Female Representation and Position Based on Facts and Members Views in the European Society of Coloproctology

BACKGROUND

There is wide variation in gender distribution in colorectal surgery across different European countries.

OBJECTIVE

This study aimed to evaluate female representation, implicit bias, and members' perception on female participation and representation at the European Society of Coloproctology 2017 annual scientific meeting.

DESIGN

This was a retrospective mixed-methods cross-sectional observational study.

SETTINGS

The study was conducted using data from the 2017 European Society of Coloproctology annual scientific meeting program and attendees.

MAIN OUTCOME MEASURES

The primary outcome measure was the percentage of female speakers in the formal program and assessment for implicit bias. Secondary outcomes were the percentage of women attending the conference, the percentage of women serving on committees, and the results of the online survey.

METHODS

Female representation was retrospectively quantified by role, session type, and topic. Implicit bias was measured classifying the introductions of speakers by moderators as formal (using a professional title) or informal (using name only), then further stratified by gender. An online survey was disseminated and analyzed to investigate the members' perception as a benchmark analysis.

RESULTS

Disparities were found between sexes, with fewer women attending the conference (25%), serving as session chairs (8%), speakers (21%), and on committees (10%) compared with men. There were no differences across sexes regarding the formal or informal introduction. The survey among our members showed that significantly fewer women felt equally endorsed within the society compared with men (33% versus 63%; p < 0.001).

LIMITATIONS

The retrospective design with data available to be analyzed was limited by the sessions recorded (27/49) and survey respondents (28%).

CONCLUSIONS

Female representation within European Society of Coloproctology as chair, speaker, attendee, and committee member was much lower than male representation, both in absolute numbers and relative to membership. Greater awareness of this disparity and inclusiveness are aims of our society. The impact of these initiatives will be determined by reevaluating these metrics at the 2020 annual meeting. See Video Abstract at http://links.lww.com/DCR/B384.

REPRESENTACIN Y POSICIN FEMENINA EN LA SOCIEDAD EUROPEA DE COLOPROCTOLOGA BASADA EN LOS HECHOS Y LAS OPINIONES DE SUS MIEMBROS

ANTECEDENTES:Existe una amplia variabilidad en la distribución de géneros en la cirugía colorrectal en los diferentes países de Europa.OBJETIVO:Evaluar la representación femenina, el sesgo implícito y la percepción de los miembros sobre la participación y representación femenina en el 12° Congreso científico anual de la Sociedad Europea de Coloproctología.DESIGN:Este fué un estudio observacional retrospectivo de métodos mixtos transversales.AJUSTES:Los análisis se realizaron utilizando los datos del programa cintífico de la reunión y los datos de los presentes en el Congreso de la ESCP en 2017.MEDIDAS PRINCIPALES DE RESULTADOS:La principal medida en el resultado fue el porcentaje de disertantes femeninas en el programa definitivo y la evaluación del sesgo implícito. Los resultados secundarios fueron el porcentaje de mujeres que asistieron a la conferencia, trabajaron en los comités y los resultados de la encuesta informática.METODOS:La representación femenina se cuantificó retrospectivamente según el rol, tipo de sesión y temas. Se midió el sesgo implícito clasificando las introducciones de los disertantes por parte de los moderadores de manera formal (usando un título profesional) o informal (usando solamente el nombre), y luego fueron estratificadas por género. Se difundió y analizó una encuesta informática para investigar la percepción de los miembros como análisis de referencia.RESULTADOS:Se encontraron disparidades de género, con menos mujeres presentes en la conferencia (25%), obrando como presidentes de sesión (8%), como disertantes (21%) y como miembros de comités (10%) comparadas con los hombres. No hubo diferencia entre sexos con respecto a la introducción formal o informal. La encuesta informática entre los miembros mostró significativamente que menos mujeres se sentían respaldadas igualitariamente dentro de la sociedad comparadas con los hombres (33% frente a 63%, p<0.001).LIMITACIONES:Diseño retrospectivo de datos limitados a las sesiones grabadas (27/49) y a los encuestados (28%) disponibles para el análisis.CONCLUSIONES:La representación femenina dentro de la Sociedad Europea de Coloproctología como presidente, disertante, asistente ó como miembro del comité fué mucho menor que la representación masculina, tanto en números absolutos como en relación con la membresía. Crear una mayor conciencia de esta disparidad de inclusión son prioridad en nuestra sociedad. El impacto de estas iniciativas se determinará re-evaluando estas variables en reuniones futuras. Consulte Video Resumen en http://links.lww.com/DCR/B384.

Pharmaceutical company payments to dermatology Clinical Practice Guideline authors in Japan

Clinical Practice Guidelines (CPGs) play significant roles in most medical fields. However, little is known about the extent of financial Conflicts of Interest (FCOIs) related to pharmaceutical companies (Pharma) selling dermatology prescription products and dermatology CPG authors in Japan. The aims of this study were to elucidate the characteristics and distribution of payments from Pharma to dermatology CPG authors in Japan, and to evaluate the extent of transparency and accuracy in their FCOI disclosures. We analyzed the records of 296 authors from 32 dermatology CPGs published by the Japanese Dermatological Association from the beginning of 2015 to the end of 2018. Using the payment data reported by 79 Pharma between 2016–2017 in Japan, we investigated the characteristics of the CPG authors and the payments from the Pharma to them. Furthermore, we evaluated the transparency and accuracy of the FCOI disclosures of the individual CPG authors. Of the 296 CPGs authors, 269 authors (90.6%) received at least one payment from the Pharma. The total monetary value of payments for the 2-year period was $7,128,762. The median and mean monetary value of payments from the Pharma reporting were $10,281 (interquartile range $2,796 -$34,962) and $26,600 (standard deviation $40,950) for the two years combined. Of the 26 CPG authors who disclosed FCOIs due to the monies received from Pharma, only the atopic dermatitis CPG authors and the acne vulgaris CPG authors published their potential FCOIs. In Japan, most dermatology CPG authors received financial payments from Pharma. The transparency of the CPGs, as reported by the CPG authors, was inadequate, and a more rigorous framework of reporting and monitoring FCOI disclosure is required to improve the accuracy and transparency with relation to possible Conflicts of Interest.

Do codes of ethics and position statements help guide ethical decision making in Australian immigration detention centres?

Australian immigration detention has been called state sanctioned abuse and a crime against humanity. The Australian healthcare community has been closely involved with these policies, calling for their reform and working within detention centres to provide healthcare. As well as having a devastating impact on health, immigration detention changes the scope and nature of healthcare, with its delivery described as a Sisyphean task. In this article I will explore the guidance that is available to clinicians who work within detention centres and argue that codes, guidelines and positions statements provide little help in relation to ethical decision making. First I will outline guidance that can be found in codes of ethics and position statements, focusing on particularly relevant principles, such as advocacy, clinical independence and the clinicians' relationship to human rights. I will then highlight the disparity between this guidance and the delivery of healthcare within detention by drawing on the testimony of clinicians who formerly worked in these environments. While this disparity should be cause for alarm and at a minimum call into question how codes and positions statements are being used (if at all), there are more fundamental reasons why codes and position statements fail to provide guidance in these circumstances. I will outline a more general criticism of codes of ethics and use this to suggest a way forward, including looking beyond codes and position statements to guide action within Australian immigration detention.

Financial Conflicts of Interest Among Authors of Endocrine Society Clinical Practice Guidelines

CONTEXT

There has been a proliferation of clinical practice guidelines in endocrinology and a coincident increased interest in transparency regarding relationships between physicians and industry.

EVIDENCE ACQUISITION

We collected self-reported disclosures and Open Payments data for 169 authors of 26 clinical practice guidelines published between 2010 and 2017 by the Endocrine Society. Conflicts of interest in which pharmaceutical and device companies manufactured drugs or products pertinent to an author's specific clinical practice guideline(s) were deemed relevant. Open Payments data were grouped into research and nonresearch (consultancies, honoraria, travel, food) categories.

EVIDENCE SYNTHESIS

We compared the policies of the Endocrine Society regarding seven conflict of interest recommendations issued by the National Academy of Medicine in 2011.

CONCLUSION

Relevant nonresearch financial conflicts of interest were self-reported by 42% of authors of clinical practice guidelines. Open Payments were recorded for 74% (84 of 113) of US authors between 2013 and 2016. Payments to 84 US authors totaled $5.5 million for nonresearch activities and $30.9 million for research. The nonresearch payments were divided into consulting (46%), honoraria (26%), travel (25%), and food (3%). The Endocrine Society partially follows the National Academy of Medicine recommendations to limit conflicts of interest. Readers should be aware of how clinical practice guidelines are developed and the policies of the organizations and journals that publish them. Professional societies and journal editors should strive to ensure that their policies and practices promote objective and unbiased clinical practice guidelines.

Medical oath: use and relevance of the Declaration of Geneva. A survey of member organizations of the World Medical Association (WMA)

The Declaration of Geneva is one of the core documents of medical ethics. A revision process was started by the World Medical Association (WMA) in 2016. The WMA has also used this occasion to examine how the Declaration of Geneva is used in countries throughout the world by conducting a survey of all WMA constituent members. The findings are highly important and raise urgent questions for the World Medical Association and its National Medical Associations (NMA): The Declaration of Geneva is only rarely used as an oath text despite the fact that physicians' oaths are generally widespread. This is not consistent with the intention and claim of the Declaration of Geneva. The article then discusses three questions. Should there be one single binding oath? Which organization should be responsible for such an oath? Which oath is the most obvious candidate? In a globalized world and despite all cultural diversity, the medical profession should have one core moral basis which is binding for physicians all over the world. The most obvious candidate for an oath incorporating this moral basis is the Declaration of Geneva.

The persistence of racially-based health care inequities

[Full article available at http://rimed.org/rimedicaljournal-2017-11.asp].

The BMA's guidance on conscientious objection may be contrary to human rights law

It is argued that the current policy of the British Medical Association (BMA) on conscientious objection is not aligned with recent human rights developments. These grant a right to conscientious objection to doctors in many more circumstances than the very few recognised by the BMA. However, this wide-ranging right may be overridden if the refusal to accommodate the conscientious objection is proportionate. It is shown that it is very likely that it is lawful to refuse to accommodate conscientious objections that would result in discrimination of protected groups. It is still uncertain, however, in what particular circumstances the objection may be lawfully refused, if it poses risks to the health and safety of patients. The BMA's policy has not caught up with these human rights developments and ought to be changed.

[Conflicts of interest in nephrology]

Since doctors disposed of effective tools to serve their patients, they had to worry about the proper management of available resources and how to deal with the relationship with the industry that provides such resources. In this relation-ship, health professionals may be involved in conflicts of interest that they need to acknowledge and learn how to handle. This article discusses the conflicts of interest in nephrology. Its objectives are to identify those areas where such conflicts could occur; to help to solve them, always considering the best interest of patients; and to help health workers to keep in mind that they have to preserve their autonomy and professional integrity. Conflicts of interest of professionals in the renal area and related scientific societies, with the industry producing equipment, supplies and drugs are reviewed. Dichotomy, payment for referral, self-referral of patients and incentives for cost control are analyzed. Finally, recommendations to help preserve a good practice in nephrology are made.

The Code of Professional Conduct for the Neurocritical Care Society

Part of the responsibility of a professional society is to establish the expectations for appropriate behavior for its members. Some codes are so essential to a society that the code itself becomes the central document defining the organization and its tenets, as we see with the Hippocratic Oath. In that tradition, we have revised the code of professional conduct for the Neurocritical Care Society into its current version, which emphasizes guidelines for personal behavior, relationships with fellow members, relationships with patients, and our interactions with society as a whole. This will be a living document and updated as the needs of our society change in time.Available online: http://www.neurocriticalcare.org/about-us/bylaws-procedures-and-code-professional-conduct (1) Code of professional conduct (this document) (2) Leadership code of conduct (3) Disciplinary policy.

Conflict of interest between professional medical societies and industry: a cross-sectional study of Italian medical societies' websites

OBJECTIVE

To describe how Italian medical societies interact with pharmaceutical and medical device industries through an analysis of the information available on their websites.

DESIGN

Cross sectional study.

SETTING

Italy.

PARTICIPANTS

154 medical societies registered with the Italian Federation of Medical-Scientific Societies.

MAIN OUTCOME MEASURES

Indicators of industry sponsorship (presence of industry sponsorship in the programme of the last medical societies' annual conference; presence of manufacturers' logos on the homepage; presence of industry sponsorship of satellite symposia during the last annual conference).

RESULTS

131 Italian medical societies were considered. Of these, 4.6% had an ethical code covering relationships with industry on their websites, while 45.6% had a statute that mentioned the issue of conflict of interest and 6.1% published the annual financial report. With regard to industry sponsorship, 64.9% received private sponsorship for their last conference, 29.0% had manufacturers' logos on their webpage, while 35.9% had industry-sponsored satellite symposia at their last conference. The presence of an ethical code on the societies' websites was associated with both an increased risk of industry sponsorship of the last conference (relative risk (RR) 1.22, 95% CIs 1.01 to 1.48 after adjustment) and of conferences and/or satellite symposia (RR 1.22, 95% CIs 1.02 to 1.48 after adjustment) but not with the presence of manufacturers' logos on the websites (RR 1.79, 95% CIs 0.66 to 4.82 after adjustment). No association was observed with the other indicators of governance and transparency.

CONCLUSIONS

This survey shows that industry sponsorship of Italian medical societies' conferences is common, while the presence of a structured regulatory system is not. Disclosure of the amount of industry funding to medical societies is scarce. The level of transparency therefore needs to be improved and the whole relationship between medical societies and industry should be further disciplined in order to avoid any potential for conflict of interest.

ACOG Scientific Integrity Deficiency in Recommendation for the Practice of Cosmetic-Plastic Gynecology Misleads Other Gynecological Societies, Inhibits Clinical Education and Research, and Jeopardizes Women's Health

OBJECTIVE

To analyze scientific integrity (scientific quality, objectivity, credibility, and appropriate transparency) of recommendations of gynecologic societies for female genital cosmetic surgery (FGCS) and their references, which were used to support these recommendations.

STUDY DESIGN

The scientific integrity of recommendations for FGCS published by gynecologic societies has never been subjected to scientific scrutiny. Electronic and manual searches for FGCS literature published in the English language were conducted and analyzed for the period of the recommendations. A methodological scientific review of recommendations of gynecologic societies for FGCS was performed. The scientific quality, objectivity, credibility, and appropriate transparency within recommendations of gynecologic societies for FGCS were evaluated.

RESULTS

Overt prejudice and residual bias were found in the recommendations of gynecologic societies relating to FGCS. Scientific imprecise interpretations and omissions of references called current recommendations into questions.

CONCLUSION

Recommendations issued by gynecologic societies relating to FGCS did not meet the scientific integrity norms for scientific quality, objectivity, credibility, and appropriate transparency.

Conflict-of-interest disclosure at medical journals in Japan: a nationwide survey of the practices of journal secretariats

OBJECTIVES

Medical journals in Japan generally have appropriate policies regarding disclosure of conflicts of interest (COI). However, COI management depends on the staff members of each journal's editorial secretariat. This study's objectives were to find out (A) whether COI disclosure and the journal's role in it are clearly understood by the journal's secretariat staff, (B) how much experience the editorial secretariat has in actually handling issues related to disclosure and (C) what kind of help or support they need.

SETTING AND DESIGN

In January 2014, questionnaires were sent to the editorial secretariats of journal-publishing societies belonging to the Japanese Association of Medical Sciences (JAMS).

PARTICIPANTS

The response rate was 100%, and the respondents represented 121 journals published by the 118 JAMS member societies (at the time of the survey).

PRIMARY AND SECONDARY OUTCOME MEASURES

Information was collected on the history of COI policies and on how those policies were implemented. At the end of the questionnaire, there was an open-ended call for comments.

RESULTS

Compulsory COI disclosure began between 2010 and 2013 for 60.3% of the journals (73/121). Handling of COI issues was not uniform: 17.4% (21/121) of respondents do not pursue cases of dubious disclosure, and 47.9% (58/121) do not require COI disclosures from editorial board members. Very few of the editorial secretariats had clearly-stated consequences for violations of COI-disclosure policy (33/121, 27.3%), and only 28.9% offered COI education (35/121). Respondents' comments indicated that uniform, easily-searchable guidance regarding COI policies and implementation would be welcome.

CONCLUSIONS

Although commitment is widespread, policy implementation is inconsistent and COI experience is lacking. Clear, easy-to-use guidelines are desired by many societies. The JAMS is to be commended for supporting this country-wide investigation; other countries and regions are encouraged to perform similar investigations to respond to needs regarding COI management.

An official American Thoracic Society policy statement: managing conscientious objections in intensive care medicine

RATIONALE

Intensive care unit (ICU) clinicians sometimes have a conscientious objection (CO) to providing or disclosing information about a legal, professionally accepted, and otherwise available medical service. There is little guidance about how to manage COs in ICUs.

OBJECTIVES

To provide clinicians, hospital administrators, and policymakers with recommendations for managing COs in the critical care setting.

METHODS

This policy statement was developed by a multidisciplinary expert committee using an iterative process with a diverse working group representing adult medicine, pediatrics, nursing, patient advocacy, bioethics, philosophy, and law.

MAIN RESULTS

The policy recommendations are based on the dual goals of protecting patients' access to medical services and protecting the moral integrity of clinicians. Conceptually, accommodating COs should be considered a "shield" to protect individual clinicians' moral integrity rather than as a "sword" to impose clinicians' judgments on patients. The committee recommends that: (1) COs in ICUs be managed through institutional mechanisms, (2) institutions accommodate COs, provided doing so will not impede a patient's or surrogate's timely access to medical services or information or create excessive hardships for other clinicians or the institution, (3) a clinician's CO to providing potentially inappropriate or futile medical services should not be considered sufficient justification to forgo the treatment against the objections of the patient or surrogate, and (4) institutions promote open moral dialogue and foster a culture that respects diverse values in the critical care setting.

CONCLUSIONS

This American Thoracic Society statement provides guidance for clinicians, hospital administrators, and policymakers to address clinicians' COs in the critical care setting.

Safeguarding the integrity of science communication by restraining 'rational cheating' in peer review

Peer review is the pillar of the integrity of science communication. It is often beset with flaws as well as accusations of unreliability and lack of predictive validity. 'Rational cheating' by reviewers is a threat to the validity of peer review. It may diminish the value of good papers by unfavourable appraisals of the reviewers whose own works have lower scientific merits. This article analyzes the mechanics and defects of peer review and focuses on rational cheating in peer review, its implications, and options to restrain it.

[The Belgian and French medicine and the "Ordres" facing the "jewish question" during the Second World War]

The attitude of the medical community and the "Ordres" to the "jewish question" differs in Belgium and France. This difference originates before the Second World War. Xenophobia and antisemitism were stronger in France. In addition, the Belgian capitulation of May 1940 and the armistice of June 22 in France do not represent the same situation. In France, a legal government, under the direction of Marshal Pétain, took a series of xenophobic measures of which the Jews were the first victims. In Belgium, in the absence of any government, the General Secretaries in Ministries were the ones who had to apply the antijewish measures dictated by the German occupant. By law, they could not legislate on the political level. The "Ordre", of French physicians was created in late 1940 by the Vichy government. In Belgium, the "Ordre " had existed since 1938 but had been unable to meet in the absence of implement decrees. An "Ordre bis" was created in late 1941, the legality of which was questioned by many lawyers and physicians. The French "Ordre" was to apply the antijewish measures by taking responsibility for the selection of Jewish physicians entitled to practice. In Belgium, the "Ordre" frowned upon by the physicians, played no official role in this regard. It simply applied the antijewish measures dictated by the Germans without protesting. After the conflict, the leaders of the "Ordres" had a different fate in both countries. In France, they escaped sentences. In Belgium, they were heavily condemned.

Should AAPL enforce its ethics? Challenges and solutions

Ethics enforcement in psychiatry occurs at the district branch and American Psychiatric Association (APA) levels under the guidance of American Medical Association (AMA) and APA ethics documents. Subspecialty ethics consequently have no formal role in the enforcement process. This reality challenges practitioners to work according to guidelines that may not be sufficiently relevant and challenges ethics reviewers to apply frameworks not intended for the subspecialties. This article offers the theoretical and practical support to amend APA Procedures to permit formal consideration of subspecialty ethics during ethics complaints and to include forensic practitioners on panels reviewing them. This is the first step toward an integration of two conflicting models of ethics enforcement, regulatory and aspirational, that bring together specialty and subspecialty ethics.

Commentary: Medical subspecialty enforcement?

From its inception, the American Academy of Psychiatry and the Law (AAPL) has decided not to investigate and adjudicate complaints of unethical conduct of its members or others, but rather refers the complainant to other organizations, such as the "local district branch of the American Psychiatric Association (APA), the state licensing board, and/or the appropriate national psychiatric organization of foreign members" (AAPL Ethics Guidelines). Loss of APA membership, however, terminates one's AAPL membership upon AAPL notification. Further, the AAPL Ethics Committee "may issue opinions on general or hypothetical questions but will not issue opinions on the ethical conduct of specific forensic psychiatrists or about actual cases" (AAPL Ethics Guidelines). This referral policy has been criticized at times with various proposals for change. Candilis and colleagues have thoughtfully considered several alternative courses of action. Extending those considerations, this Commentary considers the practices of other health care professional organizations and some implications of the proposal offered by Candilis et al.