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Adashi EY, Cohen IG, Elberg JT. Transparency and the Doctor-Patient Relationship - Rethinking Conflict-of-Interest Disclosures. N Engl J Med 2022; 386:300-302. [PMID: 35061340 DOI: 10.1056/nejmp2114495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Eli Y Adashi
- From the Department of Medical Science, Warren Alpert Medical School, Brown University, Providence, RI (E.Y.A.); Harvard Law School and the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard University, Cambridge, MA (I.G.C.); and the Center for Health and Pharmaceutical Law, Seton Hall University School of Law, Newark, NJ (J.T.E.)
| | - I Glenn Cohen
- From the Department of Medical Science, Warren Alpert Medical School, Brown University, Providence, RI (E.Y.A.); Harvard Law School and the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard University, Cambridge, MA (I.G.C.); and the Center for Health and Pharmaceutical Law, Seton Hall University School of Law, Newark, NJ (J.T.E.)
| | - Jacob T Elberg
- From the Department of Medical Science, Warren Alpert Medical School, Brown University, Providence, RI (E.Y.A.); Harvard Law School and the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard University, Cambridge, MA (I.G.C.); and the Center for Health and Pharmaceutical Law, Seton Hall University School of Law, Newark, NJ (J.T.E.)
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Affiliation(s)
| | - I Glenn Cohen
- Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School, Harvard University, Cambridge, Massachusetts
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Affiliation(s)
- Joel Lexchin
- School of Health Policy and Management, York University, Toronto, ON, Canada
- Department of Family and Community Medicine University of Toronto, Toronto, Canada
- University Health Network, Toronto, Canada
| | - Lisa A Bero
- Center for Bioethics and Humanities, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Courtney Davis
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Marc-Andre Gagnon
- School of Public Policy and Administration, Carleton University, Ottawa, ON, Canada
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Gini R. [Not Available]. Recenti Prog Med 2019; 110:529-530. [PMID: 31808435 DOI: 10.1701/3265.32351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Rodwin MA. Conflicts of Interest in Human Subject Research: The Insufficiency of U.S. and International Standards. Am J Law Med 2019; 45:303-330. [PMID: 31973668 DOI: 10.1177/0098858819892743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Researchers, as well as individuals and institutions that oversee their conduct, sometimes have conflicts of interest that weaken or render ineffective efforts to protect human research subjects. This article analyzes United States and international standards used to address conflicts of interest and reviews evidence regarding compliance. It finds current standards are insufficient and recommends that the federal government and international organizations adopt stronger legal standards that require resolving most significant conflicts of interest and specifying how to manage conflicts of interest not resolved.
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Affiliation(s)
- Marc A Rodwin
- Marc Rodwin is professor of health law and policy at Suffolk University Law School and the 2017-18 Chair in Integrated Cancer Research at IMERA Institute, Aix-Marseille University, Marseille France. Degrees: B.A. Brown University; M.A., Oxford University; J.D. University of Virginia Law School; Ph.D., Brandeis University Heller School
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Abstract
IMPORTANCE Conflicts of interest (COI) disclosure policies are critical to enhancing the integrity of research. However, it is unclear how Chinese medical journals interpret and enforce such policies. OBJECTIVES The goal of this investigation is to determine the current status of COI disclosure policy enforcement in Chinese medical journals and to promote comprehensive COI policies. METHODS In this cross-sectional study conducted from September 1st to October 29th 2017, journal instructions, websites and print issues of journals indexed by the Core Journals of China (version 2014), in the medical and health sector, were reviewed to identify whether COI disclosure policies existed and how complete these policies were. RESULTS Of 248 eligible journals, 78 (31%) mentioned COI policies; 9 (4%) applied standardized disclosure forms; 18 (7%) required disclosure statements in articles; 4 (2%) mentioned policy bases; none validated disclosed COIs; 2 (1%) mentioned how they dealt with breaches; 18 (7%) involved the management of disclosed COIs; and 62 (25%) and 55 (22%) noted financial and nonfinancial COIs, respectively. Seventy-eight journals (31%) mentioned COIs in research and authors' obligation towards disclosure; 2 (1%) and 6 (2%) mentioned family members' and institutional COIs, respectively. Twenty-two and 11 journals mentioned at least one form of financial and nonfinancial COI type in research, respectively. Seven journals (3%) required disclosure of the source of financial support in research, but no journals mentioned the amount of support. Seven (3%) and 12 (5%) journals mentioned COIs in the editorial process and peer-review, respectively. Clinical journals (45%) paid more attention to COI policies than non-clinical journals. CONCLUSIONS Approximately one-third of Chinese medical journals had COI policies, and of the journals that mentioned financial COIs most required nonfinancial COIs. However, the extent to which journals implemented COI policies was insufficient. There is a generic lack of standardized disclosure forms and management of COIs in most journals. The subject and details of COIs involved in the editorial and peer-review process received less attention than those in research.
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Affiliation(s)
- Jiayi Zhu
- International Journal of Blood Transfusion and Hematology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- * E-mail:
| | - Ji Sun
- Chinese Journal of Obstetrics & Gynecology and Pediatrics (Electronic Edition), West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Abstract
Any physician who has authored an Independent Medical Evaluation or medical record review can and should anticipate being called as an expert witness (EW). Litigants rely on EW testimony in most civil cases. The most common areas in which EWs participate and provide opinions and testimony are workers' compensation, personal injury, and medical malpractice. This report will become part of the discovery process, the process by which a party to a lawsuit can obtain information from another party or other entities involved in the lawsuit.
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Gini R, Fournie X, Dolk H, Kurz X, Verpillat P, Simondon F, Strassmann V, Apostolidis K, Goedecke T. The ENCePP Code of Conduct: A best practise for scientific independence and transparency in noninterventional postauthorisation studies. Pharmacoepidemiol Drug Saf 2019; 28:422-433. [PMID: 30838708 PMCID: PMC6594014 DOI: 10.1002/pds.4763] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/08/2019] [Accepted: 02/12/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The ENCePP Code of Conduct provides a framework for scientifically independent and transparent pharmacoepidemiological research. Despite becoming a landmark reference, practical implementation of key provisions was still limited. The fourth revision defines scientific independence and clarifies uncertainties on the applicability to postauthorisation safety studies requested by regulators. To separate the influence of the funder from the investigator's scientific responsibility, the Code now requires that the lead investigator is not employed by the funding institution. METHOD To assess how the revised Code fits the ecosystem of noninterventional pharmacoepidemiology research in Europe, we first mapped key recommendations of the revised Code against ISPE Good Pharmacoepidemiology Practices and the ADVANCE Code of Conduct. We surveyed stakeholders to understand perceptions on its value and practical applicability. Representatives from the different stakeholders' groups described their experience and expectations. RESULTS Unmet needs in pharmacoepidemiological research are fulfilled by providing unique guidance on roles and responsibilities to support scientific independence. The principles of scientific independence and transparency are well understood and reinforce trust in study results; however, around 70% of survey respondents still found some provisions difficult to apply. Representatives from stakeholders' groups found the new version promising, although limitations still exist. CONCLUSION By clarifying definitions and roles, the latest revision of the Code sets a new standard in the relationship between investigators and funders to support scientific independence of pharmacoepidemiological research. Disseminating and training on the provisions of the Code would help stakeholders to better understand its advantages and promote its adoption in noninterventional research.
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Affiliation(s)
- Rosa Gini
- Osservatorio di EpidemiologiaAgenzia regionale di sanità della ToscanaFlorenceItaly
| | - Xavier Fournie
- Global Medical AffairsICON Commercialisation & OutcomesLyonFrance
| | - Helen Dolk
- Faculty of Life and Health SciencesUniversity of Ulster at JordanstownJordanstownUK
| | - Xavier Kurz
- Pharmacovigilance and Epidemiology Department, Inspections, Human Medicines Pharmacovigilance and Committees DivisionEuropean Medicines AgencyAmsterdamThe Netherlands
| | | | - François Simondon
- Mother and Child Health Research Unit IRDUniversite Paris DescartesParisFrance
| | - Valerie Strassmann
- PharmacovigilanzBundesinstitut für Arzneimittel und Medizinprodukte (BfArM)BonnGermany
| | - Kathi Apostolidis
- Vice PresidentEuropean Cancer Patient Coalition (ECPC)BrusselsBelgium
| | - Thomas Goedecke
- Pharmacovigilance and Epidemiology Department, Inspections, Human Medicines Pharmacovigilance and Committees DivisionEuropean Medicines AgencyAmsterdamThe Netherlands
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Abstract
OBJECTIVE To determine the effect of the public disclosure of industry payments to physicians on patients' awareness of industry payments and knowledge about whether their physicians had accepted industry payments. DESIGN Interrupted time series with comparison group (difference-in-difference analyses of longitudinal survey). SETTING Nationally representative US population-based surveys. Surveys were conducted in September 2014, shortly prior to the public release of Open Payments information, and again in September 2016. PARTICIPANTS Adults aged 18 and older (n=2180). MAIN OUTCOME MEASURES Awareness of industry payments as an issue; awareness that industry payments information was publicly available; knowledge of whether own physician had received industry payments. RESULTS Public disclosure of industry payments information through Open Payments did not significantly increase the proportion of respondents who knew whether their physician had received industry payments (p=0.918). It also did not change the proportion of respondents who became aware of the issue of industry payments (p=0.470) but did increase the proportion who knew that payments information was publicly available (9.6% points, p=0.011). CONCLUSIONS Two years after the public disclosure of industry payments information, Open Payments does not appear to have achieved its goal of increasing patient knowledge of whether their physicians have received money from pharmaceutical and medical device firms. Additional efforts will be required to improve the use and effectiveness of Open Payments for consumers.
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Affiliation(s)
- Genevieve P Kanter
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel Carpenter
- Department of Government, Harvard University, Cambridge, Massachusetts, USA
| | - Lisa Lehmann
- National Center for Ethics in Health Care, Veterans Health Administration, Washington, District of Columbia, USA
| | - Michelle M Mello
- Stanford Law School, Stanford University, Stanford, California, USA
- Department of Health Research and Policy, School of Medicine, Stanford University, Stanford, California, USA
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Abstract
OBJECTIVES To describe and quantify disclosed payments from the pharmaceutical industry to the healthcare sector, and to examine the impact of the 2015 changes to Australia's self-regulated system of transparency. DESIGN Observational database study. SETTING Australia. PARTICIPANTS Publicly available reports submitted by members of Australian pharmaceutical industry trade organisations, Medicines Australia and the Generic and Biosimilar Medicines Association (GBMA) (October 2011-December 2017). EXPOSURE Changes to transparency reporting requirements with the updates of pharmaceutical industry Codes of Conduct in 2015. MAIN OUTCOME MEASURES Elements of healthcare sector spending that members of industry organisations are required to publicly disclose; cumulative amount of disclosed spending (monthly average) in the year prior to and following the revision. RESULTS There was a 34.1% reduction in disclosed spending from Medicines Australia member companies in the year after the 2015 changes to the Code of Conduct were introduced ($A89 658 566 in the preceding year, October 2014-September 2015; $A59 052 551 in the following year). The new Code allowed for reduced reporting of spending on food and beverages at events and for sponsored healthcare professionals. However, there was enhanced transparency around identification of individual health professionals receiving payments. GBMA member reporting totalled $A2 580 402 in the year prior to the revision, then ceased. CONCLUSIONS This study shows the limitations of a self-regulatory system around industry disclosure of spending. We advocate for robust regulatory systems, such as legislation, to promote mandatory long-lasting public transparency.
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Affiliation(s)
- Lisa Parker
- School of Pharmacy Faculty of Medicine & Health, The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Emily A Karanges
- School of Pharmacy Faculty of Medicine & Health, The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Lisa Bero
- School of Pharmacy Faculty of Medicine & Health, The University of Sydney Charles Perkins Centre, Sydney, New South Wales, Australia
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Affiliation(s)
- Bethany Bruno
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH 44195, USA
- Department of Bioethics, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Susannah Rose
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH 44195, USA
- Department of Bioethics, Case Western Reserve University, Cleveland, OH 44106, USA
- Office of Patient Experience, Cleveland Clinic, Cleveland, OH 44195, USA
- Center for Bioethics, Cleveland Clinic, Cleveland, OH 44195, USA
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Affiliation(s)
- Anil Chandra Anand
- Department of Gastroenterology, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi 110076, India
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Affiliation(s)
- Jeffrey R Botkin
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City
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Mello MM, Murtagh L, Joffe S, Taylor PL, Greenberg Y, Campbell EG. Beyond financial conflicts of interest: Institutional oversight of faculty consulting agreements at schools of medicine and public health. PLoS One 2018; 13:e0203179. [PMID: 30372431 PMCID: PMC6205599 DOI: 10.1371/journal.pone.0203179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 10/08/2018] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE Approximately one-third of U.S. life sciences faculty engage in industry consulting. Despite reports that consulting contracts often impinge on faculty and university interests, institutional approaches to regulating consulting agreements are largely unknown. OBJECTIVE To investigate the nature of institutional oversight of faculty consulting contracts at U.S. schools of medicine and public health. DESIGN Structured telephone interviews with institutional administrators. Questions included the nature of oversight for faculty consulting agreements, if any, and views about consulting as a private versus institutional matter. Interviews were analyzed using a structured coding scheme. SETTING All accredited schools of medicine and public health in the U.S. PARTICIPANTS Administrators responsible for faculty affairs were identified via internet searches and telephone and email follow-up. The 118 administrators interviewed represented 73% of U.S. schools of medicine and public health, and 75% of those invited to participate. INTERVENTION Structured, 15-30 minute telephone interviews. MAIN OUTCOMES AND MEASURES Prevalence and type of institutional oversight; responses to concerning provisions in consulting agreements; perceptions of institutional oversight. RESULTS One third of institutions (36%) required faculty to submit at least some agreements for institutional review and 36% reviewed contracts upon request, while 35% refused to review contracts. Among institutions with review, there was wide variation the issues covered. The most common topic was intellectual property rights (64%), while only 23% looked at publication rights and 19% for inappropriately broad confidentiality provisions. Six in ten administrators reported they had no power to prevent faculty from signing consulting agreements. Although most respondents identified institutional risks from consulting relationships, many maintained that consulting agreements are "private." CONCLUSIONS AND RELEVANCE Oversight of faculty consulting agreements at U.S. schools of medicine and public health is inconsistent across institutions and usually not robust. The interests at stake suggest the need for stronger oversight.
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Affiliation(s)
- Michelle M. Mello
- Stanford Law School and the Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, United States of America
| | - Lindsey Murtagh
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Steven Joffe
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Patrick L. Taylor
- Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics, Harvard Law School, Cambridge, Massachusetts, United States of America
| | - Yelena Greenberg
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Eric G. Campbell
- Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora, Colorado, United States of America
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Affiliation(s)
- Ladan Golestaneh
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Medicine/Renal Division, Bronx, NY 10467, USA.
| | - Ethan Cowan
- Department of Emergency Medicine, Mount Sinai Beth Israel Medical Center, Icahn Mount Sinai School of Medicine, New York, NY, USA
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Abstract
The Physician Payments Sunshine Act ("Sunshine Act"), enacted to address financial conflicts in health care, is the first comprehensive federal legislation mandating public reporting of payments between drug companies, device manufacturers, and medicine. This article analyzes the Sunshine Act's uneven record, exploring how the law serves as an intriguing example of the uncertain case for transparency regulation in health care. The Sunshine Act's bumpy rollout demonstrates that commanding transparency through legislation can be arduous because of considerable implementation challenges. Capturing all the relevant information about financial relationships and reporting it with sufficient contextual and comparative data has proven disappointingly difficult. In addition, the law suffers from uncertainty and poor design as to the intended audience. Indeed, there is strong reason to believe that it will not significantly impact decision-making of primary recipients like patients. Yet the Sunshine Act nonetheless retains important and perhaps underappreciated value. From the almost four years of information generated, we have learned that industry-medicine financial ties vary significantly by physician specialty, and somewhat by physician gender. In many medical fields the distribution of top dollar payments tends to be heavily skewed to a few recipients, all of which have important implications for optimal management of financial conflicts and for health policy more generally. Accordingly, the Sunshine Act's greatest potential is not guiding decisions of individual patients or physicians, but its downstream effects. This Article traces how secondary audiences, such as regulators, watchdogs, and counsel are already starting to make productive use of Sunshine Act information. Public reporting has, for example, made more feasible linking industry payment information with Medicare reimbursement data. As a result, policymakers can more closely examine correlations between industry spending directed at individual physicians and their prescribing and referral decisions. Moreover, savvy counsel are recognizing that Sunshine Act information provides explosive evidence in private civil litigation and this Article explores the first wave of cases.
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Affiliation(s)
- Richard S Saver
- Arch T. Allen Distinguished Professor, UNC School of Law; Professor (Secondary Appointment), UNC School of Medicine; Adjunct Professor, UNC Gillings School of Global Public Health. This article benefited from helpful comments received by participants at the UNC School of Law Faculty Workshop and a conference at Harvard Law School's Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics. Special thanks also to MacKenzie Dickerman and Kerry Dutra for excellent research assistance
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Clark JR. Conflict of Interest. Air Med J 2017; 36:160-161. [PMID: 28739232 DOI: 10.1016/j.amj.2017.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 05/17/2017] [Indexed: 06/07/2023]
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Abstract
OBJECTIVES To analyse patterns and characteristics of pharmaceutical industry sponsorship of events for Australian health professionals and to understand the implications of recent changes in transparency provisions that no longer require reporting of payments for food and beverages. DESIGN Cross-sectional analysis. PARTICIPANTS AND SETTING 301 publicly available company transparency reports downloaded from the website of Medicines Australia, the pharmaceutical industry trade association, covering the period from October 2011 to September 2015. RESULTS Forty-two companies sponsored 116 845 events for health professionals, on average 608 per week with 30 attendees per event. Events typically included a broad range of health professionals: 82.0% included medical doctors, including specialists and primary care doctors, and 38.3% trainees. Oncology, surgery and endocrinology were the most frequent clinical areas of focus. Most events (64.2%) were held in a clinical setting. The median cost per event was $A263 (IQR $A153-1195) and over 90% included food and beverages. CONCLUSIONS Over this 4-year period, industry-sponsored events were widespread and pharmaceutical companies maintained a high frequency of contact with health professionals. Most events were held in clinical settings, suggesting a pervasive commercial presence in everyday clinical practice. Food and beverages, known to be associated with changes to prescribing practice, were almost always provided. New Australian transparency provisions explicitly exclude meals from the reporting requirements; thus, a large proportion of potentially influential payments from pharmaceutical companies to health professionals will disappear from public view.
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Affiliation(s)
- Alice Fabbri
- Center of Research in Medical Pharmacology, The University of Insubria, Varese, Italy
- Charles Perkins Centre and Faculty of Pharmacy, The University of Sydney, Camperdown, Australia
| | - Quinn Grundy
- Charles Perkins Centre and Faculty of Pharmacy, The University of Sydney, Camperdown, Australia
| | - Barbara Mintzes
- Charles Perkins Centre and Faculty of Pharmacy, The University of Sydney, Camperdown, Australia
| | - Swestika Swandari
- Charles Perkins Centre and Faculty of Pharmacy, The University of Sydney, Camperdown, Australia
| | - Ray Moynihan
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
- Sydney Medical School – Public Health, The University of Sydney, Camperdown, Australia
| | - Emily Walkom
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Lisa A Bero
- Charles Perkins Centre and Faculty of Pharmacy, The University of Sydney, Camperdown, Australia
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Cherla DV, Olavarria OA, Holihan JL, Viso CP, Hannon C, Kao LS, Ko TC, Liang MK. Discordance of conflict of interest self-disclosure and the Centers of Medicare and Medicaid Services. J Surg Res 2017; 218:18-22. [PMID: 28985847 DOI: 10.1016/j.jss.2017.05.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 02/22/2017] [Revised: 03/18/2017] [Accepted: 05/08/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Open Payments Database (OPD) discloses financial transactions between manufacturers and physicians. The concordance of OPD versus self-reported conflicts of interest (COI) is unknown. MATERIALS AND METHODS Our objectives were to compare (1) industry and self-disclosed COI in clinical literature, (2) payments within each disclosure level, and (3) industry- and self-disclosed COI and payments by specialty. This was an observational study. PubMed was searched for clinical studies accepted for publication from January 2014 to June 2016. Author and OPD-disclosed COIs were compared. Articles and authors were divided into full disclosure, incomplete industry disclosure, incomplete self-disclosure, and no COI. Primary outcome (differences in reported COI per article) was assessed using McNemar's test. Payment differences were compared using Kruskal-Wallis test. RESULTS OPD- and self-disclosed COI differed (65.0% discordance rate by article, P < 0.001). Percentages of authors within each disclosure category differed between specialties (P < 0.001). Hematology articles exhibited the highest discordance rate (79.0%) and received the highest median payment for incomplete self-disclosure ($30,812). CONCLUSIONS Significant discordance exists between self- and OPD-reported COI. Additional research is needed to determine reasons for these differences.
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Affiliation(s)
- Deepa V Cherla
- Department of Surgery, Lyndon Baines Johnson Hospital, University of Texas, Houston, Texas.
| | - Oscar A Olavarria
- Department of Surgery, Lyndon Baines Johnson Hospital, University of Texas, Houston, Texas
| | - Julie L Holihan
- Department of Surgery, Lyndon Baines Johnson Hospital, University of Texas, Houston, Texas
| | - Cristina Perez Viso
- Department of Surgery, Lyndon Baines Johnson Hospital, University of Texas, Houston, Texas
| | - Craig Hannon
- Department of Surgery, Lyndon Baines Johnson Hospital, University of Texas, Houston, Texas
| | - Lillian S Kao
- Department of Surgery, Lyndon Baines Johnson Hospital, University of Texas, Houston, Texas
| | - Tien C Ko
- Department of Surgery, Lyndon Baines Johnson Hospital, University of Texas, Houston, Texas
| | - Mike K Liang
- Department of Surgery, Lyndon Baines Johnson Hospital, University of Texas, Houston, Texas
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Affiliation(s)
- Abigail Zuger
- Department of Medicine, Mount Sinai St Luke's Hospital and Mount Sinai West Hospital, New York, New York
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Affiliation(s)
- Harold C Sox
- Patient-Centered Outcomes Research Institute, Washington, DC
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Purdy S, Little M, Mayes C, Lipworth W. Debates about Conflict of Interest in Medicine: Deconstructing a Divided Discourse. J Bioeth Inq 2017; 14:135-149. [PMID: 28050797 DOI: 10.1007/s11673-016-9764-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 10/21/2016] [Indexed: 06/06/2023]
Abstract
The pharmaceutical industry plays an increasingly dominant role in healthcare, raising concerns about "conflicts of interest" (COI) on the part of the medical professionals who interact with the industry. However, there is considerable disagreement over the extent to which COI is a problem and how it should be managed. Participants in debates about COI have become entrenched in their views, which is both unproductive and deeply confusing for the majority of medical professionals trying to work in an increasingly commercialized environment. We used a modified meta-narrative review method to analyse debates about COI in the academic and grey literature. We found two Discourse Models: The Critical Discourse Model sees COI in health and biomedicine as a major problem that both can and should be addressed, while the Defensive Discourse Model argues that current efforts to control COIs are at best unnecessary and at worst harmful. Each model is underpinned by profoundly differing views about how society should be organized-in particular whether market forces should be encouraged or curtailed-and how the dangers associated with market forces should be managed. In order to make any headway, academics and policymakers must recognize that these debates are underpinned by profoundly differing worldviews.
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Affiliation(s)
- Serena Purdy
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Miles Little
- Centre for Values, Ethics and the Law in Medicine, Medical Foundation Building (K25), University of Sydney, Sydney, NSW, 2006, Australia
| | - Christopher Mayes
- Centre for Values, Ethics and the Law in Medicine, Medical Foundation Building (K25), University of Sydney, Sydney, NSW, 2006, Australia
| | - Wendy Lipworth
- Centre for Values, Ethics and the Law in Medicine, Medical Foundation Building (K25), University of Sydney, Sydney, NSW, 2006, Australia.
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Ahmed R, Lopez J, Bae S, Massie AB, Chow EK, Chopra K, Orandi BJ, Lonze BE, May JW, Sacks JM, Segev DL. The Dawn of Transparency: Insights from the Physician Payment Sunshine Act in Plastic Surgery. Ann Plast Surg 2017; 78:315-323. [PMID: 28182596 PMCID: PMC5308560 DOI: 10.1097/sap.0000000000000874] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Physician Payments Sunshine Act (PSSA) is a government initiative that requires all biomedical companies to publicly disclose payments to physicians through the Open Payments Program (OPP). The goal of this study was to use the OPP database and evaluate all nonresearch-related financial transactions between plastic surgeons and biomedical companies. METHODS Using the first wave of OPP data published on September 30, 2014, we studied the national distribution of industry payments made to plastic surgeons during a 5-month period. We explored whether a plastic surgeon's scientific productivity (as determined by their h-index), practice setting (private versus academic), geographic location, and subspecialty were associated with payment amount. RESULTS Plastic surgeons (N = 4195) received a total of US $5,278,613. The median (IQR) payment to a plastic surgeon was US $115 (US $35-298); mean, US $158. The largest payment to an individual was US $341,384. The largest payment category was non-CEP speaker fees (US $1,709,930) followed by consulting fees (US $1,403,770). Plastic surgeons in private practice received higher payments per surgeon compared with surgeons in academic practice (median [IQR], US $165 [US $81-$441] vs median [IQR], US $112 [US $33-$291], rank-sum P < 0.001). Among academic plastic surgeons, a higher h-index was associated with 77% greater chance of receiving at least US $1000 in total payments (RR/10 unit h-index increase = 1.47 1.772.11, P < 0.001). This association was not seen among plastic surgeons in private practice (RR = 0.89 1.091.32, P < 0.4). CONCLUSIONS Plastic surgeons in private practice receive higher payments from industry. Among academic plastic surgeons, higher payments were associated with higher h-indices.
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Affiliation(s)
- Rizwan Ahmed
- From the Departments of *Surgery, and †Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine; ‡Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD; and §Division of Plastic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA
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Scheffer P, Guy-Coichard C, Outh-Gauer D, Calet-Froissart Z, Boursier M, Mintzes B, Borde JS. Conflict of Interest Policies at French Medical Schools: Starting from the Bottom. PLoS One 2017; 12:e0168258. [PMID: 28068362 PMCID: PMC5221756 DOI: 10.1371/journal.pone.0168258] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/29/2016] [Indexed: 11/18/2022] Open
Abstract
Background Medical faculties have a role in ensuring that their students are protected from undue commercial influence during their training, and are educated about professional-industry interactions. In North America, many medical faculties have introduced more stringent conflict of interest (COI) policies during the last decade. We asked whether similar steps had been taken in France. We hypothesized that such policies may have been introduced following a 2009–2010 drug safety scandal (benfluorex, Mediator) in which COIs in medicine received prominent press attention. Methods We searched the websites of all 37 French Faculties of Medicine in May 2015 for COI policies and curriculum, using standardized keyword searches. We also surveyed all deans of medicine on institutional COI policies and curriculum, based on criteria developed in similar US and Canadian surveys. Personal contacts were also consulted. We calculated a summary score per faculty based on 13 criteria. [range 0–26; higher scores denoting stronger policies] Results In total, we found that 9/37 (24%) of French medical schools had either introduced related curriculum or implemented a COI-related policy. Of these, only 1 (2.5%) had restrictive policies for any category. No official COI policies were found at any of the schools. However, at 2 (5%), informal policies were reported. The maximum score per faculty was 5/26, with 28 (76%) scoring 0. Conclusion This is the first survey in France to examine COI policies at medical faculties. We found little evidence that protection of medical students from undue commercial influence is a priority, either through institutional policies or education. This is despite national transparency legislation on industry financing of health professionals and limits on gifts. The French National Medical Students Association (ANEMF) has called for more attention to COI in medical education; our results strongly support such a call.
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Affiliation(s)
- Paul Scheffer
- Sciences of Education Department, Paris 8 University, Saint-Denis France
- * E-mail:
| | | | - David Outh-Gauer
- Faculty of Medicine Purpan, Toulouse 3 University, Toulouse, France
| | | | | | - Barbara Mintzes
- Faculty of Pharmacy, Charles Perkins Centre, The University of Sydney, Sydney, Australia
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Paumgartten FJR. Pharmaceutical lobbying in Brazil: a missing topic in the public health research agenda. Rev Saude Publica 2016; 50:70. [PMID: 28099661 PMCID: PMC5152825 DOI: 10.1590/s1518-8787.2016050006508] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 10/15/2015] [Indexed: 11/21/2022] Open
Abstract
In the US, where registration of lobbyists is mandatory, the pharmaceutical industry and private health-care providers spend huge amounts of money seeking to influence health policies and government decisions. In Brazil, where lobbying lacks transparency, there is virtually no data on drug industry expenditure to persuade legislators and government officials of their viewpoints and to influence decision-making according to commercial interests. Since 1990, however, the Associação da Indústria Farmacêutica de Pesquisa (Interfarma - Pharmaceutical Research Industry Association), Brazilian counterpart of the Pharmaceutical Research and Manufacturers of America (PhRMA), main lobbying organization of the US pharmaceutical industry, has played a major role in the advocacy of interests of major drug companies. The main goals of Interfarma lobbying activities are: shortening the average time taken by the Brazilian regulatory agency (ANVISA) to approve marketing authorization for a new drug; making the criteria for incorporation of new drugs into SUS (Brazilian Unified Health System) more flexible and speeding up technology incorporation; changing the Country's ethical clearance system and the ethical requirements for clinical trials to meet the need of the innovative drug industry, and establishing a National Policy for Rare Diseases that allows a prompt incorporation of orphan drugs into SUS. Although lobbying affects community health and well-being, this topic is not in the public health research agenda. The impacts of pharmaceutical lobbying on health policies and health-care costs are of great importance for SUS and deserve to be investigated.
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Centers for Medicare & Medicaid Services (CMS), HHS. Medicare Program; Conditions for Coverage for End-Stage Renal Disease Facilities--Third Party Payment. Interim final rule with comment period. Fed Regist 2016; 81:90211-28. [PMID: 28001019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This interim final rule with comment period implements new requirements for Medicare-certified dialysis facilities that make payments of premiums for individual market health plans. These requirements apply to dialysis facilities that make such payments directly, through a parent organization, or through a third party. These requirements are intended to protect patient health and safety; improve patient disclosure and transparency; ensure that health insurance coverage decisions are not inappropriately influenced by the financial interests of dialysis facilities rather than the health and financial interests of patients; and protect patients from mid-year interruptions in coverage.
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Morciano C, Basevi V, Faralli C, Hilton Boon M, Tonon S, Taruscio D. Policies on Conflicts of Interest in Health Care Guideline Development: A Cross-Sectional Analysis. PLoS One 2016; 11:e0166485. [PMID: 27846255 PMCID: PMC5113001 DOI: 10.1371/journal.pone.0166485] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/28/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess whether organisations that develop health care guidelines have conflict of interest (COI) policies and to review the content of the available COI policies. METHODS Survey and content analysis of COI policies available in English, French, Spanish, and Italian conducted between September 2014 and June 2015. A 24-item data abstraction instrument was created on the basis of guideline development standards. RESULTS The survey identified 29 organisations from 19 countries that met the inclusion criteria. From these organisations, 19 policies were eligible for inclusion in the content analysis. Over one-third of the policies (7/19, 37%) did not report or did not clearly report whether disclosure was a prerequisite for membership of the guideline panel. Strategies for the prevention of COI such as divestment were mentioned by only two organisations. Only 21% of policies (4/19) used criteria to determine whether an interest constitutes a COI and to assess the severity of the risk imposed. CONCLUSIONS The finding that some organisations, in contradiction of widely available standards, still do not have COI policies publicly available is concerning. Also troubling were the findings that some policies did not clearly report critical steps in obtaining, managing and communicating disclosure of relationships of interest. This in addition to the variability encountered in content and accessibility of COI policies may cause confusion and distrust among guideline users. It is in the interest of guideline users and developers to design an agreed-upon, comprehensive, clear, and accessible COI policy.
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Affiliation(s)
- Cristina Morciano
- Centro Nazionale Malattie Rare, Istituto Superiore di Sanità, Rome, Italy
| | - Vittorio Basevi
- Centro di Documentazione sulla Salute Perinatale e Riproduttiva, Servizio assistenza distrettuale, medicina generale, pianificazione e sviluppo dei servizi sanitari, Regione Emilia-Romagna, Bologna, Italy
| | - Carla Faralli
- Servizio Informatico, Documentazione, Biblioteca e Attività Editoriali, Istituto Superiore di Sanità, Rome, Italy
| | - Michele Hilton Boon
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Sabina Tonon
- Formerly Centro Nazionale Malattie Rare, Istituto Superiore di Sanità, Rome, Italy
| | - Domenica Taruscio
- Centro Nazionale Malattie Rare, Istituto Superiore di Sanità, Rome, Italy
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Thompson JC, Volpe KA, Bridgewater LK, Qeadan F, Dunivan GC, Komesu YM, Cichowski SB, Jeppson PC, Rogers RG. Sunshine Act: shedding light on inaccurate disclosures at a gynecologic annual meeting. Am J Obstet Gynecol 2016; 215:661.e1-661.e7. [PMID: 27319366 DOI: 10.1016/j.ajog.2016.06.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 01/05/2016] [Revised: 05/27/2016] [Accepted: 06/07/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Physicians and hospital systems often have relationships with biomedical manufacturers to develop new ideas, products, and further education. Because this relationship can influence medical research and practice, reporting disclosures are necessary to reveal any potential bias and inform consumers. The Sunshine Act was created to develop a new reporting system of these financial relationships called the Open Payments database. Currently all disclosures submitted with research to scientific meetings are at the discretion of the physician. We hypothesized that financial relationships between authors and the medical industry are underreported. OBJECTIVES We aimed to describe concordance between physicians' financial disclosures listed in the abstract book from the 41st annual scientific meeting of the Society of Gynecologic Surgeons to physician payments reported to the Center for Medicaid and Medicare Services Open Payments database for the same year. STUDY DESIGN Authors and scientific committee members responsible for the content of the 41st annual scientific meeting of the Society of Gynecologic Surgeons were identified from the published abstract book; each abstract listed disclosures for each author. Abstract disclosures were compared with the transactions recorded on the Center for Medicaid and Medicare Services Open Payments database for concordance. Two authors reviewed each nondisclosed Center for Medicaid and Medicare Services listing to determine the relatedness between the company listed on the Center for Medicaid and Medicare Services and abstract content. RESULTS Abstracts and disclosures of 335 physicians meeting inclusion criteria were reviewed. A total of 209 of 335 physicians (62%) had transactions reported in the Center for Medicaid and Medicare Services, which totaled $1.99 million. Twenty-four of 335 physicians (7%) listed companies with their abstracts; 5 of those 24 physicians were concordant with the Center for Medicaid and Medicare Services. The total amount of all nondisclosed transactions was $1.3 million. Transactions reported in the Center for Medicaid and Medicare Services associated with a single physician ranged from $11.72 to $405,903.36. Of the 209 physicians with Center for Medicaid and Medicare Services transactions that were not disclosed, the majority (68%) had at least 1 company listed in the Center for Medicaid and Medicare Services that was determined after review to be related to the subject of their abstract. CONCLUSION Voluntary disclosure of financial relationships was poor, and the majority of unlisted disclosures in the abstract book were companies related to the scientific content of the abstract. Better transparency is needed by physicians responsible for the content presented at gynecological scientific meetings.
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Affiliation(s)
- Jennifer C Thompson
- Department of Obstetrics and Gynecology, Division of Urogynecology, University of New Mexico, Albuquerque, NM
| | - Katherine A Volpe
- Department of Obstetrics and Gynecology, Division of Urogynecology, University of New Mexico, Albuquerque, NM
| | - Lindsay K Bridgewater
- Department of Obstetrics and Gynecology, Division of Urogynecology, University of New Mexico, Albuquerque, NM
| | - Fares Qeadan
- Clinical and Translational Science Center, University of New Mexico, Albuquerque, NM
| | - Gena C Dunivan
- Department of Obstetrics and Gynecology, Division of Urogynecology, University of New Mexico, Albuquerque, NM
| | - Yuko M Komesu
- Department of Obstetrics and Gynecology, Division of Urogynecology, University of New Mexico, Albuquerque, NM
| | - Sara B Cichowski
- Department of Obstetrics and Gynecology, Division of Urogynecology, University of New Mexico, Albuquerque, NM
| | - Peter C Jeppson
- Department of Obstetrics and Gynecology, Division of Urogynecology, University of New Mexico, Albuquerque, NM
| | - Rebecca G Rogers
- Department of Obstetrics and Gynecology, Division of Urogynecology, University of New Mexico, Albuquerque, NM.
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Holzgreve H. [Sponsoring: uncertainty despite transparency law]. MMW Fortschr Med 2016; 158:34. [PMID: 27155698 DOI: 10.1007/s15006-016-8197-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Joossens L, Gilmore AB, Stoklosa M, Ross H. Assessment of the European Union's illicit trade agreements with the four major Transnational Tobacco Companies. Tob Control 2016; 25:254-60. [PMID: 26022741 PMCID: PMC4853556 DOI: 10.1136/tobaccocontrol-2014-052218] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 05/04/2015] [Indexed: 11/05/2022]
Abstract
To address the illicit cigarette trade, the European Union (EU) has signed agreements with the four major Transnational Tobacco Companies (TTCs) that involve establishing extensive systems of cooperation. All agreements foresee two types of payments: annual payments (totalling US$ 1.9 billion over 20 years) and supplementary seizure payments, equivalent to 100% of the evaded taxes in the event of seizures of their products. While limited by the fundamental lack of transparency in this area, our analysis suggests that these agreements have served largely to secure the TTCs' interests and are threatening progress in tobacco control. The seizure payments are paltry and a wholly inadequate deterrent to TTC involvement in illicit trade. Despite the agreements, growing evidence indicates the TTCs remain involved in the illicit trade or are at best failing to secure their supply chains as required by the agreements. The intention of the seizure-based payments to deter the tobacco industry from further involvement in the illicit cigarette trade has failed because the agreements contain too many loopholes that provide TTCs with both the incentive and opportunity to classify seized cigarettes as counterfeit. In addition, the shifting nature of cigarette smuggling from larger to smaller consignments often results in seizures that are too small to qualify for the payments. Consequently, the seizure payments represent a tiny fraction of the revenue lost from cigarette smuggling, between 2004 and 2012, 0.08% of the estimated losses due to illicit cigarette trade in the EU. Our evidence suggests the EU should end these agreements.
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Affiliation(s)
- Luk Joossens
- Association of the European Cancer Leagues & Tobacco Control Expert, Foundation Against Cancer, Brussels, Belgium
| | - Anna B Gilmore
- Department for Health, University of Bath and UK Centre for Tobacco and Alcohol Studies, Bath, UK
| | - Michal Stoklosa
- Economic and Health Policy Research, American Cancer Society, Atlanta, USA
| | - Hana Ross
- University of Cape Town, Cape Town, South Africa
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Affiliation(s)
- Shantanu Agrawal
- From the Centers for Medicare and Medicaid Services, Washington, DC
| | - Douglas Brown
- From the Centers for Medicare and Medicaid Services, Washington, DC
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Abstract
Faculty members are expected to abide by codes of conduct that are delineated in institutional policies and to behave ethically when engaging in scientific pursuits. As federal funds for research decrease, faculty members face increasing pressure to sustain their research activities, and many have developed new collaborations and pursued new entrepreneurial opportunities. As research collaborations increase, however, there may be competition to get credit as the first person to develop ideas, make new discoveries, and/or publish new findings. This increasingly competitive academic environment may contribute to intentional or unintentional faculty misconduct. The authors, who work in the Dean's Office at a large U.S. medical school (University of California, San Francisco), investigate one to two cases of alleged misconduct each month. These investigations, which are stressful and unpleasant, may culminate in serious disciplinary action for the faculty member. Further, these allegations sometimes result in lengthy and acrimonious civil litigation. This Perspective provides three examples of academic misconduct: violations of institutional conflict-of-interest policies, disputes about intellectual property, and authorship conflicts.The authors also describe prevention and mitigation strategies that their medical school employs, which may be helpful to other institutions. Prevention strategies include training campus leaders, using attestations to reduce violations of institutional policies, encouraging open discussion and written agreements about individuals' roles and responsibilities, and defining expectations regarding authorship and intellectual property at the outset. Mitigation strategies include using mediation by third parties who do not have a vested academic, personal, or financial interest in the outcome.
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Affiliation(s)
- Renée Binder
- R. Binder is associate dean, Office of Academic Affairs, and professor of psychiatry, School of Medicine, University of California, San Francisco, San Francisco, California. A. Friedli is executive director, Office of Academic Affairs, School of Medicine, University of California, San Francisco, San Francisco, California. E. Fuentes-Afflick is vice dean, Office of Academic Affairs, and professor of pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California
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Pope TM. Legal Briefing: Mandated Reporters and Compulsory Reporting Duties. J Clin Ethics 2016; 27:76-83. [PMID: 27045312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This issue's "Legal Briefing" column, one product of a Greenwall Foundation grant, reviews recent developments concerning compulsory reporting duties. Most licensed clinicians in the United States are "mandated reporters." When these clinicians discover certain threats to the safety of patients or the public, they are legally required to report that information to specified government officials. Over the past year, several states have legislatively expanded the scope of these reporting duties. In other states, new court cases illustrate the vigorous enforcement of already existing duties. I have organized all these legal developments into the following eight categories: 1. Overview of Mandatory Reporting Duties 2. Controversy over the Benefits of Mandatory Reporting 3. New and Expanded Duties to Report 4. Criminal Penalties for Failing to Report 5. Civil Liability for Failing to Report 6. Disciplinary Penalties for Failing to Report 7. Legal Immunity for Good-Faith Reporting 8. Protection against Employers' Retaliation.
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Affiliation(s)
- Thaddeus Mason Pope
- Mitchell Hamline School of Law, 875 Summit Avenue, Saint Paul, Minnesota 55105-3076 USA.
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Osuna E, Pérez Cárceles MD, Sánchez Ferrer ML, Machado F. Caesarean delivery: conflicting interests. Reprod Biomed Online 2015; 31:815-8. [PMID: 26371711 DOI: 10.1016/j.rbmo.2015.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/24/2015] [Accepted: 08/12/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Eduardo Osuna
- Department of Legal and Forensic Medicine, University of Murcia, E-30100, Murcia, Spain.
| | | | | | - Francisco Machado
- Department of Obstetrics, University Hospital Virgen de la Arrixaca, E-30120, Murcia, Spain
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O'Dowd A. Doctors face compulsory system to declare gifts and hospitality from drug companies. BMJ 2015; 351:h4617. [PMID: 26311722 DOI: 10.1136/bmj.h4617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Wodarg W. [More public attorneys in the jungle of health care!]. MMW Fortschr Med 2015; 157:18. [PMID: 26012806 DOI: 10.1007/s15006-015-3063-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Farquhar C, Stokes T, Grey A, Jeffery M, Griffin P. Let the sunshine in--making industry payments to New Zealand doctors transparent. N Z Med J 2015; 128:6-12. [PMID: 25820497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Cindy Farquhar
- Obstetrics and Gynaecology, University of Auckland, Park Road, Auckland 1042, New Zealand.
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Weinstock R. Dialectical principlism: an approach to finding the most ethical action. J Am Acad Psychiatry Law 2015; 43:10-20. [PMID: 25770274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Most forensic psychiatrists occasionally face complex situations in forensic work in which ethics dilemmas cause discomfort. They want to determine the most ethical action, but the best choice is unclear. Fostering justice is primary in forensic roles, but secondary duties such as traditional biomedical ethics and personal values like helping society, combating racism, and being sensitive to cultural issues can impinge on or even outweigh the presumptive primary duty in extreme cases. Similarly, in treatment the psychiatrists' primary duty is to patients, but that can be outweighed by secondary duties such as protecting children and the elderly or maintaining security. The implications of one's actions matter. In forensic work, if the psychiatrist determines that he should not assist the party who wants to hire him, despite evidence clearly supporting its side, the only ethical option becomes not to accept the case at all, because the evidence does not support the better side. Sometimes it can be ethical to accept cases only for one side. In ethics-related dilemmas, I call the method of prioritizing and balancing all types of conflicting principles, duties, and personal and societal values in a dialectic to resolve conflicts among them dialectical principlism. This approach is designed to help determine the most ethical action. It is aspirational and is not intended to get the psychiatrist into trouble.
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Affiliation(s)
- Robert Weinstock
- Dr. Weinstock is Health Sciences Clinical Professor of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA. A version of this paper was presented as the President's Address at the 45th Annual Meeting of the American Academy of Psychiatry and the Law.
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Young JL. Commentary: is the plot thickening for partisan forensic expert witnesses? J Am Acad Psychiatry Law 2015; 43:32-34. [PMID: 25770276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Knowledge of the past has a powerful way of clarifying the challenges of the present. Dr. Weiss enables the reader to exploit this phenomenon as it applies to the important perennial struggle of the expert witness for objectivity.
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Affiliation(s)
- John L Young
- Dr. Young is Clinical Professor of Psychiatry, Law and Psychiatry Division, Department of Psychiatry, Yale School of Medicine, New Haven, CT.
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Weiss KJ. John H. Wigmore on the abolition of partisan experts. J Am Acad Psychiatry Law 2015; 43:21-31. [PMID: 25770275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The American justice system traditionally has relied on expert witnesses hired by adverse parties, resulting in the appearance of dueling hired guns. There have been attempts to reform the system through court-appointed impartial experts, but trial attorneys have resisted them. Celebrated cases have brought the problem to the forefront--for example, the 1924 murder trial of Richard Loeb and Nathan Leopold, Jr, in Chicago. These young men were on trial for kidnapping and killing a teenage boy. That there was no motive but thrill-seeking incensed citizens, who called for their death. Several psychiatrists testified at the penalty phase. The judge sentenced the defendants to life in prison, ostensibly because of their age. Commenting on the case, John H. Wigmore, Dean of Northwestern Law School and authority on evidence, critiqued the system of partisan experts. This article contains a reprint of his editorial and a discussion of it in the context of evolving expert testimony standards. My conclusion is that a robust but honest airing of opinions is most helpful in criminal cases and that court-appointed experts may be more appropriate in civil and domestic relations matters.
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Affiliation(s)
- Kenneth J Weiss
- Dr. Weiss is Clinical Professor and Associate Director of the Forensic Fellowship Program, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Affiliation(s)
- Sachin Santhakumar
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Eli Y Adashi
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
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