Surveying the Chemical Anthropocene

Faced with the non-optional acceptance of toxic chemical artifacts, the ubiquitous interweaving of chemicals in our social fabric oft en exists out of sight and out of mind. Yet, for many, toxic exposures signal life-changing or life-ending events, phantom threats that fail to appear as such until they become too late to mitigate. Assessments of toxicological risk consist of what Sheila Jasanoff calls “sociotechnical imaginaries,” arbitrations between calculated costs and benefits, known risks and scientifically wrought justifications of safety. Prevalent financial conflicts of interest and the socially determined hazards posed by chemical exposure suggest that chemical safety assessments and regulations are a form of postnormal science. Focusing on the histories of risk assessments of pesticides such as DDT, atrazine, PFAS, and glyphosate, this article critically reviews Michel Serres’s notion of “appropriation by contamination.”

Historical trends in health care-related financial holdings among members of Congress

Background Revelations that some members of Congress, including members of key health care committees, hold substantial personal investments in the health care industry have raised concerns about lawmakers’ financial conflicts of interest (COI) and their potential impact on health care legislation and oversight. Aims 1) To assess historical trends in both the number of legislators holding health care-related assets and the value and composition of those assets. 2) To compare the financial holdings of members of health care-focused committees and subcommittees to those of other members of the House and Senate. Methods We analyzed 11 years of personal financial disclosures by all members of the House and Senate. For each year, we calculated the percentage of members holding a health care-related asset (overall, by party, and by committee); the total value of all assets and health care-related assets held; the mean and median values of assets held per member; and the share of asset values attributable to 9 health asset categories. Findings During the study period, over a third of all members of Congress held health care-related assets. These assets were often substantial, with a median total value per member of over $43,000. Members of health care-focused committees and subcommittees in the House and Senate did not hold health care-related assets at a higher rate than other members of their respective chambers. Conclusions These findings suggest that lawmakers’ health care-related COI warrant the same level of attention that has been paid to the COI of other actors in the health care system.

Improving financial disclosures in oncology.

e18642 Background: The Physician Payments Sunshine Act, as part of the Affordable Care Act, was enacted in 2010 to improve transparency of payments from drug and medical device manufacturers to physicians, which are easily accessible in a public database (OpenPayments CMS). However, in a review conducted of clinical drug trials in oncology, one-third of oncologist authors did not disclose their industry payments. Failure to disclose financial conflicts of interest can lead to a loss of public trust and in some cases may lead to legal liability. The American Society for Clinical Oncology and our institutional polices require all faculty to fully report financial conflicts of interest (COI). This pilot project aims to evaluate the accuracy of financial COI disclosures among our oncologists at the University of Chicago, and improve subsequent disclosures. Methods: This project was approved through the institutional quality improvement process. In May 2020, we crossmatched COI disclosures on journal publications for 37 practicing clinical hematologists/oncologists in our institution with 2017 and 2018 records on OpenPayments. We then conducted a department-wide Grand Rounds to review omissions, and to remind faculty of ASCO and University COI policies. In addition, we privately contacted individual oncologists to review any COI omissions. We reminded faculty that at the end of 2020 we would again review the accuracy of their disclosures. Results: We examined a total of 37 practicing hematologists/oncologists’ disclosure forms. At initial review, 6/37 (16.2%) of oncologists had incomplete or missing disclosures. A total of $569,182.95 in payments was not disclosed in 2018. 2 of these 6 oncologists did not disclose relevant payments from pharmaceutical companies whose drugs were referred to in publications. Several disclosure errors appeared to be inadvertent omissions as they were disclosed in other publications. Reasons given for disclosure omissions were: “oversight”, “did not believe to be relevant to publication”, “confusion over journal COI policies”, “unnecessary due to low payment amount”, "too many journals to update disclosures in". At the final review, only 2 of the 6 oncologists with disclosure omissions had updated disclosures at the end of the year despite education provided at multiple grand rounds and private communications. Conclusions: This pilot project demonstrated that education sessions and individual feedback improved adherence to COI disclosure policies, but not fully. Additional feedback and enforcement mechanisms may be required for full compliance. In addition, a centralized disclosure form (such as ASCO’s disclosure form) that journals can easily access may improve disclosure adherence.

Discrepancies in self-reported financial conflicts of interest disclosures by physicians: a systematic review

BackgroundThere is a high prevalence of financial conflicts of interest (COI) between physicians and industry.ObjectivesTo conduct a systematic review with meta-analysis examining the completeness of self-reported financial COI disclosures by physicians, and identify factors associated with non-disclosure.Data sourcesMEDLINE, Embase and PsycINFO were searched for eligible studies up to April 2020 and supplemented with material identified in the references and citing articles.Data extraction and synthesisData were independently abstracted by two authors. Data synthesis was performed via systematic review of eligible studies and random-effects meta-analysis.Main outcomes and measuresThe proportion of discrepancies between physician self-reported disclosures and objective payment data was the main outcome. The proportion of discrepant funds and factors associated with non-disclosure were also examined.Results40 studies were included. The pooled proportion of COI discrepancies at the article level was 81% (range: 54%–98%; 95% CI 72% to 89%), 79% at the payment level (range: 71%–89%; 95% CI 67% to 89%), 93% at the authorship level (range: 71%–100%; 95% CI 79% to 100%) and 66% at the author level (range: 8%–99%; 95% CI 48% to 78%). The proportion of funds discrepant was 33% (range: 2%–77%; 95% CI 12% to 58%). There was high heterogeneity between studies across all five analyses (I2=94%–99%). Most undisclosed COI were related to food and beverage, or travel and lodging. While the most common explanation for failure to disclose was perceived irrelevance, a median of 45% of non-disclosed payments were directly or indirectly related to the work. A smaller monetary amount was the most common factor associated with nondisclosure.ConclusionsPhysician self-reports of financial COI are highly discrepant with objective data sources reporting payments from industry. Stronger policies are required to reduce reliance on physician self-reporting of financial COI and address non-compliance.