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2.
Rinsho Ketsueki ; 62(8): 1349-1356, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34497226

RESUMO

Conflict of interest (COI) is a conflict between related parties, such as researchers, research institutions, academic societies, and third parties (commercial companies and patients). COI sometimes twists research and clinical practice, resulting in the profit instruction of related individuals or organizations. In medical research, high ethical standards are demanded to protect human rights, life, and safety of study participants, and COI must be properly enforced to maintain study fairness and ensure transparency. In Japan, the Japanese Association of Medical Science issued COI guideline in 2017, which formed the basis of many societies in making their common COI guidelines. The Japanese Society of Hematology issued COI management guideline in 2018 and is strictly managing COI of its members, organization, and clinical guideline committee members. As industry-academia collaboration activities become more active, the concept of COI is deepening; therefore, appropriate COI disclosure should be conducted based on recent trends to promote sound research and business activities.


Assuntos
Conflito de Interesses , Hematologia , Revelação , Humanos , Japão , Sociedades Médicas
5.
Environ Health ; 20(1): 90, 2021 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-34412643

RESUMO

BACKGROUND: Critical knowledge of what we know about health and disease, risk factors, causation, prevention, and treatment, derives from epidemiology. Unfortunately, its methods and language can be misused and improperly applied. A repertoire of methods, techniques, arguments, and tactics are used by some people to manipulate science, usually in the service of powerful interests, and particularly those with a financial stake related to toxic agents. Such interests work to foment uncertainty, cast doubt, and mislead decision makers by seeding confusion about cause-and-effect relating to population health. We have compiled a toolkit of the methods used by those whose interests are not aligned with the public health sciences. Professional epidemiologists, as well as those who rely on their work, will thereby be more readily equipped to detect bias and flaws resulting from financial conflict-of-interest, improper study design, data collection, analysis, or interpretation, bringing greater clarity-not only to the advancement of knowledge, but, more immediately, to policy debates. METHODS: The summary of techniques used to manipulate epidemiological findings, compiled as part of the 2020 Position Statement of the International Network for Epidemiology in Policy (INEP) entitled Conflict-of-Interest and Disclosure in Epidemiology, has been expanded and further elucidated in this commentary. RESULTS: Some level of uncertainty is inherent in science. However, corrupted and incomplete literature contributes to confuse, foment further uncertainty, and cast doubt about the evidence under consideration. Confusion delays scientific advancement and leads to the inability of policymakers to make changes that, if enacted, would-supported by the body of valid evidence-protect, maintain, and improve public health. An accessible toolkit is provided that brings attention to the misuse of the methods of epidemiology. Its usefulness is as a compendium of what those trained in epidemiology, as well as those reviewing epidemiological studies, should identify methodologically when assessing the transparency and validity of any epidemiological inquiry, evaluation, or argument. The problems resulting from financial conflicting interests and the misuse of scientific methods, in conjunction with the strategies that can be used to safeguard public health against them, apply not only to epidemiologists, but also to other public health professionals. CONCLUSIONS: This novel toolkit is for use in protecting the public. It is provided to assist public health professionals as gatekeepers of their respective specialty and subspecialty disciplines whose mission includes protecting, maintaining, and improving the public's health. It is intended to serve our roles as educators, reviewers, and researchers.


Assuntos
Métodos Epidemiológicos , Conflito de Interesses , Projetos de Pesquisa , Incerteza
7.
BMJ Open ; 11(7): e045406, 2021 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-34285004

RESUMO

OBJECTIVES: Transparent reporting of trials is necessary to assess their internal and external validity. Currently, little is known about the quality of reporting in antibiotics trials. Our study investigates the reporting of adverse events, conflicts of interest and funding information in trials of penicillins, cephalosporins and macrolides. DESIGN: A secondary analysis of trials included in a convenience sample of three systematic reviews. METHODS: All randomised controlled trials included in the systematic reviews were included, although duplicates were removed. Eligible trials compared the specified antibiotics to placebo, for any indication. Author pairs independently extracted the data on reporting of adverse events from parent reviews, and data on funding and conflict of interest information from the trial reports. We calculated the overall proportion of trials reporting adverse events, conflict of interest information and funding information, and their proportion before and after the publication of the Consolidated Standards of Reporting Trials (CONSORT) 2001 Statement. RESULTS: We included 432 trials. Overall, 62% of trials reported adverse events of any kind, although reporting of deaths or antibiotic resistance was less frequent (20% and 37%, respectively). Conflict-of-interest information was provided in 26% of the trials, and funding information was provided in 66% of the trials. There was no significant difference in reporting of adverse events before and after the publication of CONSORT 2001 Statement (62% vs 62%, p=0.92). Conflict of interest statements were provided more frequently (2% vs 55%, p<0.001) and conflict was present more often (0% vs 14%, p<0.001). There was no difference in the provision of the information about trial funding before (62%) and after (70%) CONSORT 2001 publication. CONCLUSIONS: Information about adverse events, conflict of interest and funding, remains under-reported in trials of antibiotics.


Assuntos
Antibacterianos , Conflito de Interesses , Ensaios Clínicos Controlados Aleatórios como Assunto , Antibacterianos/efeitos adversos , Cefalosporinas , Humanos , Macrolídeos , Penicilinas
15.
Med Teach ; 43(7): 765-773, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34182879

RESUMO

Clinical competency committees (CCCs) are increasingly used within health professions education as their decisions are thought to be more defensible and fairer than those generated by previous training promotion processes. However, as with most group-based processes, it is inevitable that conflict will arise. In this paper the authors explore three ways conflict may arise within a CCC: (1) conflicting data submissions that are presented to the committee, (2) conflicts between members of the committee, and (3) conflicts of interest between a specific committee member and a trainee. The authors describe each of these conflict situations, dissect out the underlying problems, and explore possible solutions based on the current literature.


Assuntos
Competência Clínica , Conflito de Interesses , Processos Grupais , Humanos , Relações Interpessoais
16.
BMJ ; 373: n1583, 2021 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-34158287
17.
Bull Cancer ; 108(7-8): 677-685, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34175111

RESUMO

Clinical practice and medical research can expose to several situations with risks of conflicts of interests. Such situations can induce attenuations of their primary professional interest in favor of, so-called, secondary interests, and leading to bias in their judgement and actions. In this area, if financial conflicts of interests are consistent and frequently dominant, intellectual conflicts of interests have to be analyzed and considered, like those amplified and even induced by the current tremendous competition for scientific publication. In this article, after a contextual review of conflicts of interests in medicine, we will document and discuss more specifically those frequently induced by leaks of financial interests and those linked by evolutions of the current scientific expansion and competition.


Assuntos
Pesquisa Biomédica/ética , Conflito de Interesses/economia , Ética Médica , Editoração/ética , Viés , Pesquisa Biomédica/economia , Raciocínio Clínico , Comunicação , Competição Econômica , Empoderamento , Setor de Assistência à Saúde/economia , Setor de Assistência à Saúde/ética , Humanos , Poder Psicológico , Má Conduta Científica/ética
19.
PLoS Med ; 18(6): e1003645, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34061852

RESUMO

BACKGROUND: The rapidly increased spending on insulin is a major public health issue in the United States. Industry marketing might be one of the upstream determinants of physicians' prescription of long-acting insulin-the most commonly used and costly type of insulin, but the evidence is lacking. We therefore aimed to investigate the association between industry payments to physicians and subsequent prescriptions of long-acting insulin. METHODS AND FINDINGS: Using the databases of Open Payments and Medicare Part D, we examined the association between the receipt of industry payments for long-acting insulin in 2016 and (1) the number of claims; (2) the costs paid for all claims; and (3) the costs per claim of long-acting insulin in 2017. We also examined the association between the receipt of payments and the change in these outcomes from 2016 to 2017. We employed propensity score matching to adjust for the physician-level characteristics (sex, years in practice, specialty, and medical school attended). Among 145,587 eligible physicians treating Medicare beneficiaries, 51,851 physicians received industry payments for long-acting insulin worth $22.3 million. In the propensity score-matched analysis including 102,590 physicians, we found that physicians who received the payments prescribed a higher number of claims (adjusted difference, 57.8; 95% CI, 55.8 to 59.7), higher costs for total claims (adjusted difference, +$22,111; 95% CI, $21,387 to $22,836), and higher costs per claim (adjusted difference, +$71.1; 95% CI, $69.0 to $73.2) of long-acting insulin, compared with physicians who did not receive the payments. The association was also found for changes in these outcomes from 2016 to 2017. Limitations to our study include limited generalizability, confounding, and possible reverse causation. CONCLUSIONS: Industry marketing payments to physicians for long-acting insulin were associated with the physicians' prescriptions and costs of long-acting insulin in the subsequent year. Future research is needed to assess whether policy interventions on physician-industry financial relationships will help to ensure appropriate prescriptions and limit overall costs of this essential drug for diabetes care.


Assuntos
Compensação e Reparação , Conflito de Interesses/economia , Indústria Farmacêutica/economia , Hipoglicemiantes/uso terapêutico , Insulina de Ação Prolongada/uso terapêutico , Padrões de Prática Médica/economia , Atitude do Pessoal de Saúde , Bases de Dados Factuais , Prescrições de Medicamentos/economia , Uso de Medicamentos/economia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Medicare Part D , Pontuação de Propensão , Estados Unidos
20.
Ann Intern Med ; 174(8): 1126-1132, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34029483

RESUMO

In response to the COVID-19 pandemic, the Scientific Medical Policy Committee (SMPC) of the American College of Physicians (ACP) began developing "practice points" to provide clinical advice based on the best available evidence for the public, patients, clinicians, and public health professionals. As one of the first organizations in the United States to develop evidence-based clinical guidelines, ACP continues to lead and advance the science of evidence-based medicine by implementing new methods to rapidly publish practice points and maintain them as living advice that regularly assesses and incorporates new evidence. The overarching aim of practice points is to answer targeted key questions for which there is a timely need to synthesize evidence for decision making. The SMPC believes these methods can potentially be adapted to address various clinical and public health topics beyond the COVID-19 pandemic. This article presents an overview of the SMPC's living, rapid practice points development process, which includes a rapid systematic review, use of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method, use of stringent policies on the disclosure of interests and management of conflicts of interest, incorporating a public (nonclinician) perspective, and maintenance of the documents as living through ongoing surveillance and synthesis of new evidence as it emerges.


Assuntos
COVID-19/diagnóstico , COVID-19/terapia , Medicina Baseada em Evidências/métodos , Guias de Prática Clínica como Assunto , Teste para COVID-19 , Tomada de Decisão Clínica , Conflito de Interesses , Humanos , Pandemias , Revisões Sistemáticas como Assunto/métodos , Estados Unidos
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