The Unintended Consequences of Conflict of Interest Disclosure: Three Ethics Committee Chairs Discuss the Conundrum

2012 ◽  
Vol 12 (8) ◽  
pp. 18
Author(s):  
Orly Avitzur
2012 ◽  
Vol 67 (6) ◽  
pp. 334-336
Author(s):  
George Loewenstein ◽  
Sunita Sah ◽  
Daylian M. Cain

2020 ◽  
pp. 52-58
Author(s):  
L.S. Ovcharenko ◽  
◽  
A.A. Vertehel ◽  
T.G. Andrienko ◽  
I.V. Samokhin ◽  
...  

Objective: to increase the efficiency and safety of the treatment of the bronchi secretory-evacuation disorders in acute bronchitis with impaired respiratory function in children by using a medication with minimal effect on the cardiovascular system. Materials and methods. Under observation were 60 children aged 6 to 11 years. 2 observation groups were formed (30 children in each group): 1st group — children receiving the Bronchipret® for 10 days with acute bronchitis with impaired respiratory function; 2nd group — children who do not receive the Bronchipret in acute bronchitis with impaired respiratory function. Results. In the group of patients taking Bronchipret®, in addition to faster clinical dynamics, according to spirography, there was an improvement in the parameters of the external respiration function, characterizing the obstructive component of the obstruction of the air flow. After therapy with Bronchipret®, normalization of the functioning of the autonomic nervous system and the predominance of eutonia were observed against the background of a decrease in the number of registration of parasympathicotonia. Conclusion. The good tolerance and safety of Bronchipret® during 7-day use in patients aged 6–11 years allows us to recommend this drug as a highly effective treatment for bronchi secretory-evacuation disorders in acute bronchitis in children. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: children, bronchitis, spirography, treatment, thyme, ivy.


JAMA ◽  
2012 ◽  
Vol 307 (7) ◽  
pp. 669 ◽  
Author(s):  
George Loewenstein ◽  
Sunita Sah ◽  
Daylian M. Cain

2017 ◽  
Vol 1 (2) ◽  
pp. 177-189 ◽  
Author(s):  
SUNITA SAH

AbstractAdvisors, such as physicians, financial advisors, lawyers and accountants, often face a conflict of interest – that is, a clash between their professional and personal interests. Such conflicts can lead to biased and corrupt advice. In this paper, I focus on how conflicts of interest can cause good people to unintentionally cross ethical boundaries and how we can avoid succumbing to this bias. I first discuss two mechanisms through which advisors may convince themselves to accept conflicts of interest while vehemently believing that they remain unbiased: (1) a sense of entitlement; and (2) a sense of invulnerability created by their belief in their own professionalism. I then discuss several proposed policy solutions to manage conflicts of interest, such as education and training, sanctions, second opinions and disclosure policies. These proposed solutions for dealing with conflicts of interest are largely based on inaccurate intuitions regarding the psychological processes that underlie them; consequently, these policies tend to fail or have unintended consequences. In the absence of eliminating conflicts of interest, solutions that are more likely to be successful consist of identifying and changing the professional norms that exert powerful influences on employee behaviour.


2021 ◽  
pp. 36-42
Author(s):  
R.A. Nakonechnyy ◽  
◽  
A.Y. Nakonechnyi ◽  

Purpose – to establish cystoscopic prognostic criteria for vesicoureteral reflux (VUR) in children. Materials and methods. Clinical material covers 270 patients with VUR II–IV grades aged 9 months to 14 years and 22 healthy children. The study included patients with VUR in the period of clinical and laboratory remission without symptoms of neurogenic bladder. During cystoscopy, the condition of the bladder mucosa was assessed; location, shape, hydrodistention degree, and ureteral orifices contractility. Results. Patients with VUR were diagnosed ureteral orifices in the form of: horseshoes – 127 (47.04%) patients, stadium – 106 (39.26%) and golf holes – 37 (13.7%). They were in the zones: A – 13 (4.81%) children, B – 154 (57.04%), C – 67 (24.81%), D – 36 (13.33%), and were characterized by the hydrodistention degree: H0 – 7 (2.59%) patients, H1 – 173 (64.07%), H2 – 60 (22.22%) and H3 – 30 (11.11%). In children with VUR, sluggish peristalsis of the ureter orifices clearly prevailed – 252 (93.33%) cases, relative to active peristalsis in only 18 (6.67%) patients. Conclusions. For ureteral orifices in the form of a stadium and with more pronounced signs of deepening, which are shifted to zone B and laterally to the sidewall of the bladder, with a hydrodistention degree above H1 has a positive association with VUR at the highest specificity of tests. Unfavorable prognostic diagnostic markers for effective minimally invasive interventions in patients with VUR should be considered ureteral orifices, which combine such morpho-topographic characteristics as pronounced signs of deepening to the shape of a golf hole, lateralization to the sidewall of the bladder in zone D, and hydrodistention H3 degree. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: vesicoureteral reflux, ureteral orifice, cystoscopy, children.


BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e026886 ◽  
Author(s):  
Ben Goldacre ◽  
Carl Reynolds ◽  
Anna Powell-Smith ◽  
Alex J Walker ◽  
Tom A Yates ◽  
...  

ObjectivesApproximately one in eight practices in primary care in England are ‘dispensing practices’ with an in-house dispensary providing medication directly to patients. These practices can generate additional income by negotiating lower prices on higher cost drugs, while being reimbursed at a standard rate. They, therefore, have a potential financial conflict of interest around prescribing choices. We aimed to determine whether dispensing practices are more likely to prescribe high-cost options for four commonly prescribed classes of drug where there is no evidence of superiority for high-cost options.DesignA list was generated of drugs with high acquisition costs that were no more clinically effective than those with the lowest acquisition costs, for all four classes of drug examined. Data were obtained prescribing of statins, proton pump inhibitors (PPIs), angiotensin receptor blockers (ARBs) and ACE inhibitors (ACEis). Logistic regression was used to calculate ORs for prescribing high-cost options in dispensing practices, adjusting for Index of Multiple Deprivation score, practice list size and the number of doctors at each practice.SettingEnglish primary care.ParticipantsAll general practices in England.Main outcome measuresMean cost per dose was calculated separately for dispensing and non-dispensing practices. Dispensing practices can vary in the number of patients they dispense to; we, therefore, additionally compared practices with no dispensing patients, low, medium and high proportions of dispensing patients. Total cost savings were modelled by applying the mean cost per dose from non-dispensing practices to the number of doses prescribed in dispensing practices.ResultsDispensing practices were more likely to prescribe high-cost drugs across all classes: statins adjusted OR 1.51 (95% CI 1.49 to 1.53, p<0.0001), PPIs OR 1.11 (95% CI 1.09 to 1.13, p<0.0001), ACEi OR 2.58 (95% CI 2.46 to 2.70, p<0.0001), ARB OR 5.11 (95% CI 5.02 to 5.20, p<0.0001). Mean cost per dose in pence was higher in dispensing practices (statins 7.44 vs 6.27, PPIs 5.57 vs 5.46, ACEi 4.30 vs 4.24, ARB 11.09 vs 8.19). For all drug classes, the more dispensing patients a practice had, the more likely it was to issue a prescription for a high-cost option. Total cost savings in England available from all four classes are £628 875 per month or £7 546 502 per year.ConclusionsDoctors in dispensing practices are more likely to prescribe higher cost drugs. This is the largest study ever conducted on dispensing practices, and the first contemporary research suggesting some UK doctors respond to a financial conflict of interest in treatment decisions. The reimbursement system for dispensing practices may generate unintended consequences. Robust routine audit of practices prescribing higher volumes of unnecessarily expensive drugs may help reduce costs.


ASHA Leader ◽  
2003 ◽  
Vol 8 (14) ◽  
pp. 25-25 ◽  
Author(s):  
Allan O. Diefendorf
Keyword(s):  

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