Exposing drug industry funding of UK patient organisations

Drug company payment disclosures have limited transparency, but Piotr Ozieranski and colleagues find that they are increasing in value and are targeted at select patient organisations

[Annual "Door Knock" Fundraising Campaign Jubilee--for the patients and against the disease]

Marking the annual "Door Knock" Fundraising Campaign Jubilee, this article provides an overview of the Israel Cancer Association (ICA) activity for patients and against the disease, that comply with the principles of the World Cancer Declaration (WCD) of the UICC (Union for International Cancer Control). To elucidate, as a voluntary organization, all of ICA's resources are derived exclusively from public contributions--with no funding from the government budget. This independence enables ICA to operate according to strictly professional criteria, while maintaining a global and national point of view and vision. ICA activity will be presented with respect to the international treaty, from monitoring the disease at the national level, to activity to promote research, prevention methods, early detection, enhancing treatment modalities and rehabilitation, and maintaining quality of life for patients and survivors. This presentation will also provide an overview of how ICA's initiative, in close collaboration with the Ministry of Health, and the HMO's, white relying on the volunteer activity of members of the ICA professional committees, and that of many other volunteers, leads Israel to significant accomplishments in each one of the treaty sections. These activities have resulted in concrete achievements at the national level, positioning Israel high on the global scale.

A conflict of responsibility: no patient left behind

In its program END THE WAIT, the National Kidney Foundation (NKF) outlined four comprehensive strategies to achieve the goal that within 10 years, every individual on the US waiting list will receive a transplant within 1 year of listing. Lifetime immunosuppressive coverage is a critical piece of the foundation of this program. Events in 2009 that were dedicated toward achieving a lifetime immunosuppressive benefit were complicated by legislative challenges and a dynamic that placed oral medications in the ESRD bundling proposal in direct conflict with the potential for the lifetime immunosuppressive benefit. In line with its mission, the NKF could not sacrifice one kidney patient constituency for another. Successful patient-centered organizations stay consistent with their mission. The NKF had to weigh the risk of postponing a long-sought goal and its relationships with other organizations with standards of patient safety and equitable and efficient patient care. In a perfect world, we never have to make such choices. In the real world, we can use such choices to forge new ways and dialogue to achieve better health care for all patients affected by kidney disease.

National Kidney Registry: 213 transplants in three years

Since its establishment in 2008, the National Kidney Registry has facilitated 213 kidney transplants between unrelated living donors and recipients at 28 transplant centers. Rapid innovations in matching strategies, advanced computer technologies, good communication and an evolving understanding of the processes at participating transplant centers and histocompatibility laboratories are among the factors driving the success of the NKR. Virtual cross match accuracy has improved from 43% to 91% as a result of changes to the HLA typing requirements for potential donors and improved mechanisms to list unacceptable HLA antigens for sensitized patients. A uniform financial agreement among participating centers eliminated a major roadblock to facilitate unbalanced donor kidney exchanges among centers. The NKR transplanted 64% of the patients registered since 2008 and the average waiting time for those transplanted in 2010 was 11 months.

Philanthropies croisées: a joint venture in public health at Lyon (1917-1940)

Since the end of the First World War the Rockefeller Foundation has spearheaded a large-scale programme in the field of education for the health professions (doctors and nurses). In several countries throughout the world, but with its efforts concentrated on Europe, it has financed schools, constructed information networks, granted research scholarships and awarded training bursaries. In so doing it has not, however, been in the business of propagating an irresistible "American model," nor has it pursued a huge undertaking in disinterested aid. Through an attempt to contextualize these programmes, to bring to light the existence of common reference points, to retrace the work with local participants and to appraise cleavages within the philanthropic apparatus, this article proposes a fine-grained reading of the role of the Rockefeller Foundation at the Faculté de Médecine (Faculty of Medicine) and the Ecole d'Infirmières et d'assistantes sociales (Training School for Nurses and Social Workers) in Lyon between 1917- and 1940. It analyses these institutions in terms of the transactions, negotiations and appropriations that highlight their joint-venture character and it identifies their varied impact.

Economic aspects of a therapy and support service for people with long-term stroke and aphasia

BACKGROUND

This paper considers some economic aspects of a therapy and support service for people with stroke and aphasia. This material was part of a broader evaluation of the service, which is reported elsewhere (van der Gaag et al. 2005, van der Gaag and Mowles 2005).

AIMS

The purpose of this part of the study was to investigate the feasibility of undertaking economic appraisal in a voluntary sector service providing therapy for people with aphasia and their families.

METHODS & PROCEDURES

The costs of delivering therapy and support services were calculated. These costs were compared with the costs of equivalent services in the National Health Service (NHS). The EQ-5D health-related quality of life instrument was used to calculate quality-adjusted life years (QALYs).

OUTCOMES & RESULTS

The cost of delivering therapy was lower than expected for a customized service of this nature. The study generated cost data for delivering therapy services, allowing some comparisons to be made with equivalent services in NHS settings. QALY data were generated for a sample of 25 clients on one of the programmes.

CONCLUSIONS

The economics of speech and language therapy service delivery have received scant attention in the published literature. The paper argues that decision-making about methods of service delivery can be aided by the explicit consideration of the costs and consequences of different programmes.

Treatment of external genital warts at Planned Parenthood Federation of America centers

OBJECTIVE

To compare patterns and cost of treating external genital warts (EGW) at 5 major Planned Parenthood Federation of America (PPFA) affiliates.

STUDY DESIGN

Charts of 422 women and 78 men treated for EGW were reviewed. Treatment must have been successful and occurred at a single clinic. Data included anatomic site, number and dates of office visits, treatment modality and cost.

RESULTS

Women required average of 3.01 visits and average cost of $291.36 to reach clearance and males 2.35 visits and $301.81. Monotherapy TCA required 3.2 visits and $263.65 while cryotherapy alone required 3.3 visits and $481.97. Initial imiquimod monotherapy required 2.3 visits and $217.62. Combination therapy of imiquimod and trichloroacetic acid averaged 1.5 visits and $236.53. The largest reduction in visits and cost occurred in patients with multiple or recurrent EGW and those requiring >3 visits. From these data an EGW treatment algorithm was developed allowing more effective management and better utilization of health care resources.

CONCLUSION

In the PPFA clinic setting, imiquimod alone or in combination should be initial treatment for patients with multiple or recurrent EGW or for those who do not experience complete clearance by the third clinic visit when nonimiquimod therapy is first employed.

Changing dynamics in the Canadian voluntary sector: challenges in sustaining organizational capacity to support healthy communities

The voluntary sector is recognized, by citizens, industry and government, as an increasingly vital contributor to healthy communities within Canadian society, called upon to provide front-line service delivery in areas of community support that were in the past often served by government and or religious charity. (The voluntary sector is large, consisting of an estimated 180,000 non-profit organizations [of which 80,000 are registered as charities] and hundreds of thousands more volunteer groups that are not incorporated [Statistics Canada, 2002].) The dynamics of the sector have changed considerably over the past decade, as government has pulled back the level of core organizational funding support and the role of the church has diminished. As community health is directly related to the organizational health of service-providing non-profits and charities, these organizations are looking increasingly towards corporate and individual donors, along with new self-financing approaches that generate revenues. They are also facing challenges in attracting and retaining skilled and motivated volunteers. As the scope of the voluntary sector and its overall influence grows, so do the organizational and financial challenges it faces. This article will address in particular the issue of funding support for healthy communities and examine a number of potential and existing best practices for sustaining community health in Canada. We will also look at the issue of volunteerism and human resource capacity challenges for organizations. This is an area in which the Canadian government has decided to focus as a result of explicit policy decisions taken in the late 1990s.

The role of community acceptance over time for costs of HIV and STI prevention interventions: analysis of the Masaka Intervention Trial, Uganda, 1996-1999

OBJECTIVE

The objective of this study is to estimate the annual costs of information, education, and communication (IEC), both community- and school-based; strengthened public and private sexually transmitted infections treatment; condom social marketing (CSM); and voluntary counseling and testing (VCT) implemented in Masaka, Uganda, over 4 years, and to explore how unit costs change with varying population use/uptake.

STUDY

Total economic provider's costs and intervention outputs were collected annually to estimate annual unit costs between 1996 and 1999.

RESULTS

In early intervention years, uptake of all activities grew dramatically and continued to grow for public STI treatment, CSM, and VCT. Attendance at IEC performances started to drop in year 4. Unit costs dropped rapidly with increasing uptake of and participation in interventions.

CONCLUSIONS

When implementing long-term community-based interventions, it is important to take into account that it takes time for communities to scale up their participation, since this can lead to large variations in unit costs.

The returns from cardiovascular research: the impact of the National Heart Foundation of Australia's investment

OBJECTIVE

To evaluate the outcomes of the research investment of the National Heart Foundation of Australia (NHF).

DESIGN AND SETTING

The NHF Research Evaluation Working Group was established in 2002 to oversee evaluation of research funding and outcomes data collected over a 5-year period. The evaluation included a bibliometric analysis conducted by the Research Evaluation and Policy Project at the Australian National University.

OUTCOME MEASURES

Level and leverage of research funding; funding levels across the disciplines of biomedical, clinical, and public health research; and visibility and knowledge impact of NHF-supported research in international cardiovascular journals.

RESULTS

The NHF's investment in research increased by 27% from 2001 to 2005. This increase resulted from leveraged support for fellowships and scholarships of $1.5 million over this period, and $2.2 million from the pharmaceutical industry. There was an increase in fellowship and scholarship funding from 26% in 2001 to 46% in 2005. There was a 75% increase in the funding allocated to public health research from 2002 to 2004. NHF-funded research publications were found in high impact journals at levels above Australian and world averages, but received fewer citations than expected based on citation rates for all similar articles.

CONCLUSIONS

The NHF has been successful in implementing a policy to allocate 50% of its research funding to people and 50% to projects. This strategy has led to an increase in funding support for public health research. NHF-funded research has performed very well in terms of knowledge impact. The NHF is now well placed to strategically fund relevant research in the future.

Advertising and disclosure of funding on patient organisation websites: a cross-sectional survey

BACKGROUND

Patient organisations may be exposed to conflicts of interest and undue influence through pharmaceutical industry (Pharma) donations. We examined advertising and disclosure of financial support by pharmaceutical companies on the websites of major patient organisations.

METHOD

Sixty-nine national and international patient organisations covering 10 disease states were identified using a defined Google search strategy. These were assessed for indicators of transparency, advertising, and disclosure of Pharma funding using an abstraction tool and inspection of annual reports. Data were analysed by simple tally, with medians calculated for financial data.

RESULTS

Patient organisations websites were clear about their identity, target audience and intention but only a third were clear on how they derived their funds. Only 4/69 websites stated advertising and conflict of interest policies. Advertising was generally absent. 54% of sites included an annual report, but financial reporting and disclosure of donors varied substantially. Corporate donations were itemised in only 7/37 reports and none gave enough information to show the proportion of funding from Pharma. 45% of organisations declared Pharma funding on their website but the annual reports named more Pharma donors than did the websites (median 6 vs. 1). One third of websites showed one or more company logos and/or had links to Pharma websites. Pharma companies' introductions were present on 10% of websites, some of them mentioning specific products. Two patient organisations had obvious close ties to Pharma.

CONCLUSION

Patient organisation websites do not provide enough information for visitors to assess whether a conflict of interest with Pharma exists. While advertising of products is generally absent, display of logos and corporate advertisements is relatively common. Display of clear editorial and advertising policies and disclosure of the nature and degree of corporate donations is needed on patient organisations' websites. An ethical code to guide patient organisations and their staff members on how to collaborate with Pharma is also necessary, if patient organisations are to remain independent and truly represent the interests and views of patients. As many organizations rely on Pharma donations, self-regulation may not suffice and independent oversight bodies should take the lead in requiring this.

Advocacy and people with learning disabilities in the UK: how can local funders find value for money?

Advocacy schemes have been established throughout the United Kingdom (UK) but their evaluation by funders is varied. This article reviews the literature in respect of models of evaluation of advocacy schemes for people with learning disability. It discusses the six main models and the issues that arise in evaluation. The advantages and disadvantages of each model are analysed. The article concludes that whilst fears exist about the potential for evaluation to infringe advocacy schemes' autonomy, funders need to undertake such a process for reasons of public accountability. Advocacy schemes may find it useful to consider which model of evaluation works best for them and will be appropriate and useful for their funders.

Tobacco Industry Sponsorship of Community-Based Public Health Initiatives

The objective of this study was to understand the reasons community-based public health organizations in the United States accept or refuse tobacco industry sponsorship. A formative pilot study involving 13 interviews with representatives of AIDS and Domestic Violence organizations in California or the Northeast was used. Semistructured interviews were conducted with leaders and fund-raisers working at AIDS and domestic violence organizations that either accepted grants from the tobacco industry or explicitly refused tobacco corporate support. Respondents that accepted grants did so because they believed that the tangible benefits of additional capacity to serve their constituents outweighed the minimal effect they believed refusing funds could have on tobacco control and prevention. Organizations that refused sponsorship either saw tobacco prevention as part of their mission of promoting overall health or social justice, or expressed concern about public association with the tobacco industry. Public health responses to this phenomenon are most effective when they are informed by the realities facing nonprofit leaders as they grapple with the question of whether to accept industry funds. Further research is needed to determine whether accepting sponsorship results in a change in public opinion about tobacco control. Possible interventions include creating positive publicity for organizations that refuse tobacco industry philanthropy.

The importance of being earnest about your business plan

Writing about the importance of business planning for a financially oriented audience may equate with preaching to the choir.

CAM research funding in the UK: surveys of medical charities in 1999 and 2002

A custom-made questionnaire was sent to all UK medical charities in 1999 and again in 2002. Its primary aim was to assess the commitment of these institutions towards funding research in complementary and alternative medicine (CAM). Sixty-two (1999) and 60 (2002) answers were received corresponding to response rates of 62% and 55%. The total CAM research funds have increased from pound 70,000 in 1999 to pound 412,755 in 2002. In terms of total research budgets, this amounts to 0.05% and 0.31%, respectively. The number of CAM research projects has increased but so has the number of charities who do not fund CAM research. We conclude from these data that CAM research funding by UK medical charities has increased. In relative terms it does, however, remain low and out of proportion to the prevalence of CAM use in the UK.

[Healthcare for migrant workers in Israel]

An estimated 300.000 migrant workers are currently living in Israel, which is about 5% of the general population. More then half of this population is undocumented and have very limited access to public health care. Due to the financial difficulties within the Israel's public health system, the entity is unable to deal with the needs of migrant workers. Hence, when these migrant workers need inpatient care, hospitals have to bear the costs and this situation creates a divergence between medical and economic considerations. The open clinic of "Physicians for Human Rights", which is operated by volunteer physicians and nurses, is able to provide medical aid for mild and transient illnesses, but not for chronic diseases. Israeli physicians are regularly confronted with ethical issues, regarding the therapy they would like to provide to undocumented migrant workers, but are unable to do so. In Europe, undocumented migrant workers have better access to public health care than in Israel. The Israeli public health system should permit all migrant workers to insure themselves at affordable prices, or another inexpensive insurance system should be created for them.

Shifting the burden: the private sector's response to the AIDS epidemic in Africa

As the economic burden of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) increases in sub-Saharan Africa, allocation of the burden among levels and sectors of society is changing. The private sector has more scope to avoid the economic burden of AIDS than governments, households, or nongovernmental organizations, and the burden is being systematically shifted away from the private sector. Common practices that transfer the burden to households and government include pre-employment screening, reductions in employee benefits, restructured employment contracts, outsourcing of low skilled jobs, selective retrenchments, and changes in production technologies. Between 1997 and 1999 more than two-thirds of large South African employers reduced the level of health care benefits or increased employee contributions. Most firms also have replaced defined-benefit retirement funds, which expose the firm to large annual costs but provide long-term support for families, with defined-contribution funds, which eliminate risks to the firm but provide little for families of younger workers who die of AIDS. Contracting out previously permanent jobs is also shielding firms from benefit and turnover costs, effectively shifting the responsibility to care for affected workers and their families to households, nongovernmental organizations, and the government. Many of these changes are responses to globalization that would have occurred in the absence of AIDS, but they are devastating for the households of employees with HIV/AIDS. We argue that the shift in the economic burden of AIDS is a predictable response by business to which a deliberate public policy response is needed. Countries should make explicit decisions about each sector's responsibilities if a socially desirable allocation is to be achieved.

Dental aid organisations: baseline data about their reality today

AIM

To collect basic data about non-governmental dental aid organisations on a global scale and thus contribute to a better understanding of their diversity, activities and limitations.

METHODS

Data was collected through a mailed questionnaire to all organisations listed by the FDI World Dental Federation. A second questionnaire was e-mailed to those organisations identified as non-governmental organisations (NGO) by the first questionnaire.

FINDINGS

The response rate to the first questionnaire to detect NGOs was 36.2%, to the second e-mailed form 84.4%. About two thirds of NGOs originated in developed countries, one third responded from developing countries. The majority had been established after 1980. Developed countries dental NGOs tended to have larger membership and disposed of greater budgets. In general, income was generated predominantly from donations and own resources. The workforce was primarily based on volunteers. High priority activities: service provision, education and training, technical assistance, community development. Measures for quality assurance showed low complexity. Frequent areas of problems were associated with funding and staff. Collaborative links with other stakeholders in development were weak and focussed on information exchange.

CONCLUSIONS

Recommendations for NGOs, donors, FDI and future research are developed.

The IRS and the Internet: new issues for tax-exempt organizations

Tax-exempt healthcare organizations increasingly are using the Internet to provide an inexpensive, easily accessible forum for information exchange, organization publicity, and community-relations programs. A tax-exempt organization that engages in certain activities on its Web site, however, risks losing its tax-exempt status. Such activities may include political messages and lobbying, substantial advertising and other revenue-generating programs, and inappropriate solicitation of charitable contributions. Therefore, providers should carefully monitor all information on their Web sites, including hyperlinks to other Web sites, chat-room and bulletin-board content, and advertisements, to make certain they comply with IRS rules.

Interprofessional collaboration: a stakeholder approach to evaluation of voluntary participation in community partnerships

A major goal of community coalitions is to engage the community in large-scale systems change. This paper examines how five interprofessional partnerships in South Africa involved their local communities as well as a variety of voluntary agencies in the long-term planning and delivery of health care. The obstacles and difficulties encountered by the volunteers who participate in the partnerships are highlighted. The paper compares the views of 427 participants from four stakeholders: the community health workers; the projects' core staff; 'solo' community members; and representatives of voluntary agencies, community-based agencies and non-governmental organisations. This article considers the benefits and costs of participation as well as satisfaction, ownership, representation, contributions, and commitment. The findings suggest that while the stakeholders value their partnerships, some of the costs associated with their participation may affect their satisfaction and commitment. The challenges of working in partnerships with volunteers in a community setting are discussed and strategies for addressing them are considered. The implications for coalition functioning and the lessons for future community involvement in the planning of local health services by way of interprofessional partnerships are also addressed.

Filling the information gap. Not-for-profits are gradually opening up to bondholders

Once the exclusive domain of the corporate world, now not-for-profit health care organizations are gravitating toward greater financial disclosure. The reason: a growing consensus among boards and executives that accountability boosts investor confidence and may pay off in better bond ratings.