Regulating for Bias in Medical Education - Reaction to the Pharmaceutical Industry Updated EFPIA Code of Practice.

The European Federation of Pharmaceutical Industries and Associations (EFPIA) representing the pharmaceutical industry operating in Europe, introduced three codes of conduct between 2007 and 2013, which had a common goal of self-regulating interactions with healthcare professionals and patient organisations. This former set of rules was appreciated as a first self-regulatory step, although self-regulation itself is still considered by many stakeholders as insufficient to provide thorough transparency. EFPIA agreed to replace the separate codes with a new, consolidated EFPIA Code of Practice. The consolidated Code was broadened to include a new section on medical education that outlines the scope of member companies' engagement in "medical education activities?. This new section is controversial as it explicitly confirms that EFPIA members can be involved in medical education. In our view "independent Medical Education" per se prevents industry from "organising" events, i.e. industry must not influence content, presentation, choice of lecturers or publication of results. What is more, only events respecting this key principle (amongst others) can be recognised for purposes of continuing medical education/continuing professional development (CME/CPD). A substantial portion of the medical education is currently funded by the pharmaceutical and medical device industries. This practice carries a significant risk to public and personal health, especially if it is not adequately safeguarded by a high standard of accreditation. We are most concerned by the fact that EFPIA, representing the pharmaceutical industry, is trying to broaden the approach to medical education, to include activities that are not independently evaluated as free from undue influence and conflicts of interest. We believe that in order to preserve scientific integrity and independence, pharmaceutical companies must not be granted the right to influence the content of medical education.

The influence of distracters, stimulus duration and hemianopia on first saccade in patients with unilateral neglect.

The aim of the present study was to assess the influence of visual distracters, stimulus duration and the presence of contralesional hemianopia on direction of the first saccade in right brain damaged (RBD) patients affected by left unilateral neglect (UN). During a visual search task we recorded eye movements in five RBD patients with UN and hemianopia (N+H+), nine RBD patients with UN but no hemianopia (N+H-), four RBD patients with neither neglect nor hemianopia and four normal controls. Two task variables were orthogonally manipulated: (a) presence or absence of distracters and (b) short or long stimulus duration. A significant interaction was found between groups, presence of distracters, stimulus duration and the direction of the first saccade made in the search. Independently of the temporal duration of targets, in N+H+ patients the presence of distracters enhanced the frequency of saccades directed ipsilesionally (i.e., rightward). In N+H- patients, distracters biased the first saccade toward the right side only at short stimulus duration. These data show that bias of attentional orienting toward stimuli in the right half of space is specific of UN. This pathological mechanism (a) is enhanced and prolonged, over the period of exploration, by concomitant complete contralateral hemianopia and (b) is most evident, even in the absence of concomitant visual field defects, when voluntary planning of attention and eye movements are precluded by the short duration of stimuli to be inspected.

Apolipoprotein E epsilon4 allele differently affects the patterns of neuropsychological presentation in early- and late-onset Alzheimer's disease patients.

The presence of the apolipoprotein E (APOE) epsilon4 allele is a definite risk factor for the onset of Alzheimer's disease (AD). Its presence seems to affect especially the memory in the early stage of the disease, but the effect on the progression of the disease and survival is still controversial. Some longitudinal studies could be influenced by variables other than APOE, such as the response to medical treatment, rehabilitation therapy and inclusion of patients at different stages of progression at baseline. Moreover, the inclusion in the same study sample of patients of different ages at onset of the disease (below 65 or above 80 years) appears arbitrary. In our study, we evaluated a population of newly diagnosed untreated AD patients at their first neuropsychological examination and with the onset of their first symptoms not longer than 3 years ago. In order to analyse the different effects of the APOE epsilon4 allele on the different ages at the onset of the disease, we split the study sample into two groups: (1) subjects under 65 years [early-onset AD (EOAD); n = 30] and subjects over 70 years [late-onset AD (LOAD); n = 41], excluding subjects with an age of onset between 66 and 69 years. Our results show that the APOE epsilon4 allele carriers are characterised by a different neuropsychological pattern at the disease onset; however, only in the EOAD group is this effect significant: in EOAD, the epsilon4 allele carriers obtained worse performances in learning, long-term verbal memory and general intelligence tasks. On the contrary, in LOAD patients, the pattern of cognitive impairment at the onset is not dependent on the possession of an epsilon4 allele in the genotype. Such data could suggest a careful control of the study sample concerning age at the onset of the disease since APOE could play a different role in EOAD and LOAD mainly due to the different pathogenic mechanism at the onset and evolution of AD.