Key opinion leaders - a critical perspective.

Enormous progress has been made in the field of rheumatology in the past several decades, historically led by publicly funded academic innovators but in more recent times with much greater involvement of the pharmaceutical industry. This shift in resources has created a complex new model for reinvestment in the medical community in which the vast majority of private funds are redirected towards influencing the prescription behaviour of practitioners through 'key opinion leaders', with the main purpose of enhancing and perpetuating profit rather than innovation and critical thinking, and often at the expense of partnerships with scientists (that is, basic and translational researchers) and academic collaborations. This new episteme brings multiple opportunities to rethink approaches to sustaining long-term critical research in the field, ultimately maximizing the return on investment: scientific knowledge for the benefit of patients and society. Central to such strategies should be the rebalancing of academia-industry partnerships towards academic research and the involvement of 'innovation and knowledge leaders', rather than mostly key opinion leaders.

Reconciling corruption with conservation triage: Should investments shift from the last best places?

Considerable outside funding will be required to overcome the financial shortfalls faced by most of Africa's protected areas. Given limited levels of external support, it will be essential to allocate these funds wisely. While most recent studies on conservation triage have recommended prioritizing reserves with the highest remaining conservation value (the "last best places"), such investments are complicated by the fact that these same reserves often attract the greatest revenues from ecotourism and thus the most attention from corrupt local governments. Alternatively, philanthropic organizations might achieve greater returns from investing in the management of neglected areas with lower current conservation value but with less financial leakage from corruption. We outline here how high levels of corruption could favor a strategy that shifts investments away from the last best places.

Immorally obtained principal increases investors' risk preference.

Capital derived from immoral sources is increasingly circulated in today's financial markets. The moral associations of capital are important, although their impact on investment remains unknown. This research aims to explore the influence of principal source morality on investors' risk preferences. Three studies were conducted in this regard. Study 1 finds that investors are more risk-seeking when their principal is earned immorally (through lying), whereas their risk preferences do not change when they invest money earned from neutral sources after engaging in immoral behavior. Study 2 reveals that guilt fully mediates the relationship between principal source morality and investors' risk preferences. Studies 3a and 3b introduce a new immoral principal source and a new manipulation method to improve external validity. Guilt is shown to the decrease the subjective value of morally flawed principal, leading to higher risk preference. The findings show the influence of morality-related features of principal on people's investment behavior and further support mental account theory. The results also predict the potential threats of "grey principal" to market stability.

Enhancing quality and integrity in biomedical research in Africa: an international call for greater focus, investment and standardisation in capacity strengthening for frontline staff.

The integrity of biomedical research depends heavily on the quality of research data collected. In turn, data quality depends on processes of data collection, a task undertaken by frontline research staff in many research programmes in Africa and elsewhere. These frontline research staff often have additional responsibilities including translating and communicating research in local languages, seeking informed consent for study participation and maintaining supportive relationships between research institutions and study participants and wider communities. The level of skills that fieldworkers need to undertake these responsibilities clearly affects the quality of data collected, the ethics of research 'on the ground' and the short and long term acceptability of research.We organised an international workshop in Kenya in July 2014 to discuss the role of frontline staff in scientific research. A total of 25 field managers from 9 African countries and the UK met for 2.5 days to discuss the relationship between data quality and institutional performance management systems and how they affect career progression and supportive supervision policies of research frontline staff.From this workshop, and supporting an expanding literature on the role of fieldworkers in international health research, participants agreed that fieldworkers' roles present them with practical and ethical challenges that their routine training does not adequately prepare them for. We argue that the common and complex challenges facing fieldworkers should in part be addressed through increased investment and collaborative agreements across types of research institutions in Africa. We call for standardization of core elements of training for this critically important cadre of research staff who perform similar roles and encounter similar challenges in many African settings. Although many valuable training elements are offered in institutions, there is a need to develop broader, more grounded and innovative strategies to address complex realities for fieldworkers, and support the integrity and ethics of health research in these settings.

Infectious disease research investments follow colonial ties: questionable ethics.

BACKGROUND: International funding for global health research is not systematically documented. We have assessed the level of research funding awarded by UK funders of international research to low- and middle-income countries or research institutions in these countries. METHODS: We analysed 6165 studies; from these we selected 522 that matched our criteria and used them to evaluate research funding by pathogen, disease, research and development value chain, funding organisation and country. RESULTS: Investment in infectious disease research in the countries studied totalled £264 million. Distribution of research investments closely mirrored that of the UK's former colonial territories; the top five countries, and eight of the top 10, have historical links with the UK, being current or former members of the Commonwealth of Nations. HIV, malaria and neglected tropical diseases attracted the greatest investment (£219 million; 82.8%), with most studies focussing on operational and epidemiological research (£109 million; 41.3%). CONCLUSIONS: International financing of infectious disease research by UK funding organisations follows former colonial ties. Funding institutions should review their funding policies to ensure that they also assist low- and middle-income countries without colonial ties to address their disease burden. A global investment surveillance system is needed to map and monitor funding for international research and guide the allocation of scarce resources to reduce the global disease burden.

Masters of the universe: how power and accountability influence self-serving decisions under moral hazard.

This article provides an answer to the question of why agents make self-serving decisions under moral hazard and how their self-serving decisions can be kept in check through institutional arrangements. Our theoretical model predicts that the agents' power and the manner in which they are held accountable jointly determine their propensity to make self-serving decisions. We test our theory in the context of financial investment decisions made under moral hazard using others' funds. Across 3 studies, using different decision-making tasks, different manipulations of power and accountability, and different samples, we show that agents' power makes them more likely to behave in a self-serving manner under moral hazard, but only when the appropriate accountability mechanisms are not in place. Specifically, we distinguish between outcome and procedural accountability and show that holding agents accountable for their decision-making procedure reduces the level of self-serving decisions under moral hazard and also curbs the negative consequences of power. Implications for decisions under moral hazard, the psychology of power, and the accountability literature are discussed.

Do physicians/researchers trade stock based on privileged information? A closer look at trading patterns surrounding the annual ASCO conference.

The goal of this paper was to assess whether, given the opportunity, physicians/researchers would try to profit (by trading stocks) from information that only they were made privy to. The Annual ASCO (American Society of Clinical Oncology) Conference, the largest annual oncology conference, provided the perfect venue to fully explore this question. Up until 2008, ASCO abstracts were released exclusively to ASCO members (i.e., physicians, oncologists) two weeks prior to the conference, and many speculated about unusual trading patterns during these two weeks. In 2008, in response to concerns about such illicit activities, ASCO changed this policy (by distributing these abstracts instead to the general public). We decided to take a closer look at these trading patterns to determine the true impact of ASCO's 2008 decision and whether the differences prior to and following 2008 reveal something about the likelihood of physicians/researchers to profit from "privileged information."

Taxonomía práctica de la «desinversión sanitaria» en lo que no añade valor, para hacer sostenible el Sistema Nacional de Salud / Practical taxonomy of health care containment/disinvestment in non-value-added care in order to have a sustainable NHS

El entorno de severa contención de costes obligará a buscar de forma activa la sostenibilidad interna en los sistemas sanitarios; la desinversión en todos los servicios que no añaden valor es una de las herramientas a utilizar. En este artículo se aporta una taxonomía práctica para identificar los cuidados inefectivos, inseguros, innecesarios, inútiles, inclementes e insensatos, y se analizan las implicaciones en relación a pacientes ordenados por su gravedad y en función a las ganancias de salud esperables por la intervención. Finalmente se analiza la factibilidad de las políticas de desinversión en relación al ámbito macro-meso o micro de la gestión(AU)

The environment of severe cost containment has led to the active search of "internal sustainability" of health systems; the disinvestment in all non-value added services is one of the tools used. This article provides the taxonomy to identify ineffective, unsafe, unnecessary, unsuccessful, unkind and unwise care practices and discusses their implications in relation to patients ordered according to their severity, as well as the expected health gains of the intervention. Finally, the feasibility of those disinvestment policies is analysed according to macro-,middle, and micro-management scenarios(AU)