, USA
| | - Micah Hartwell
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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Makhinson M, Seshia SS, Young GB, Smith PA, Stobart K, Guha IN. The iatrogenic opioid crisis: An example of 'institutional corruption of pharmaceuticals'? J Eval Clin Pract 2021; 27:1033-1043. [PMID: 33760335 DOI: 10.1111/jep.13566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 11/28/2022]
Abstract
RATIONALE Prescribed opioids are major contributors to the international public health opioid crisis. Such widespread iatrogenic harms usually result from collective decision failures of healthcare organizations rather than solely of individual organizations or professionals. Findings from a system-wide safety analysis of the iatrogenic opioid crisis that includes roles of pertinent healthcare organizations may help avoid or mitigate similar future iatrogenic consequences. In this retrospective exploratory study, we report such an analysis. METHODS The study population encompassed the entire age spectrum and included those in whom opioids prescribed for chronic pain (unrelated to malignancy) were associated with death or morbidity. Root cause analysis, incorporating recent suggestions for improvement, was used to identify possible contributory factors from the literature. Based on their mandated roles and potential influences to prevent or mitigate the iatrogenic crisis, relevant organizations were grouped and stratified from most to least influential. RESULTS The analysis identified a chain of multiple interrelated causal factors within and between organizations. The most influential organizations were pharmaceutical, political, and drug regulatory; next: experts and their related societies, and publications. Less influential: accreditation, professional licensing and regulatory, academic and healthcare funding bodies. Collectively, their views and decisions influenced prescribing practices of frontline healthcare professionals and advocacy groups. Financial associations between pharmaceutical and most other organizations/groups were common. Ultimately, patients were adversely affected. There was a complex association with psychosocial variables. LIMITATIONS The analysis suggests associations not causality. CONCLUSION The iatrogenic crisis has multiple intricately linked roots. The major catalyst: pervasive pharma-linked financial conflicts of interest (CoIs) involving most other healthcare organizations. These extensive financial CoIs were likely triggers for a cascade of erroneous decisions and actions that adversely affected patients. The actions and decisions of pharma ranged from unethical to illegal. The iatrogenic opioid crisis may exemplify 'institutional corruption of pharmaceuticals'.
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Affiliation(s)
- Michael Makhinson
- Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine at the University of California, Los Angeles, California, USA.,Department of Psychiatry, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Shashi S Seshia
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Gordon Bryan Young
- Clinical Neurological Sciences and Medicine (Critical Care), Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada.,Grey Bruce Health Services, Owen Sound, Ontario, Canada
| | - Preston A Smith
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kent Stobart
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Indra Neil Guha
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
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38
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Goldowsky A, Sen R, Hoffman G, Feuerstein JD. Is there a standardized practice for the development of international ulcerative colitis and Crohn's disease treatment guidelines? Gastroenterol Rep (Oxf) 2021; 9:408-417. [PMID: 34733526 PMCID: PMC8560035 DOI: 10.1093/gastro/goab009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/17/2020] [Accepted: 10/25/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Guidelines are published by international gastroenterology societies regarding the management of ulcerative colitis (UC) and Crohn's disease (CD) to help clinicians to provide high-quality patient care. We examined the guidelines for the quality and strength of evidence used to develop the recommendations, methods for grading evidence, differences in disease-specific recommendations, conflicts of interest, and plans for guideline updates. METHODS A systematic search was performed on PubMed using "ulcerative colitis," "Crohn's disease," and "guidelines" in April 2019. International gastroenterology society websites were searched for UC- and CD-specific guidelines. Guidelines from 12 societies were examined by two authors. Chi-squared tests were used for comparing evidence-level grades, strength of recommendations, and reported conflicts of interest. Linear-regression modeling was used to evaluate the relationship between the number of authors and the number of recommendations in a given guideline. RESULTS Of 28 guidelines reviewed, 25 (89%) used a total of three different systems to grade the level of evidence and 2 (7%) used an unknown system. Three (11%) reviewed guidelines did not provide a conflict-of-interest statement, while three (11%) provided a timeline for guideline updates. Of 1,265 total statements examined, 246 (19%) reported no grade of evidence quality or explicitly stated that the recommendation was based on "expert opinion." One hundred and thirty-five (22%) UC recommendations were noted to be "weak/conditional" and 95 (16%) did not have a recommendation strength. Two hundred and forty-two (37%) CD recommendations were noted to be "weak/conditional" and 151 (23%) did not have a recommendation strength. CONCLUSION The majority of UC and CD guidelines are based on a low/very low quality of evidence and are further weakened due to the lack of homogeneity in specific aspects of management recommendations as well as conflicts of interest.
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Affiliation(s)
- Alexander Goldowsky
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Rohan Sen
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Gila Hoffman
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Joseph D Feuerstein
- Department of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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39
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Murayama A, Kida F, Ozaki A, Saito H, Sawano T, Tanimoto T. Financial and Intellectual Conflicts of Interest Among Japanese Clinical Practice Guidelines Authors for Allergic Rhinitis. Otolaryngol Head Neck Surg 2021; 166:869-876. [PMID: 34399654 DOI: 10.1177/01945998211034724] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To elucidate financial and intellectual conflicts of interest (COIs) among clinical practice guideline (CPG) authors of allergic rhinitis in Japan and to evaluate the extent of transparency and accuracy in COIs by CPG authors of allergic rhinitis. STUDY DESIGN A cross-sectional analysis of the payment data from all 79 pharmaceutical companies in Japan between 2016 and 2017. SETTING Japan. METHODS We considered all 27 CPG authors from 2 different versions of the most prominent CPGs for allergic rhinitis in Japan. Using payment data disclosed by 79 major pharmaceutical companies between 2016 and 2017, we assessed the magnitude and characteristics of financial COIs of CPG authors. We also evaluated the intellectual COIs of the CPG authors by counting self-citations of research articles related to CPG statements and recommendations. RESULTS Of 27 CPG authors, 26 authors (96.3%) received at least 1 payment from a combined total of $1,333,552 between 2016 and 2017. The 2-year combined average and median monetary values per author were $49,391 (SD, $67,438) and $18,400 (interquartile range: $6,216-$72,494), respectively. Pharmaceutical companies with novel drugs predominantly made these payments. The percentage of citations with at least 1 CPG author relative to total citations was 47.6% in 2016 and 27.9% in 2020. There were no formal COI disclosure statements in either version. CONCLUSION This study found that allergic rhinitis CPG authors had significant financial relationships with pharmaceutical companies, particularly those marketing novel drugs. In addition, CPG authors had relatively high self-citation rates, a potential marker of intellectual COIs. More rigorous and comprehensive COI management strategies are needed.
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Affiliation(s)
- Anju Murayama
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - Futa Kida
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - Akihiko Ozaki
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan.,Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Toyoaki Sawano
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan
| | - Tetsuya Tanimoto
- Department of Internal Medicine, Navitas Clinic, Tachikawa, Tokyo, Japan
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Manguele A, Sidat M, IJsselmuiden C, Ferrinho P. Addressing conflicts of interest of ethical reviewers of health planning, management, policy and systems research proposals. Int J Health Plann Manage 2021; 36:2044-2047. [PMID: 34382265 DOI: 10.1002/hpm.3295] [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: 02/11/2021] [Revised: 07/09/2021] [Accepted: 07/27/2021] [Indexed: 11/05/2022] Open
Abstract
Steering health systems towards universal health coverage requires research on themes that are of particular interest to health planning, management, policy and systems researchers. Some issues, such as strikes regarded as illegal and health sector corruption, because of their social and political sensitivity have, for too long, remained outside adequate research inquiry. Their emergence in the research agenda raises some challenges for Human Research Ethics Committees, particularly related to their conflicts of interests as reviewers, that need clarification.
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Affiliation(s)
| | - Mohsin Sidat
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique.,Research Centre on Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Carel IJsselmuiden
- Council on Health Research for Development, Geneva, Switzerland.,School of Applied Human Sciences, Univ of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Paulo Ferrinho
- Research Centre on Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
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Radparvar J, Tian T, Karamchandani M, Aalberg J, Driscoll D, Homsy C, Chatterjee A. Assessment of Financial Conflicts of Interest Related to the Use of Dermal Substitutes in Burn Management. J Burn Care Res 2021; 43:586-591. [PMID: 34318879 DOI: 10.1093/jbcr/irab136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/15/2022]
Abstract
This study aims to systematically review the accuracy of the self-reporting of conflicts of interest (COI) among studies related to the use of dermal substitute products in burn management and evaluate factors associated with increased discrepancies. To do so, a literature search was done to identify studies investigating the use of dermal substitutes in burn management published between 2015 - 2019. Industry payments were collected using the Centers for Medicare & Medicaid Services Open Payments database. Declared COI were then compared with the listed payments. Studies and authors were considered to have a COI if they received payments totaling >$100 for each company. A total of 51 studies (322 authors) were included for analysis. Thirty-eight studies (75%) had at least one author received an undisclosed payment from industry. From 2015 to 2019, 1391 general payments (totaling $1,696,848) and 108 research payments (totaling $1,849,537) were made by 82 companies. When increasing the threshold on what would be considered an undisclosed payment, the proportion of authors with discrepancies gradually decreased, from 88% of authors with undisclosed payments >$100 to 27% of authors with undisclosed payments >$10,000. Author order, journal impact factor, and study type were not significantly associated with increased risk of discrepancy. We found that the majority of studies investigating the use of dermal substitute products for burn management did not accurately declare COI, highlighting the need for a uniform declaration process and greater transparency of industry sponsorship by authors when publishing peer-reviewed burn surgery research papers.
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Affiliation(s)
- Jacob Radparvar
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Tina Tian
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Jeffrey Aalberg
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Daniel Driscoll
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Christopher Homsy
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Abhishek Chatterjee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
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Abstract
CONTEXT Partnerships between the public and private sectors are necessary in public health and health care. Each partner provides skills, resources, and capabilities. When the public sector, including government, enters into a partnership with a nongovernmental or corporate entity, it is important to determine in advance whether there are real or perceived ethical, financial, or programmatic risks to the organization that might need mitigation. PROGRAM This article describes how the Centers for Disease Control and Prevention has approached assessing ethical considerations of public-private partnerships, especially those involving monetary or in-kind gifts. IMPLEMENTATION There are practices that can be applied no matter the size or structure of the organization that can lead to transparency and accountability for a potential partnership. DISCUSSION Examples in this article include a list of practical considerations to review before entering into a new partnership, as well as illustrative anecdotes.
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Affiliation(s)
- Diana M Yassanye
- Public-Private Partnerships Team, Office of the Chief of Staff, Office of the Director (Mss Yassanye and Anason), and Public Health Ethics and Strategy Unit, Office of Scientific Integrity, Office of Science (Dr Barrett), Centers for Disease Control and Prevention, Atlanta, Georgia
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Corcoran A, Hillman C, Cole T, Anderson M, Weaver M, Johnson BS, Hartwell M, Vassar M. Association between author conflicts of interest and industry-sponsorship with the favorability of outcomes of systematic reviews focusing on treatments of erectile dysfunction. Andrology 2021; 9:1819-1827. [PMID: 34173351 DOI: 10.1111/andr.13064] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/18/2021] [Accepted: 06/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Authors' conflicts of interest and industry sponsorship have been shown to influence study outcomes. OBJECTIVE We aimed to determine whether author conflicts of interest and industry sponsorship influenced the nature of results and conclusions of systematic reviews focusing on treatment interventions for erectile dysfunction. MATERIALS AND METHODS We searched PubMed and Embase for systematic reviews and meta-analyses focusing on erectile dysfunction treatments published between September 1, 2016, and June 2, 2020. Authors' conflicts of interest were collected from the systematic reviews' disclosure statements. These disclosures were verified using the information provided by the Open Payments, Dollars for Profs, Google Patents, and US Patent and Trademark Office databases and from previously published disclosure statements. RESULTS Our study included 24 systematic reviews authored by 138 authors. Nineteen authors (13.8%) were found to have conflicts of interest (disclosed, undisclosed, or both). No authors completely disclosed all conflicts. Nine reviews (37.5%) contained at least one author with conflicts of interest; of which eight reported narrative results favoring the treatment group, and seven reported conclusions favoring the treatment group. Of the 15 (62.5%) reviews without a conflicted author, 11 reported results favoring the treatment group, and 12 reported conclusions favoring the treatment group. DISCUSSION The results and conclusions of systematic reviews for erectile dysfunction treatments did not appear to be influenced by authors who reported conflicts of interest. However, our search algorithm relied on the US-based Open Payments database and a large percentage of reviews in our study were produced by authors with international affiliations. Our study results underscore the difficulties in conducting such analyses. CONCLUSION Although we found that undisclosed conflicts of interest (COI) were problematic among systematic reviews of erectile dysfunction treatment, only 14% of authors in our sample possessed them and these COI did not appear to influence the favorability of systematic review outcomes.
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Affiliation(s)
- Adam Corcoran
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Cody Hillman
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Tanner Cole
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Michael Anderson
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Michael Weaver
- Kansas City University of Medicine and Biosciences, College of Osteopathic Medicine, Joplin, Missouri, USA
| | - Bradley S Johnson
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Micah Hartwell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA.,Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA.,Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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Tian T, Shah AY, Darling J, Zaepfel C, Chatterjee A, Iafrati M, Salehi P. Assessment of Self-Reported Financial Conflicts of Interest in Vascular Surgery Studies. J Vasc Surg 2021; 74:2047-2053. [PMID: 34171423 DOI: 10.1016/j.jvs.2021.05.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/21/2020] [Accepted: 05/11/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION With increased collaboration between surgeons and industry, there has been a push towards improving transparency of conflicts of interest (COI). This study aims to determine the accuracy of reporting of COIs among studies in major vascular surgery journals. METHODS A literature search identified all comparative studies published from January 2018 - December 2018 from three major United States vascular surgery journals (Journal of Vascular Surgery, Vascular and Endovascular Surgery, and Annals of Vascular Surgery). Industry payments were collected using the Centers for Medicare & Medicaid Services (CMS) Open Payments database. COI discrepancies were identified by comparing author declaration statements with payments found for the year of publication and year prior. RESULTS A total of 239 studies (1642 authors) were identified. Two hundred twenty-one studies (92%) and 669 authors (63%) received undisclosed payments when utilizing a cut-off payment amount of $250. In 2018, 10,778 payments (totaling $22,174,578) were made by 145 companies. Food and beverage payments were the most commonly reported transaction (42%), but accounted for only 3% of total reported monetary values. Authors who accurately disclosed payments received significantly higher median general payments compared to authors who did not accurately disclose payments ($56,581 [IQR: $2441 - $100,551] vs $2,361 [IQR: $525 - $9,699], p < .001). When stratifying by dollar-amount discrepancy, the proportions of authors receiving undisclosed payments decreased with increasing payment thresholds. Multivariate analysis demonstrated that first and senior authors were both significantly more likely to have undisclosed payments (OR 2.0, 95% CI 1.1-3.6 and OR 2.9, 95% CI 1.6-5.2, respectively). CONCLUSIONS There is a significant discordance between self-reported COI in vascular surgery studies compared to payments received in the CMS Open Payments database. This study highlights the need for increased efforts to both improve definitions of what constitutes a relevant COI and encourage a standardized reporting process for vascular surgery studies.
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Affiliation(s)
- Tina Tian
- Department of Surgery, Tufts Medical Center; Boston, MA
| | - Anand Y Shah
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center; Boston, MA
| | | | - Charlie Zaepfel
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center; Boston, MA
| | - Abhishek Chatterjee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center; Boston, MA
| | - Mark Iafrati
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center; Boston, MA
| | - Payam Salehi
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center; Boston, MA.
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Rulon Z, Powers K, Anderson JM, Weaver M, Johnson A, Hartwell M, Vassar M. Conflicts of Interest Among Authors of Systematic Reviews and Meta-analyses Investigating Interventions for Melanoma: Cross-sectional Literature Study. JMIR Dermatol 2021; 4:e25858. [PMID: 37632810 PMCID: PMC10501528 DOI: 10.2196/25858] [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] [Received: 11/18/2020] [Revised: 02/11/2021] [Accepted: 04/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous studies have highlighted the potential influence that industry relationships may have on the outcomes of medical research. OBJECTIVE We aimed to determine the prevalence of author conflicts of interest (COIs) in systematic reviews focusing on melanoma interventions, as well as to determine whether the presence of these COIs were associated with an increased likelihood of reporting favorable results and conclusions. METHODS This cross-sectional study included systematic reviews with or without meta-analyses focusing on interventions for melanoma. We searched MEDLINE and Embase for eligible systematic reviews published between September 1, 2016, and June 2, 2020. COI disclosures were cross-referenced with information from the CMS (Centers for Medicare & Medicaid Services) Open Payments database, Dollars for Profs, Google Patents, the United States Patent and Trademark Office, and previously published COI disclosure statements. Results were quantified using descriptive statistics, and relationships were evaluated by Fisher exact tests. RESULTS Of the 23 systematic reviews included in our sample, 12 (52%) had at least one author with a COI. Of these 12 reviews, 7 (58%) reported narrative results favoring the treatment group and 9 (75%) reported conclusions favoring the treatment group. Of the 11 systematic reviews without a conflicted author, 4 (36%) reported results favoring the treatment group and 5 (45%) reported conclusions favoring the treatment group. We found no significant association between the presence of author COIs and the favorability of results (P=.53) or conclusions (P=.15). CONCLUSIONS Author COIs did not appear to influence the outcomes of systematic reviews regarding melanoma interventions. Clinicians and other readers of dermatology literature should be cognizant of the influence that industry may have on the nature of reported outcomes, including those from systematic reviews and meta-analyses.
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Affiliation(s)
- Zane Rulon
- Center for Health Sciences, Oklahoma State University, Tulsa, OK, United States
| | - Kalyn Powers
- College of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK, United States
| | - J Michael Anderson
- Center for Health Sciences, Oklahoma State University, Tulsa, OK, United States
| | - Michael Weaver
- College of Osteopathic Medicine, Kansas City University of Medicine and Biosciences, Joplin, OK, United States
| | - Austin Johnson
- Center for Health Sciences, Oklahoma State University, Tulsa, OK, United States
| | - Micah Hartwell
- Center for Health Sciences, Oklahoma State University, Tulsa, OK, United States
| | - Matt Vassar
- Center for Health Sciences, Oklahoma State University, Tulsa, OK, United States
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Darveau SC, Leary OP, Persad-Paisley EM, Shaaya EA, Oyelese AA, Fridley JS, Sampath P, Camara-Quintana JQ, Gokaslan ZL, Niu T. Existing clinical evidence on the use of cellular bone matrix grafts in spinal fusion: updated systematic review of the literature. Neurosurg Focus 2021; 50:E12. [PMID: 34062506 DOI: 10.3171/2021.3.focus2173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/24/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spinal fusion surgery is increasingly common; however, pseudarthrosis remains a common complication affecting as much as 15% of some patient populations. Currently, no clear consensus on the best bone graft materials to use exists. Recent advances have led to the development of cell-infused cellular bone matrices (CBMs), which contain living components such as mesenchymal stem cells (MSCs). Relatively few clinical outcome studies on the use of these grafts exist, although the number of such studies has increased in the last 5 years. In this study, the authors aimed to summarize and critically evaluate the existing clinical evidence on commercially available CBMs in spinal fusion and reported clinical outcomes. METHODS The authors performed a systematic search of the MEDLINE and PubMed electronic databases for peer-reviewed, English-language original articles (1970-2020) in which the articles' authors studied the clinical outcomes of CBMs in spinal fusion. The US National Library of Medicine electronic clinical trials database (www.ClinicalTrials.gov) was also searched for relevant ongoing clinical trials. RESULTS Twelve published studies of 6 different CBM products met inclusion criteria: 5 studies of Osteocel Plus/Osteocel (n = 354 unique patients), 3 of Trinity Evolution (n = 114), 2 of ViviGen (n = 171), 1 of map3 (n = 41), and 1 of VIA Graft (n = 75). All studies reported high radiographic fusion success rates (range 87%-100%) using these CBMs. However, this literature was overwhelmingly limited to single-center, noncomparative studies. Seven studies disclosed industry funding or conflicts of interest (COIs). There are 4 known trials of ViviGen (3 trials) and Bio4 (1 trial) that are ongoing. CONCLUSIONS CBMs are a promising technology with the potential of improving outcome after spinal fusion. However, while the number of studies conducted in humans has tripled since 2014, there is still insufficient evidence in the literature to recommend for or against CBMs relative to cheaper alternative materials. Comparative, multicenter trials and outcome registries free from industry COIs are indicated.
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Bottema-Beutel K, Crowley S. Pervasive Undisclosed Conflicts of Interest in Applied Behavior Analysis Autism Literature. Front Psychol 2021; 12:676303. [PMID: 34025538 PMCID: PMC8131529 DOI: 10.3389/fpsyg.2021.676303] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
Many autistic people (including researchers and non-researchers) are becoming increasingly involved in, and increasingly critical of, autism intervention research. They have expressed concerns regarding applied behavior analysis (ABA) interventions on a number of grounds, one of which is the prevalence of conflicts of interests (COIs) among autism intervention researchers. These concerns are now also being addressed by non-autistic researchers. COIs can introduce bias into the research process, and allow researchers to demonstrate positive effects for interventions that are not actually effective. Despite these concerns, there are no studies to date that examine the prevalence of COIs in behavioral journals. Because ABA services are routinely provided to autistic people in the United States as a means to address difficulties experienced by autistic people, this is an important area of investigation. We tallied author COIs in articles published over a 1-year period that tested, commented on, or reviewed ABA autism intervention strategies, extracted from eight journals devoted to publishing behavioral research. We coded included studies for COIs related to researcher employment as an ABA clinical provider or a training consultant to ABA clinical providers. We found that 84% of studies had at least one author with this type of COI, but they were only disclosed as COIs in 2% of studies. Additionally, 87% of studies with statements claiming the authors did not have COIs, were authored by researchers found to have clinical/training consultancy COIs. Pervasive, undisclosed COIs likely lead to researcher bias, and could at least partially account for persistent poor quality research in this area. The high prevalence of COIs among this research corroborates the concerns expressed by many autistic people. The autism community - including autistic people, autism researchers, and other stakeholders - should be aware of the prevalence of undisclosed COIs in this literature and take this into account when using, providing, or recommending ABA services.
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Affiliation(s)
- Kristen Bottema-Beutel
- Lynch School of Education and Human Development, Boston College, Chestnut Hill, MA, United States
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Shaw D. Triaging ethical issues in the coronavirus pandemic: how to prioritize bioethics research during public health emergencies. Bioethics 2021; 35:380-384. [PMID: 33751622 PMCID: PMC8251638 DOI: 10.1111/bioe.12859] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/29/2020] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
Much of the ethical discourse concerning the coronavirus pandemic has focused on the allocation of scarce resources, be it potentially beneficial new treatments, ventilators, intensive care beds, or oxygen. Somewhat ironically, the more important ethical issues may lie elsewhere, just as the more important medical issues do not concern intensive care or treatment for COVID-19 patients, but rather the diversion towards these modes of care at the expense of non-Covid patients and treatment. In this article I explore how ethicists can and should prioritize which ethical issues to deal with, and develop a method of triage for identification and prioritization of ethical issues both in the next public health emergency and in bioethics more widely.
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Affiliation(s)
- David Shaw
- Department of Health, Ethics and SocietyCare and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
- Institute for Biomedical EthicsUniversity of BaselBaselSwitzerland
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DeFrance MJ, Yayac MF, Courtney PM, Squire MW. The Impact of Author Financial Conflicts on Robotic-Assisted Joint Arthroplasty Research. J Arthroplasty 2021; 36:1462-1469. [PMID: 33199093 DOI: 10.1016/j.arth.2020.10.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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] [Received: 09/09/2020] [Revised: 10/08/2020] [Accepted: 10/20/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Recent studies have suggested clinical superiority with robotic-assisted arthroplasty compared to traditional techniques. However, concerns exist regarding the author's financial conflicts of interest (COI), which may influence research outcomes. This study aimed to determine whether COI relating to robotic-assisted arthroplasty influences the results of published outcomes following total hip (THA), total knee (TKA), and unicompartmental knee arthroplasty (UKA). METHODS We performed a systematic review to identify all studies evaluating the use of robotics in THA, TKA, and UKA. An author's financial COI was identified if they reported a relevant disclosure through the American Academy of Orthopedic Surgeons or within the study article. We then queried the Open Payments website to record all payments made from a robotic company in the year prior to publication. Each study was categorized as either favoring robotics (n = 42), neutral (n = 10), or favoring traditional techniques (n = 2). We then compared the number of conflicted authors, journal impact factor, level of evidence, and mean annual industry payment to each author. RESULTS Of the 54 studies meeting inclusion criteria, 49 (91%) had an author financial COI. Conflicted studies were more likely to report favorable results of robotics than nonconflicted studies. When compared to studies favoring conventional techniques, those demonstrating favorable robotics outcomes had a higher number of conflicted authors and a higher mean industry payment per author. There was no difference in the level of evidence or journal impact factor. DISCUSSION Nearly all studies comparing robotic THA, TKA, and UKA to conventional techniques involve financially conflicted authors. Further studies without COI may provide unbiased results.
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Affiliation(s)
| | - Michael F Yayac
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - P Maxwell Courtney
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Matthew W Squire
- University of Wisconsin School of Medicine and Public Health, Madison, WI
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Abstract
Policy Points Despite the pandemic's ongoing devastating impacts, it also offers the opportunity and lessons for building a better, fairer, and sustainable world. Transformational change will require new ways of working, challenging powerful individuals and industries who worsened the crisis, will act to exploit it for personal gain, and will work to ensure that the future aligns with their interests. A flourishing world needs strong and equitable structures and systems, including strengthened democratic, research, and educational institutions, supported by ideas and discourses that are free of opaque and conflicted influence and that challenge the status quo and inequitable distribution of power.
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Affiliation(s)
- May Ci VAN Schalkwyk
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine
| | - Nason Maani
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine.,School of Public Health, Boston University
| | | | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine
| | - Mark Petticrew
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine
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