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\"Medical professionals are expected to act in the interest of patients, the public, and the pursuit of medical knowledge. Their disinterested pursuit offers them credibility and authority. But what happens when doctors' supposed impartiality comes under fire? Medicine and Morality considers the ways in which moral and scientific norms in Canadian medicine have emerged and evolved over time. Critics of biomedicine tend to discuss conflict of interest as a contemporary phenomenon - namely in relation to the damaging influence of the pharmaceutical industry on medical practice and research. But Helen Kang examines three moments in the history of the medical profession in Canada, spanning more than 150 years, when doctors' moral and scientific authority was questioned. Kang shows that, in these moments of crisis, the profession was compelled to re-examine its priorities, strategize in order to regain credibility, and redefine what it means to be a good doctor. Medicine and Morality reveals that professional medicine defines integrity, objectivity, accountability, neutrality, and other ideals according to its social, political, historical, and economic struggles with the state, the media, and even the public. In other words, moral and scientific standards in medicine are determined in direct relation to, not in spite of, conflict of interest.\"-- Provided by publisher.

Objective To examine the association between the presence of individual principal investigators’ financial ties to the manufacturer of the study drug and the trial’s outcomes after accounting for source of research funding.Design Cross sectional study of randomized controlled trials (RCTs).Setting Studies published in “core clinical” journals, as identified by Medline, between 1 January 2013 and 31 December 2013.Participants Random sample of RCTs focused on drug efficacy.Main outcome measure Association between financial ties of principal investigators and study outcome.Results A total of 190 papers describing 195 studies met inclusion criteria. Financial ties between principal investigators and the pharmaceutical industry were present in 132 (67.7%) studies. Of 397 principal investigators, 231 (58%) had financial ties and 166 (42%) did not. Of all principal investigators, 156 (39%) reported advisor/consultancy payments, 81 (20%) reported speakers’ fees, 81 (20%) reported unspecified financial ties, 52 (13%) reported honorariums, 52 (13%) reported employee relationships, 52 (13%) reported travel fees, 41 (10%) reported stock ownership, and 20 (5%) reported having a patent related to the study drug. The prevalence of financial ties of principal investigators was 76% (103/136) among positive studies and 49% (29/59) among negative studies. In unadjusted analyses, the presence of a financial tie was associated with a positive study outcome (odds ratio 3.23, 95% confidence interval 1.7 to 6.1). In the primary multivariate analysis, a financial tie was significantly associated with positive RCT outcome after adjustment for the study funding source (odds ratio 3.57 (1.7 to 7.7). The secondary analysis controlled for additional RCT characteristics such as study phase, sample size, country of first authors, specialty, trial registration, study design, type of analysis, comparator, and outcome measure. These characteristics did not appreciably affect the relation between financial ties and study outcomes (odds ratio 3.37, 1.4 to 7.9).Conclusions Financial ties of principal investigators were independently associated with positive clinical trial results. These findings may be suggestive of bias in the evidence base.

The objective of the study is to review the literature for studies that assessed the concordance of financial conflicts of interest disclosures with payments’ databases and evaluate their methods. We conducted a systematic survey of the health literature to identify eligible studies. We searched both Medline and EMBASE up to February 2017. We conducted study selection, data abstraction, and methodological quality assessment in duplicate and independently using standardized forms. We subcategorized ‘nonconcordant disclosures’ as either ‘partially nonconcordant’ or ‘completely nonconcordant’. The main outcome was the percentage of authors with ‘nonconcordant’ disclosures. We summarized results by three levels of analysis: authors, companies, and studies. We identified 27 eligible journal articles. The top two types of documents assessed were published articles (n = 13) and published guidelines (n = 9). The most commonly used payment database was the Open Payments Database (n = 16). The median percentage of authors with ‘nonconcordant’ disclosures was 81%; the median percentage was 43% for ‘completely nonconcordant’ disclosures. The percentage of ‘nonconcordant’ conflict of interest (COI) reporting by companies varied between 23% and 85%. The methods of concordance assessment, as well as the labeling and definitions of assessed outcomes varied widely across the included studies. We judged three of the included studies as high-quality studies. Underreporting of health science researchers’ financial COIs is pervasive. Studies assessing COI underreporting suffer from a number of limitations that could have overestimated their findings.

The American College of Chest Physicians Antithrombotic Guidelines ninth iteration placed restrictions on panelists with recommendations on which they disclosed a primary conflict of interest (COI). We aimed to describe panelists' financial and intellectual COI and evaluate to what extent, beyond assessing financial COI, assessing intellectual COI affected COI management. We classified financial and intellectual COI into primary (causes voting restriction) and secondary (no restrictions). We analyzed disclosures respectively with panelists and recommendations as units of analysis. One hundred two panelists made 4,030 disclosures for 431 recommendations. The median number (and range) of panelists per recommendation who disclosed the various categories of COI was 0 (0–5) for primary financial COI, 0 (0–4) for secondary financial COI, 0 (0–7) for primary intellectual COI, and 1 (0–6) for secondary intellectual COI. Of the 431 recommendations, 63 (15%) had at least one panelist with a primary intellectual COI but no primary financial COI. COI had a relatively low prevalence and a skewed distribution, many panelists with none and some with many disclosures. A substantial number of disclosures should have resulted in restrictions based on intellectual COI in the absence of financial COI.

To assess the adequacy of reporting of funder and authors' financial conflicts of interest information in randomized trial publications of drugs or devices, and to assess to which degree the missing information can be obtained from other sources. We took a random sample of 200 randomized trial publications indexed in MEDLINE in May 2022. Two authors independently assessed the adequacy of funder and authors' conflicts of interest information. We considered funder information adequate when name of funder(s), type(s) of support, and funder's involvement were reported. Similarly, we considered authors' financial conflicts of interest information adequate when name of organization(s), type of relationship(s), and the involvement of author(s) with financial conflicts of interest were reported. We attempted to obtain missing information through multiple approaches (eg, searching websites, trial registries, and public disclosure databases) and recorded the time taken. We found that information on funder was adequately reported in 67 (34%) trial publications, partly adequate in 110 (55%), inadequate in 12 (6%), and 11 (6%) had no information available. Often, trial publications did not report the type(s) of support (40%) and the funders' involvement in the trial design, conduct, analysis, and reporting (58%). After obtaining missing information, the proportion of trial publications with adequate funder information increased by 32% (we obtained information on all domains for 64 of 133 trial publications) by spending a median time of 13 minutes per trial. Information on authors' financial conflicts of interest was adequately reported in 180 (90%) trial publications, and we obtained the missing information for four trials (20%) by spending a median time of 28 minutes per trial. In contemporary trial publications, funder information was rarely adequately reported, whereas authors' financial conflicts of interest information was adequately reported in almost all trial publications. Our approaches for obtaining missing information improved the adequacy of funder and conflicts of interest information. Our approaches were particularly effective in obtaining funder information, whereas efforts to obtain conflicts of interest information were less successful and more time-consuming. Our findings provide context for systematic review authors when deciding if and how to search for missing funder and conflicts of interest information while balancing the need for obtaining information with the time spent searching. •34% of trial publications adequately reported funder information.•90% of trial publications adequately reported information on authors’ financial conflicts of interest.•After obtaining missing information, the proportion of trial publications with adequate funder information increased by 32% by spending a median of 13 minutes per trial.•We obtained the missing information on authors’ financial conflicts of interest for 4 trials (20%) by spending a median of 28 minutes per trial.•Our findings provide context for review authors when deciding if and how to search for missing information while balancing the need for obtaining information with the time spent searching.

Monoclonal antibody drugs are widely used, highly marketed, expensive compounds. Relationships between these drug manufacturers and physicians may increase the potential for bias in relevant studies. The aim of this study is to determine the rate of disclosures among physicians receiving compensations for monoclonal antibody drugs (MAbDs). This is a retrospective, population-based, cross-sectional study. The 50 physicians who received the highest financial compensation for selected MAbDs from 2016 to 2020 were included. Payment data were obtained from the Open Payments Database, bibliometric data were obtained from SCOPUS, and disclosure data were obtained from relevant publications found in PubMed. The primary outcome was rate of disclosure concordance between self-declared conflict-of-interest and industry-reported payments documented in the Open Payments Database. Of the 50 physicians examined, 74% (N = 37) had publications examined. A cumulative 6170 payments totaling $18,484,228 were analyzed. A total of 418 relevant papers were reviewed. The rate of full disclosure (all relevant financial relationships disclosed) was 39.5%, partial disclosure (some but not all financial relationships disclosed) was 28.0%, and no disclosure was 26.3%. 6.2% did not require disclosure. Publications authored by dermatologists had the highest rate of full disclosure at 49.3%. There was no association between h-index and disclosure rate. Practice guidelines had the highest rate of full disclosure at 69.2% while basic science papers had the lowest (0%). Lastly, substantial variations in specific journal disclosure policies were found. Substantial inconsistencies were found between self-reported disclosures and the Open Payments Database among physicians receiving high compensation for MAbDs. A policy of full disclosure for all publications should be adopted.

Conflict of interest, conflict management, and conflict resolution are often used interchangeably, leading to confusion and ineffective strategies in educational settings. Conflict of interest involves personal interests interfering with professional responsibilities. Conflict management focuses on minimizing negative impacts and fostering constructive outcomes, while conflict resolution addresses underlying issues for a final solution. Understanding these distinctions is essential for effective conflict handling, as conflating the terms can result in inappropriate strategies and ethical violations.

Groups such as the Institute of Medicine emphasize the importance of attention to financial conflicts of interest. Little guidance exists, however, on managing the risk of bias for systematic reviews from nonfinancial conflicts of interest. We sought to create practical guidance on ensuring adequate clinical or content expertise while maintaining independence of judgment on systematic review teams. Workgroup members built on existing guidance from international and domestic institutions on managing conflicts of interest. We then developed practical guidance in the form of an instrument for each potential source of conflict. We modified the Institute of Medicine's definition of conflict of interest to arrive at a definition specific to nonfinancial conflicts. We propose questions for funders and systematic review principal investigators to evaluate the risk of nonfinancial conflicts of interest. Once risks have been identified, options for managing conflicts include disclosure followed by no change in the systematic review team or activities, inclusion on the team along with other members with differing viewpoints to ensure diverse perspectives, exclusion from certain activities, and exclusion from the project entirely. The feasibility and utility of this approach to ensuring needed expertise on systematic reviews and minimizing bias from nonfinancial conflicts of interest must be investigated.

Despite repeated calls to prohibit or limit conflicts of interests among authors and sponsors of clinical guidelines, the problem persists. Jeanne Lenzer investigates