Financial conflicts of interest between pharmaceutical companies and executive board members of internal medicine subspecialty societies in Japan between 2016 and 2020.

RATIONALE: Pharmaceutical companies make payments to physicians such as compensations for lecturing or consulting. Of particular, financial relationships between pharmaceutical companies and leaders of professional medical societies are concern in medical community. However, little was known about them in Japan. AIMS AND OBJECTIVES: This study aimed to evaluate the magnitude and prevalence of personal payments to executive board members (EBMs) of 15 medical associations representing different subspecialties within the Japanese Society of Internal Medicine. METHOD: All EBMs of 15 medical associations representing internal medicine subspecialties were collected from each association webpage. Payments to the EBMs were extracted from the pharmaceutical companies belonging to the Japan Pharmaceutical Manufacturers Association between 2016 and 2020. We performed descriptive analysis on the payment data. RESULTS: Of the 353 different EBMs identified, 350 (99.2%) received one or more personal payments from the pharmaceutical companies over the 5 years. 99.2% (350) and 97.2% (343) of all EBMs received personal payments 3 years before and in the year of their board membership. A total of $70,796,014 were made to the EBMs over the 5 years. The median 5-year combined personal payments per EBM was $150,849 (interquartile range [IQR]: $73,412-$282,456). EBMs who were chairman or vice chairman of executive board received significantly larger median personal payments than those who were not ($225,685 vs. $143,885, p = 0.01 in the U test). Among the 15 societies, there were 12 (80.0%) societies with all (100%) EBMs receiving personal payments from the pharmaceutical companies. Although every society has their own conflicts of interest policy, none publicly discloses the financial relationships between pharmaceutical companies and their EBMs due to their privacy. CONCLUSION: This study demonstrated that nearly all EBMs of 15 medical associations representing internal medicine subspecialties had substantial financial relationships with the pharmaceutical companies in Japan over the past 5 years.

[Rights and duties of liberal professions]. / Rechte und Pflichten freier Berufe.

BACKGROUND: The medical profession is categorized as a liberal profession. But what does this mean specifically for members of the profession? OBJECTIVES: What rights and obligations apply to a physician as a member of a liberal profession-and does this apply to all physicians? Or is membership of the liberal professions influenced by employment status? MATERIALS AND METHODS: Legislative and normative texts that shape the concept of liberal professions and its consequences are examined. RESULTS: The rights and obligations are not laid down jointly, but result from an interplay of various regulations and may vary for different professional groups. They are reflected in particular in professional law. CONCLUSION: Characteristics, rights, and duties of a liberal profession cannot be considered separately, but are mutually dependent.

An analysis of American physician professional statements about gun violence against children.

BACKGROUND: We examine the content of physician professional association statements and assess the extent to which these statements kept gun violence-especially against children-on policymakers' agendas. METHODS: After constructing a list of U.S. physician professional associations, we located position statements by consulting association websites, conducting a PubMed search, and reviewing the citations of identified statements. Once unique statements were identified (N = 32), two reviewers independently coded content such as major events, pediatric focus, firearm type, and policy recommendations. RESULTS: Recent statements appear to be timed following mass casualty events such as the Sandy Hook and Parkland school shootings. Associations have increasingly adopted public health framing over time. Nine statements focused on the pediatric population, while an additional 13 made reference to the pediatric population. The most common recommendations include increased gun violence research or research funding (84%), freedom of physician counseling (75%), mandatory background checks (72%), and safe storage (72%). CONCLUSION: Based on this analysis, recent statement volume appears to be tied to current events rather than keeping daily gun violence against children continuously on the agenda. Mentions of "gun control" have receded over time and have been replaced by public health framing that places advocacy for firearm injury prevention in the physician's domain. LEVEL OF EVIDENCE: III/IV.

In Service of the Society? Medical Associations as Agents of Social Change-Implications for Health Policy and Education in Israel.

This study aims to explore what medical associations in Israel do to promote public health, what values underpin their activities, and how their actions can be interpreted. For this purpose, an analysis of both individual and organizational levels was applied in an effort to yield a more nuanced understanding of the relationship between society and the medical profession. In-depth interviews with senior physicians were conducted, combined with a review of policy and public initiatives of medical associations between 2008 and 2018. The findings of this study reveal that medical associations engage in a range of social and policy initiatives designed to promote public health, but, at the same time, they tend to construct socially related health issues as medical problems in a manner that fits their sectorial agendas. This may reflect organized medicine's efforts to extend its dominance over society through the application of the biomedical model to social issues. It is necessary to integrate biosocial training with medical education to ensure that future physicians are equipped with the skills needed to implement social medicine.

Trajectories of Professional Authority: A Comparative Study of Medical Associations and Professional Authority Claims.

Medical associations not only organize their members' interests but also exercise professional authority within the field of health policy. An important aspect of professional authority is the medical profession's ability to position itself in relation to national health policy and whether its command of professional knowledge enables the profession to claim exclusive authority for reflecting on health policy. This article analyzes and compares how medical associations claim authority over health policy and how they reposition their claims in light of perceived contestations to medical authority in public debates or from the political system. The study is based on a qualitative, descriptive analysis of 975 editorials in the medical associations' lead journals in the United States, the United Kingdom, and Denmark over a period of 60 years. The analysis explores the trajectories of authority claims in the three countries and how professional authority claims may be reconfigured to reflect external changes in health policy institutions. Whereas all the medical associations were highly critical of state-organized health systems in the 1950s and early 1960s, the British and Danish associations seem to shift positions entirely after national health systems are gradually implemented and the associations begin to present themselves as these public institutions' strongest supporters.

La Asociación Médica Franco-Argentina: fundación y visión pionera. Homenaje al Dr. Louis Pasteur Vallery-Radot a cincuenta años de su fallecimiento / The Franco-Argentine Medical Association: foundation and pioneering vision. Tribute to doctor Louis Pasteur Vallery-Radot on the 50th anniversary of his death

Se hace una reseña histórica de la fundación de la Asociación Médica Franco-Argentina. Se mencionan sus propósitos fundacionales, sus protagonistas y su contexto social.

A historical review of the foundation of the Franco-Argentine Medical Association is made. Its foundational purposes, their protagonists and the social context are mentioned.

Doctor Guillermo Soberón Acevedo: destacado médico mexicano / Doctor Guillermo Soberón Acevedo: outstanding Mexican doctor

En la presente entrevista, realizada en 1999, el doctor Guillermo Soberón Acevedo (1925- 2020) opina sobre distintos temas relacionados con la medicina y la salud pública. Comenta su proceso de formación como médico, la responsabilidad de los especialistas que se preparan en el extranjero y regresan a México, así como sus trabajos como rector de la UNAM y en el sector público, donde dirigió la transformación de la entonces Secretaría de Salubridad y Asistencia en la actual Secretaría de Salud. Asimismo, aborda temas como el carácter mutifacético de la medicina, la importancia de la investigación y las facultades de medicina, el valor de la certificación, el trabajo de los colegios y las asociaciones médicas y el futuro de la ciencia médica, además de que ofrece su punto de vista sobre la Homeopatía.

In this interview, conducted in 1999, Dr. Guillermo Soberón Acevedo (1925-2020) gives his opinion on different topics related to medicine and public health. He comments on his training process as a doctor, the responsabilities of the specialists who prepare abroad and return to Mexico, as well as his work as Rector of the Universidad Nacional Autónoma de México (National Autonomous University of Mexico) As well as his experience in the public sector, in which he directed the transformation of the then Secretaría de Salubridad y Asistencia (Ministry of Healthiness and Assistance) into the current Secretaría de Salud (Ministry of Health). It also addresses topics such as the multifaceted nature of medicine, the importance of research and medical schools, the value of certification, the work of medical colleges and associations, and the future of medical science, in addition to offering his point of view on Homeopathy.

The Role of the Medical Profession in Victorian Assisted Dying Law Reform.

The Voluntary Assisted Dying Act Vic will commence operation on 19 June 2019. Doctors were highly visible in the debate which informed the recent law reform process, and Victorian legislators relied considerably on the diverse views of the medical profession. It is important to pay attention to the role played by doctors in the legalisation of assisted dying in Victoria, not only because the current political environment suggests that further reforms may be likely in other Australian jurisdictions, but also because doctors' knowledge and expertise visibly contributed to the outcome of that process in Victoria. This article aims to map the participation of doctors in the recent law reform process to analyse how their professional attributes positioned them in the Victorian assisted dying space. It is suggested that doctors were afforded a place in law reform because of the routine acceptance of doctors as knowledge keepers in matters of life and death and an acknowledgment of the integral role of medical expertise in the legislation. A textual analysis of the Hansard record of the Victorian debate reflects that individual practitioner advocacy for legalisation prevailed over opposition by the national branch of the Australian Medical Association in the deliberations of parliamentarians.

[The History of International Associations of Museums of Medicine].

The article considers history of activity of international associations of museums of Europe and North America from the moment of organization of the first International Association of Medical Museums existed from 1907 to 1955 and to the European association of Museums of History of Medical Sciences (since 1983) and the Association of Medical Museums (since 1985) both existing at the present time. The analysis is presented concerning their role in unification of scientific community, development of research methods, determination and reconsideration of professional concepts and also alterations of functions of medical collections and museums with the course of time and new trends in medical education, clinical and fundamental medicine and museum business. The existence and development of museum associations is compared with concept of three "museum revolutions": professionalization of museum sector (at the turn of XIX-XX centuries), orientation on education of broad masses of population (second half of XX century), establishment of principles of social inclusion and multi-culturality (beginning of XXI century). The method of study is analysis of such sources untranslated to Russian previously as archives of "Vestnik" and reports and also scientific publications of members of associations involved into their activities. The results of study determined possible directions of work related to coordination of activities of medical museums, development of scientific research and scientific education methods and exposition work. The conclusions are made about an important role of international associations in systematization of knowledge, organization of scientific activities and medical community, development of guidelines for regional museums and also organization of unified information space for workers of medical museums.

[On the occasion of the 70th congress of the German Society of Urology : Examples of networks and think tanks at its founding in 1906/1907 and further developments]. / Zum 70. Kongress der Deutschen Gesellschaft für Urologie e. V. : Beispiele zu Netzwerken und Denkkollektiven bei ihrer Gründung 1906/1907 und weiteren Entwicklung.

The German Society of Urology was founded in 1906/1907 with a historical background starting in 1896 shortly after the death of Maximilian Nitze, the "inventor" of the cystoscope. This reflects the end of the first phase in the establishment of modern scientific urology as a specialty of its own within German-speaking countries (Imperial Germany, the Austria-Hungary Empire and Switzerland). Supported by German emigrants, the international orientation of German urology and networks was important during this time period. After WWI and WWII and Nazi atrocities, it took time to rebuild these relationships and exchanges from the 1960s to the 1990s-first within the former East and West Germany and then with European countries and the USA. From the 1990s onwards, the society continued to bridge borders behind the Iron Curtain.

The Importance of Wound Care Researchers and Manufactures Working with Medical Associations When Bringing New Products to the Marketplace.

Every day products and their accompanying procedures are delivered to the marketplace and touted to aid physicians and other qualified health care professionals (QHPs) in taking care of patients who have chronic wounds. Some of these products/procedures have been developed with the patient in mind and with a serious regulatory and reimbursement strategy, and other products/procedures make physicians, other QHPs, and payers scratch their heads about the true purpose of the product/procedure. Researchers and developers often only focus on gaining Food and Drug Administration (FDA) clearance and often plunge into the marketplace unaware of the reimbursement stumbling blocks that can prevent the expected market acceptance. Researchers and developers should simultaneously plan for FDA clearance and reimbursement from the product's inception. If a product/procedure requires a new procedure code, researchers and manufacturers should seek the help and guidance of professional medical associations to navigate the Current Procedural Terminology (CPT®; CPT is a registered trademark of the American Medical Association), to make available useful new products/procedures for appropriate patients and to adequately reimburse the physician and other QHPs.

Future perspective on international affairs for Korean doctors

The Korean Medical Association (KMA) has been requested to respond proactively and effectively to local agendas reflecting global perspectives in order to lead our society through the dynamic and fast-changing health care environment, which faces issues such as big data, artificial intelligence, and the increasing health-related impacts of climate change and fine particulate matter. Since the KMA joined the World Medical Association (WMA) in 1949 and the Confederation of Medical Associations in Asia and Oceania (CMAAO) in 1956, the KMA has made continuous progress in international affairs. Based on these achievements, the KMA has recently played important roles, such as the chair of the WMA Finance and Planning Committee, a council member in the WMA, and a council chair in the CMAAO. For the next several decades, the WMA and CMAAO are still expected to be the basic channels for sharing trends and visions, discussing health challenges across borders, and developing powerful initiatives that improve people's health. Maintaining current partnerships with the WMA and CMAAO and strengthening strategic collaboration with promising national medical associations are required to extend the KMA's influence. Training next-generation representatives to build capacity for international relations might also be necessary for the sustainability of international collaboration. Through the KMA's advancements in international affairs, incorporating harmonious perspectives on local, regional, and global agendas, the KMA is fully expected to contribute to addressing health challenges by demonstrating its leadership.

Continuing medical education and pharmaceutical industry involvement: An evaluation of policies adopted by Canadian professional medical associations.

BACKGROUND: Professional medical associations (PMAs) play a crucial role in providing accredited continuing medical education (CME) to physicians. Funding from the pharmaceutical industry may lead to biases in CME. OBJECTIVE: This study examines publicly available policies on CME, adopted by Canadian PMAs as of December 2015. METHODS: Policies were evaluated using an original scoring tool comprising 21 items, two questions about PMAs' general and CME funding from industry, and three enforcement measures. RESULTS: We assessed 236 policies adopted by Canadian PMAs (range, 0 to 32). Medical associations received summative scores that ranged from 0% to 49.2% of the total possible points (maximum score = 63). Twenty-seven associations received an overall score of 0%. The highest mean scores were achieved in the areas of industry involvement in planning CME activities (mean: 1.1/3), presence of a review process for topics of CME activities (mean: 1.1/3), content review for balanced information (mean: 1.1/3), and responsibility of distribution of funds (mean: 1.0/3). The lowest mean scores were achieved in the areas of awards (mean: 0.0/3), industry personnel, representatives, and employees (mean: 0.1/3), distribution of industry-funded educational materials at CME activities (mean: 0.1/3), and distinction between marketing and educational materials (mean: 0.1/3). CONCLUSION: These results suggest that Canadian PMAs' publicly available policies on industry involvement in CME are generally weak or non-existent; therefore, the accredited CME that is provided to Canadian physicians may be viewed as open to bias. We encourage all Canadian medical associations to strengthen their policies to avoid the potential for industry influence in CME.

Uma análise da luta das entidades médicas brasileiras diante do Programa Mais Médicos / An analysis of the Brazilian medical associations struggles confronting the More Doctors Program / Un análisis de la lucha de las entidades médicas ante el Programa Más Médicos

Buscamos analisar a agenda política das principais entidades médicas nacionais brasileiras e suas lutas em torno do Programa Mais Médicos do Ministério da Saúde do Brasil. Trata-se de pesquisa de natureza qualitativa, de nível exploratório e de caráter analítico, baseada em diversas fontes que veicularam posições dessas entidades, de maio de 2010 a dezembro de 2014, e em publicações da imprensa, de junho de 2013 a dezembro de 2014, que foram sistematizadas segundo categorias elaboradas a partir da própria análise. Identificamos que as entidades médicas brasileiras realizaram intensa atuação conjunta, integrando interesses voltados aos setores público e privado. O apogeu se deu entre junho e outubro de 2013, nas mobilizações de resistência ao Programa Mais Médicos. Entretanto, registramos que divergências em torno das lutas contra este Programa fragilizaram as articulações políticas dessas entidades que haviam sido construídas nos últimos anos.

We sought to analyze the political agenda of the main Brazilian national medical entities and their struggles around the More Doctors Program implemented by the Brazilian Ministry of Health. It is a research of qualitative nature, of exploratory level and of analytical character, based on several sources presenting positions of these entities, from May 2010 to December 2014, and in press publications, from June 2013 to December 2014, systematized according to categories elaborated from the analysis itself. We identified that the Brazilian medical entities performed intense joint action integrating interests directed to the public and private sectors. The apogee took place between June and October of 2013, through mobilizations of resistance to the More Doctors Program. However, we note that divergences around the struggles against this Program have weakened the political links of these entities that had been built in recent years.

Nuestro objetivo fue analizar la agenda política de las principales entidades médicas nacionales brasileñas y sus luchas frente al programa Más Médicos del Ministerio de la Salud de Brasil. Se trata de investigación de naturaleza cualitativa, de nivel exploratorio y de carácter analítico con base en diversas fuentes que publicaron posiciones de esas entidades, desde mayo de 2010 a diciembre de 2014 y en publicaciones de la prensa, de junio de 2013 a diciembre de 2104, que han sido sistematizadas según categorías elaboradas a partir del propio análisis. Identificamos que las entidades médicas brasileñas realizaron una intensa actuación conjunta integrando intereses enfocados en los sectores público y privado. El apogeo fue entre junio y octubre de 2013 en las movilizaciones de resistencia al Programa Más Médicos. No obstante, registramos que las divergencias alrededor de las luchas contra este Programa fragilizaron las articulaciones políticas de esas entidades que se habían construido en los últimos años.

Present Situation and Prospective Issues of Continuing Medical Education for Physicians / 医学教育

1) To improve the quality of medical care and to ensure patient safety, physicians have the professional duty and responsibility to constantly study the newest medical knowledge and technology.<BR>2) The terminology for “continuing education”for physicians differs in meaning from that generally used to refer to “life-long education.”<BR>3) Continuing medical education (CME) in Japan is independently carried out by medical associations and by numerous academic medical societies. Present CME activities in Japan are reviewed, and CME in the United States is explained.<BR>4) Continuing professional development is introduced as a new paradigm of CME for physicians, created to improve the health-care system in the United Kingdom.<BR>5) To further improve CME for physicians in Japan, prospective issues are discussed. Establishment of a third-party organization that discusses, manages, and operates the CME system for physicians, is strongly recommended.

Guidelines, editors, pharma and the biological paradigm shift.

Private investment in biomedical research has increased over the last few decades. At most places it has been welcomed as the next best thing to technology itself. Much of the intellectual talent from academic institutions is getting absorbed in lucrative positions in industry. Applied research finds willing collaborators in venture capital funded industry, so a symbiotic growth is ensured for both.There are significant costs involved too. As academia interacts with industry, major areas of conflict of interest especially applicable to biomedical research have arisen. They are related to disputes over patents and royalty, hostile encounters between academia and industry, as also between public and private enterprise, legal tangles, research misconduct of various types, antagonistic press and patient-advocate lobbies and a general atmosphere in which commercial interest get precedence over patient welfare.Pharma image stinks because of a number of errors of omission and commission. A recent example is suppression of negative findings about Bayer's Trasylol (Aprotinin) and the marketing maneuvers of Eli Lilly's Xigris (rhAPC). Whenever there is a conflict between patient vulnerability and profit motives, pharma often tends to tilt towards the latter. Moreover there are documents that bring to light how companies frequently cross the line between patient welfare and profit seeking behaviour.A voluntary moratorium over pharma spending to pamper drug prescribers is necessary. A code of conduct adopted recently by OPPI in India to limit pharma company expenses over junkets and trinkets is a welcome step.Clinical practice guidelines (CPG) are considered important as they guide the diagnostic/therapeutic regimen of a large number of medical professionals and hospitals and provide recommendations on drugs, their dosages and criteria for selection. Along with clinical trials, they are another area of growing influence by the pharmaceutical industry. For example, in a relatively recent survey of 2002, it was found that about 60% of 192 authors of clinical practice guidelines reported they had financial connections with the companies whose drugs were under consideration. There is a strong case for making CPGs based not just on effectivity but cost effectivity. The various ramifications of this need to be spelt out. Work of bodies like the Appraisal of Guidelines Research and Evaluation (AGREE) Collaboration and Guidelines Advisory Committee (GAC) are also worth a close look.Even the actions of Foundations that work for disease amelioration have come under scrutiny. The process of setting up 'Best Practices' Guidelines for interactions between the pharmaceutical industry and clinicians has already begun and can have important consequences for patient care. Similarly, Good Publication Practice (GPP) for pharmaceutical companies have also been set up aimed at improving the behaviour of drug companies while reporting drug trialsThe rapidly increasing trend toward influence and control by industry has become a concern for many. It is of such importance that the Association of American Medical Colleges has issued two relatively new documents - one, in 2001, on how to deal with individual conflicts of interest; and the other, in 2002, on how to deal with institutional conflicts of interest in the conduct of clinical research. Academic Medical Centers (AMCs), as also medical education and research institutions at other places, have to adopt means that minimize their conflicts of interest.Both medical associations and research journal editors are getting concerned with individual and institutional conflicts of interest in the conduct of clinical research and documents are now available which address these issues. The 2001 ICMJE revision calls for full disclosure of the sponsor's role in research, as well as assurance that the investigators are independent of the sponsor, are fully accountable for the design and conduct of the trial, have independent access to all trial data and control all editorial and publication decisions. However the findings of a 2002 study suggest that academic institutions routinely participate in clinical research that does not adhere to ICMJE standards of accountability, access to data and control of publication.There is an inevitable slant to produce not necessarily useful but marketable products which ensure the profitability of industry and research grants outflow to academia. Industry supports new, not traditional, therapies, irrespective of what is effective. Whatever traditional therapy is supported is most probably because the company concerned has a product with a big stake there, which has remained a 'gold standard' or which that player thinks has still some 'juice' left.Industry sponsorship is mainly for potential medications, not for trying to determine whether there may be non-pharmacological interventions that may be equally good, if not better. In the paradigm shift towards biological psychiatry, the role of industry sponsorship is not overt but probably more pervasive than many have realised, or the right thinking may consider good, for the health of the branch in the long run.An issue of major concern is protection of the interests of research subjects. Patients agree to become research subjects not only for personal medical benefit but, as an extension, to benefit the rest of the patient population and also advance medical research.We all accept that industry profits have to be made, and investment in research and development by the pharma industry is massive. However, we must also accept there is a fundamental difference between marketing strategies for other entities and those for drugs.The ultimate barometer is patient welfare and no drug that compromises it can stand the test of time. So, how does it make even commercial sense in the long term to market substandard products? The greatest mistake long-term players in industry may make is try to adopt the shady techniques of the upstart new entrant. Secrecy of marketing/sales tactics, of the process of manufacture, of other strategies and plans of business expansion, of strategies to tackle competition are fine business tactics. But it is critical that secrecy as a tactic not extend to reporting of research findings, especially those contrary to one's product.Pharma has no option but to make a quality product, do comprehensive adverse reaction profiles, and market it only if it passes both tests.Why does pharma adopt questionable tactics? The reasons are essentially two:What with all the constraints, a drug comes to the pharmacy after huge investments. There are crippling overheads and infrastructure costs to be recovered. And there are massive profit margins to be maintained. If these were to be dependent only on genuine drug discoveries, that would be taking too great a risk.Industry players have to strike the right balance between profit making and credibility. In profit making, the marketing champions play their role. In credibility ratings, researchers and paid spokes-persons play their role. All is hunky dory till marketing is based on credibility. When there is nothing available to make for credibility, something is projected as one and marketing carried out, in the calculated hope that profits can accrue, since profit making must continue endlessly. That is what makes pharma adopt even questionable means to make profits.Essentially, there are four types of drugs. First, drugs that work and have minimal side-effects; second, drugs which work but have serious side-effects; third, drugs that do not work and have minimal side-effects; and fourth, drugs which work minimally but have serious side-effects. It is the second and fourth types that create major hassles for industry. Often, industry may try to project the fourth type as the second to escape censure.The major cat and mouse game being played by conscientious researchers is in exposing the third and fourth for what they are and not allowing industry to palm them off as the first and second type respectively. The other major game is in preventing the second type from being projected as the first. The third type are essentially harmless, so they attract censure all right and some merriment at the antics to market them. But they escape anything more than a light rap on the knuckles, except when they are projected as the first type.What is necessary for industry captains and long-term players is to realise:Their major propelling force can only be producing the first type. 2. They accept the second type only till they can lay their hands on the first. 3. The third type can be occasionally played around with to shore up profits, but never by projecting them as the first type. 4. The fourth type are the laggards, real threat to credibility and therefore do not deserve any market hype or promotion.In finding out why most pharma indulges in questionable tactics, we are lead to some interesting solutions to prevent such tactics with the least amount of hassles for all concerned, even as both profits and credibility are kept intact.