Including more than 50'000 documents - as well as 500 doctoral theses - the Globethics.net Health Ethics collection is a unique online resource covering topics related to health ethics such as pharmaceuticals, health economics, health politics, access to medical care, environmental issues and bioethics.

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  • To Serve the Community or Oneself: The Public Servant's Dilemma

    Serneels, Pieter; Lindelöw, Magnus; Barr, Abigail (World Bank, Washington, D.C., 2004-01)
    Embezzlement of resources is hampering public service delivery throughout the developing world. Research on this issue is hindered by problems of measurement. To overcome these problems, the authors use an economic experiment to investigate the determinants of corrupt behavior. They focus on three aspects of behavior: 1) Embezzling by public servants. 2) Monitoring effort by designated monitors. 3) Voting by community members when provided with an opportunity to select a monitor. The experiment allows the authors to study the effect of wages, effort observance, rules for monitor assignment, and professional norms. Their experimental subjects are Ethiopian nursing students. The authors find that service providers who earn more embezzle less, although the effect is small. Embezzlement is also lower when observance (associated with the risk of being caught and sanctioned) is high, and when service providers face an elected, rather than a randomly selected monitor. Monitors put more effort into monitoring when they face reelection, and when the public servant receives a higher wage. Communities reelect monitors who put more effort into exposing embezzlement. Framing-whereby players are referred to as "health workers" and "community members" rather than by abstract labels-affects neither mean embezzlement nor mean monitoring effort, but significantly increases the variance in both. This suggests that different types of experimental subjects respond differently to the framing, possibly because they adhere to different norms.
  • Addressing the Ethical, Legal, and Social Issues Raised by Voting by Persons with Dementia

    Knopman, David; Patusky, Christopher; Lyketsos, Constantine; Karlan, Pamela S; Kane, Rosalie A; Karlawish, Jason H; Bonnie, Richard J; Appelbaum, Paul S; James, Bryan (ScholarlyCommons, 2004-09-01)
    This article addresses an emerging policy problem in the United States participation in the electoral process by citizens with dementia. At present, health care professionals, family caregivers, and long-term care staff lack adequate guidance to decide whether individuals with dementia should be precluded from or assisted in casting a ballot. Voting by persons with dementia raises a series of important questions about the autonomy of individuals with dementia, the integrity of the electoral process, and the prevention of fraud. Three subsidiary issues warrant special attention: development of a method to assess capacity to vote; identification of appropriate kinds of assistance to enable persons with cognitive impairment to vote; and formulation of uniform and workable policies for voting in long-term care settings. In some instances, extrapolation from existing policies and research permits reasonable recommendations to guide policy and practice. However, in other instances, additional research is necessary.
  • Eurobarometer 39.1: Energy Policies, Biotechnology, and Genetic Engineering, May - June, 1993

    The Eurobarometer (EB) survey series is a unique programme of cross-national and cross-temporal comparative social science research. Since the early seventies representative national samples in all European Union (EU) (formerly the European Community (EC)) member states have been simultaneously interviewed in the spring and autumn of each year. Starting with EB 34.1 (autumn 1990), separate supplementary surveys on special issues have been conducted under almost every EB number. The EB is designed to provide regular monitoring of public social and political attitudes in the EU through specific trend questions. More information about the series may be found on the Zentralarchiv fuer Empirische Sozialforschung (ZA - Central Archive for Empirical Social Research, University of Cologne) Eurobarometer Survey Series web pages. Background Work on European survey series began in early 1970, when the Commission of the European Community sponsored simultaneous surveys of the EC. These surveys were designed to measure public awareness of, and attitudes toward, the Common Market and other EC institutions, in complementary fashion. They also probed the goals given top priority for each respondent's nation. These concerns have remained a central part of the EC's research efforts - which were carried forward in the summer of 1971 with another six-nation survey that gave special attention to agricultural problems. The nine EC member countries were then surveyed again on the same topic areas in September 1973. After 1973, the surveys took on a somewhat broader scope in content as well as in geographical coverage, with measures of subjective satisfaction and the perceived quality of life becoming standard features of the EC public opinion surveys. Over time, the member states of the EC/EU have increased in number, and the coverage of the EB surveys has widened accordingly. In 1974, nine countries were surveyed: France, Germany, United Kingdom, Italy, Netherlands, Belgium, Denmark, Ireland and Luxembourg. Greece has been included since the autumn 1980 survey (EB 14) onwards, Portugal and Spain since autumn 1985 (EB 24), the former German Democratic Republic since autumn 1990 (EB 34), Finland since the spring of 1993 (EB 39), and Sweden and Austria since the autumn of 1994 (EB 42). Norway has been included in some surveys since 1991, from EB 36 onwards. In 2004, the Czech Republic, Cyprus, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, Slovakia and Slovenia joined the EU, and in 2007, Bulgaria and Romania (some of these countries participated in the Candidate Countries Eurobarometer survey series (see under GN 33343) before full accession). Some surveys are also conducted in Turkey, and in the Turkish Cypriot Community (Northern Cyprus). The Eurobarometer public opinion surveys are conducted on behalf of and co-ordinated by the European Commission, DG Press and Communication - Opinion Polls Sector (European Commission Public Opinion Analysis). Special topic modules are carried out at the request of the responsible EU Directorate General. Main Topics: This round of Eurobarometer surveys queried respondents on standard Eurobarometer measures such as public awareness of and attitudes toward the Common Market and the European Union (EU), and also focused on biotechnology, genetic engineering, and energy policies. Respondents were questioned about their opinions regarding the application of biotechnology and genetic engineering to humans, animals, and plants. Opinions were also gathered on the need for ethical rules for the application of biotechnology, the use of biotechnology for changing hereditary characteristics, the need to balance animal and human welfare, the effectiveness of traditional breeding methods compared to genetic engineering, protection of the environment, and the influence of people and groups on the development of biotechnology. Energy-related topics covered the efficiency of public bodies in acting to conserve energy, the responsibility for energy investment decisions, the importance of stable energy prices, reliable energy supplies, and low pollution risks, and proposals to increase taxes on energy consumption and on packaging that pollutes the environment. In addition, respondents were queried about their satisfaction with their current housing, the area in which they lived, and the travel time from home to work. Respondent willingness to move in order to find or change jobs and their reasons for moving or not moving were also probed. On EU matters, respondents were asked about their satisfaction with and expectations for product purchases in other EU countries, whether national institutions of the relevant EU country or EU institutions were better able to solve potential buying or selling problems with other EU member states, and whether the respondent lived within 30 kilometres of another EU country. Demographic and other background information was gathered on number of people residing in the home, size of locality, home ownership, trade union membership, region of residence, and occupation of the head of household, as well as the respondent's age, gender, marital status, education, occupation, work sector, religiosity, subjective social class, left-right political self-placement, and opinion leadership.
  • Eurobarometer 46.1: Modern Biotechnology, Privacy on Computer Networks, and the Common European Currency, October - November, 1996

    The Eurobarometer (EB) survey series is a unique programme of cross-national and cross-temporal comparative social science research. Since the early seventies representative national samples in all European Union (EU) (formerly the European Community (EC)) member states have been simultaneously interviewed in the spring and autumn of each year. Starting with EB 34.1 (autumn 1990), separate supplementary surveys on special issues have been conducted under almost every EB number. The EB is designed to provide regular monitoring of public social and political attitudes in the EU through specific trend questions. More information about the series may be found on the Zentralarchiv fuer Empirische Sozialforschung (ZA - Central Archive for Empirical Social Research, University of Cologne) Eurobarometer Survey Series web pages. Background Work on European survey series began in early 1970, when the Commission of the European Community sponsored simultaneous surveys of the EC. These surveys were designed to measure public awareness of, and attitudes toward, the Common Market and other EC institutions, in complementary fashion. They also probed the goals given top priority for each respondent's nation. These concerns have remained a central part of the EC's research efforts - which were carried forward in the summer of 1971 with another six-nation survey that gave special attention to agricultural problems. The nine EC member countries were then surveyed again on the same topic areas in September 1973. After 1973, the surveys took on a somewhat broader scope in content as well as in geographical coverage, with measures of subjective satisfaction and the perceived quality of life becoming standard features of the EC public opinion surveys. Over time, the member states of the EC/EU have increased in number, and the coverage of the EB surveys has widened accordingly. In 1974, nine countries were surveyed: France, Germany, United Kingdom, Italy, Netherlands, Belgium, Denmark, Ireland and Luxembourg. Greece has been included since the autumn 1980 survey (EB 14) onwards, Portugal and Spain since autumn 1985 (EB 24), the former German Democratic Republic since autumn 1990 (EB 34), Finland since the spring of 1993 (EB 39), and Sweden and Austria since the autumn of 1994 (EB 42). Norway has been included in some surveys since 1991, from EB 36 onwards. In 2004, the Czech Republic, Cyprus, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, Slovakia and Slovenia joined the EU, and in 2007, Bulgaria and Romania (some of these countries participated in the Candidate Countries Eurobarometer survey series (see under GN 33343) before full accession). Some surveys are also conducted in Turkey, and in the Turkish Cypriot Community (Northern Cyprus). The Eurobarometer public opinion surveys are conducted on behalf of and co-ordinated by the European Commission, DG Press and Communication - Opinion Polls Sector (European Commission Public Opinion Analysis). Special topic modules are carried out at the request of the responsible EU Directorate General. Main Topics: This round of Eurobarometer surveys queried respondents on standard Eurobarometer measures such as public awareness of and attitudes toward the European Union (EU), and also focused on modern biotechnology, the common European currency, and privacy on computer networks. With respect to modern biotechnology issues, respondents were asked for their opinions regarding which organizations should regulate modern biotechnology, and the likelihood that in the next 20 years biotechnology would lead to events such as reduction of environmental pollution and world hunger, creation of dangerous new diseases, solving more crimes through genetic fingerprinting, curing genetic diseases, and producing `designer babies'. Computer network privacy issues covered respondents' worries about leaving `electronic tracks' of personal identifying information when using computer network services and concerns about the use of information collected from network services for advertising, or by shops, insurance companies and public bodies. Other data protection questions probed for respondents' willingness to use new communication technologies and electronic services, given that someone else might use their personal information; awareness and concern about using a means of payment on networks that might leave tracks; awareness of laws that protect privacy; the importance of EU measures to protect personal information, and the importance of worldwide privacy of personal information. Also covered were respondent interest in on-screen computer or television network technologies and in the capabilities these technologies provide, such as obtaining a medical opinion on a health issue, an on-line guided tour of a museum, receiving instant access to newspapers, taking part in a training program, making it easier to look for a job, taking part in discussion groups, receiving and sending electronic mail, managing bank and financial accounts, and organizing a trip. Common European currency items included whether respondents were for or against one European currency in all member states and why, how well-informed they felt about the common European currency, their knowledge of the conditions member countries must meet in order to join the European Economic and Monetary Union, when notes and coins in the European currency would be introduced, their own country's ability to take part in the Single European Currency in 1999, the consequences of not participating, and what the rate of introduction should be for the common European currency. Questions asked only in Sweden concerned attitudes toward expanding or reducing nuclear power, the respondent's three favourite activities, and highest level of education completed. Demographic items include age, gender, marital status, household size, monthly income, age when stopped full-time education, and occupation.
  • Improving Public Policy for Children: A Vote for Each Child

    Pantell, Robert H.; Shannon, Maureen T. (DEU, 2019-04-04)
    Changes in social policy in the United States (US) over the past four decades have provided health insurance for 100 percent of persons over age 65 and decreased poverty for this group while the number of children in poverty has risen and ten million are uninsured. This increasing intergenerational inequity reflects political decisions where children lack a voice. The purposes of this paper are to: 1) summarize, from the fields of ethics, government, law, social welfare and public health, current thinking about enfranchisement of children; 2) review the evolution of voting and representation in the US and identify misperceptions about barriers to equitable representation of children; 3) discuss the legal basis for children being regarded as adults and adult proxy decision making for children; and 4) suggest strategies to stimulate an equitable system of child representation by altering our current system of voting.
  • Informing the euthanasia debate: Perceptions of Australian politicians

    McGee, Andrew; Purser, Kelly; Stackpoole, Christopher; White, Ben; Willmott, Lindy; Davis, Juliet (University of New South Wales, 2018-11-30)
    <b>Free to read on publisher website</b>
 
 In the debate on euthanasia or assisted dying, many different arguments have been advanced either for or against legal reform in the academic literature, and much contemporary academic research seeks to engage with these arguments. However, very little research has been undertaken to track the arguments that are being advanced by politicians when Bills proposing reform are debated in Parliament. Politicians will ultimately decide whether legislative reform will proceed and, if so, in what form. It is therefore essential to know what arguments the politicians are advancing in support of or against legal reform so that these arguments can be assessed and scrutinised. This article seeks to fill this gap by collecting, synthesising and mapping the pro- and anti-euthanasia and assisted dying arguments advanced by Australian politicians, starting from the time the first ever euthanasia Bill was introduced.
  • Eine bessere Politik für Kinder: jedem Kind eine Stimme

    Pantell, Robert H.; Shannon, Maureen T. (DEU, 2013-01-17)
    Veränderungen in der Sozialpolitik der Vereinigten Staaten im Laufe der letzten vier Jahrzehnte haben 100 Prozent der Menschen über 65 mit einer Gesundheitsversicherung versehen und
 die Armut dieser Gruppe reduziert, während
 die Zahl der Kinder in Armut gestiegen ist und zehn Millionen unversichert sind. Diese zunehmende intergenerationelle Ungerechtigkeit spiegelt politische Entscheidungen wider, in denen Kindern eine Stimme fehlt. Die Ziele des vorliegenden Artikels sind 1) eine Zusammenfassung
 gegenwärtiger Ansichten zum Stimmrecht für Kinder aus den Bereichen Ethik, Regierungslehre, Recht, Sozial- und
 Gesundheitswesen; 2) eine Überprüfung der
 Entwicklung von Abstimmung und Repräsentation
 in den USA und eine Identifikation der
 Fehleinschätzungen, die eine gleichberechtigte Repräsentation von Kindern behindern; 3)eine Diskussion der Rechtsgrundlage, die Kinder als Erwachsene begreift und elterliches Entscheiden
 in Vertretung für Kinder gestattet;
 sowie 4) Vorschläge von Strategien, um ein
 gleichberechtigtes Repräsentationssystem für
 Kinder durch Änderung unseres gegenwärtiges
 Wahlsystems anzuregen.
  • Health: A non-issue in Indian elections

    Vishal Sharma, DM (University College of Medical Sciences, 2014-04-01)
  • John E. McDonough Papers, 1984-1997: Guide

    State Library of Massachusetts. Special Collections Dept. (State Library of Massachusetts, Special Collections Dept., 2013-01-10)
    This collection documents McDonough’s terms as Massachusetts Representative from the 11th Suffolk District from 1985 to 1997.
  • Medical Students' Exposure to and Attitudes About Drug Company Interactions: A National Survey

    Sierles, Frederick S.; Brodkey, Amy C.; Cleary, Lynn M.; McCurdy, Frederick A.; Mintz, Matthew; Frank, Julia; Lynn, D. Joanne; Chao, Jason; Morgenstern, Bruce Z.; Shore, William; et al. (2016-01-08)
    CONTEXT: While exposure to and attitudes about drug company interactions among residents have been studied extensively, relatively little is known about relationships between drug companies and medical students. OBJECTIVE: To measure third-year medical students' exposure to and attitudes about drug company interactions. DESIGN, SETTING, AND PARTICIPANTS: In 2003, we distributed a 64-item anonymous survey to 1143 third-year students at 8 US medical schools, exploring their exposure and response to drug company interactions. The schools' characteristics included a wide spectrum of ownership types, National Institutes of Health funding, and geographic locations. In 2005, we conducted a national survey of student affairs deans to measure the prevalence of school-wide policies on drug company-medical student interactions. MAIN OUTCOME MEASURES: Monthly frequency of students' exposure to various activities and gifts during clerkships, and attitudes about receiving gifts. RESULTS: Overall response rate was 826/1143 (72.3%), with range among schools of 30.9%-90.7%. Mean exposure for each student was 1 gift or sponsored activity per week. Of respondents, 762/818 (93.2%) were asked or required by a physician to attend at least 1 sponsored lunch. Regarding attitudes, 556/808 (68.8%) believed gifts would not influence their practices and 464/804 (57.7%) believed gifts would not affect colleagues' practices. Of the students, 553/604 (80.3%) believed that they were entitled to gifts. Of 183 students who thought a gift valued at less than $50 was inappropriate, 158 (86.3%) had accepted one. The number of students who simultaneously believed that sponsored grand rounds are educationally helpful and are likely to be biased was 452/758 (59.6%). Students at 1 school who had attended a seminar about drug company-physician relationships were no more likely than the nonattending classmates to show skepticism. Of the respondents, 704/822 (85.6%) did not know if their school had a policy on these relationships. In a national survey of student affairs deans, among the 99 who knew their policy status, only 10 (10.1%) reported having school-wide policies about these interactions. CONCLUSIONS: Student experiences and attitudes suggest that as a group they are at risk for unrecognized influence by marketing efforts. Research should focus on evaluating methods to limit these experiences and affect the development of students' attitudes to ensure that physicians' decisions are based solely on helping each patient achieve the greatest possible benefit.
  • Promotion of Prescription Drugs to Consumers

    Rosenthal, Meredith B.; Berndt, Ernst R.; Donohue, Julie M.; Frank, Richard G.; Epstein, Arnold M. (2016-01-09)
    BACKGROUND: Spending on prescription drugs is the fastest growing component of the health care budget. There is public concern about the possibility that direct-to-consumer advertising of prescription drugs will result in inappropriate prescribing and higher costs of care. Guidelines issued in 1997 by the Food and Drug Administration (FDA) regarding advertising to consumers through electronic media are considered by some to be responsible for unleashing a flood of direct-to-consumer advertising. METHODS: Using data on spending for promotional purposes and sales of prescription drugs, we examined industrywide trends for various types of promotion. We also tracked the relation between promotional efforts and sales over time. Finally, we documented the variation in direct-to-consumer advertising among and within five therapeutic classes of drugs and compared the variation in the intensity of such advertising with variation in the intensity of promotion to health care professionals. RESULTS: Annual spending on direct-to-consumer advertising for prescription drugs tripled between 1996 and 2000, when it reached nearly $2.5 billion. Despite this increase, such advertising accounts for only 15 percent of the money spent on drug promotion and is highly concentrated on a subgroup of products. Within a therapeutic class, there is marked variation in the intensity of direct-to-consumer advertising, and the amount of such advertising for specific products fluctuates over time. The initial surge in direct-to-consumer advertising preceded the 1997 FDA guidelines that clarified the rules for electronic direct-to-consumer advertising, and thus the 1997 guidelines may not have been the most important reason for the overall increase. CONCLUSIONS: Although the use of direct-to-consumer advertising has grown disproportionately to other forms of promotion, it continues to account for a small proportion of total promotional efforts. Nevertheless, physicians must assist patients in evaluating health-related information obtained through direct advertising.
  • Effect of Exposure to Small Pharmaceutical Promotional Items on Treatment Preferences

    Grande, David; Frosch, Dominick L.; Perkins, Andrew W.; Kahn, Barbara E. (2016-01-09)
    BACKGROUND: Policy discussions concerning pharmaceutical promotion often assume that small promotional items are unlikely to influence prescribing behavior. Our experiment measures whether exposure to these items results in more favorable attitudes toward marketed products and whether policies that restrict pharmaceutical marketing mitigate this effect. METHODS: This is a randomized controlled experiment of 352 third- and fourth-year medical students at two US medical schools with differing policies toward pharmaceutical marketing. Participants assigned to treatment were exposed to small branded promotional items for Lipitor (atorvastatin) without knowledge that the exposure was part of the study. We measured differences in implicit (ie, unconscious) attitudes toward Lipitor and Zocor (simvastatin) in exposed and control groups with the Implicit Association Test (IAT). Self-reported attitudes were also measured, and a follow-up survey was administered measuring attitudes toward marketing. RESULTS: Fourth-year students at the University of Miami Miller School of Medicine exposed to Lipitor promotional items had more favorable implicit attitudes about that brand-name drug compared to the control group (IAT effect: 0.66 vs 0.47; P = .05), while the effect was reversed at the University of Pennsylvania School of Medicine (IAT effect: 0.22 vs 0.52; P = .002) where restrictive policies are in place limiting pharmaceutical marketing (interaction effect: P = .003). No significant effect was observed among third-year students. On a "skepticism" scale, University of Miami students held more favorable attitudes toward pharmaceutical marketing compared to University of Pennsylvania students (0.55 vs 0.42; P
  • The Negative Impact of Stark Law Exemptions on Graduate Medical Education and Health Care Costs: The Example of Radiation Oncology

    Anscher, Mitchell S.; Anscher, Barbara M.; Bradley, Cathy J. (2016-01-09)
    PURPOSE: To survey radiation oncology training programs to determine the impact of ownership of radiation oncology facilities by non-radiation oncologists on these training programs and to place these findings in a health policy context based on data from the literature. METHODS AND MATERIALS: A survey was designed and e-mailed to directors of all 81 U.S. radiation oncology training programs in this country. Also, the medical and health economic literature was reviewed to determine the impact that ownership of radiation oncology facilities by non-radiation oncologists may have on patient care and health care costs. Prostate cancer treatment is used to illustrate the primary findings. RESULTS: Seventy-three percent of the surveyed programs responded. Ownership of radiation oncology facilities by non-radiation oncologists is a widespread phenomenon. More than 50% of survey respondents reported the existence of these arrangements in their communities, with a resultant reduction in patient volumes 87% of the time. Twenty-seven percent of programs in communities with these business arrangements reported a negative impact on residency training as a result of decreased referrals to their centers. Furthermore, the literature suggests that ownership of radiation oncology facilities by non-radiation oncologists is associated with both increased utilization and increased costs but is not associated with increased access to services in traditionally underserved areas. CONCLUSIONS: Ownership of radiation oncology facilities by non-radiation oncologists appears to have a negative impact on residency training by shifting patients away from training programs and into community practices. In addition, the literature supports the conclusion that self-referral results in overutilization of expensive services without benefit to patients. As a result of these findings, recommendations are made to study further how physician ownership of radiation oncology facilities influence graduate medical education, treatment patterns and utilization, and health care costs. Patients also need to be aware of financial arrangements that may influence their physician's treatment recommendations.
  • Der Einfluss Einer Krankenhausinternen Richtlinie Auf Die Einstellung Von Arzten Zur Pharmazeutischen Industrie

    Gundermann, C.; Meier-Hellmann, A.; Bauer, M.; Hartmann, M. (2016-01-09)
    BACKGROUND AND OBJECTIVE: Several hospitals have issued their own guidelines that regulate the conduct of staff members toward the pharmaceutical industry. The effect of theses guidelines on the attitude of the doctors toward the pharmaceutical industry in Germany has so far been unknown. This study investigated whether hospital doctors with guidelines and those without guidelines differ in their attitude toward the pharmaceutical industry. METHODS: A retrospective analysis was undertaken to determine the influence of hospital guidelines on the attitude of doctors toward the pharmaceutical industry. In May 2008 all doctors in intensive care of a hospital with and one without guidelines were asked anonymously by a questionnaire about their dealings with the pharmaceutical industry. The response rate was 64.9 % (37/57) and 55.1 % (59/107) respectively. The cooperation rate in both groups was 100 %. RESULTS: In the hospital with guidelines every doctor was on average carrying 0.56 +/- 0.64 pharmaceutical advertising gifts with a company logo, while the average in the institution without guidelines was 1.2 +/- 0.61 advertising gifts (p = 0.026). Whereas 49 % of doctors with guidelines considered the acceptance of advertising gifts as not questionable, 81 % without guidelines did (p = 0.001; RRR = 0.65; 95 % CI = 0.48-0.91). Furthermore, 70 % of doctors in the institution with guidelines compared with 92 % of those doctors in the hospital without guidelines believed that the advertising practices of the pharmaceutical industry had no influence on their prescribing behaviour (p = 0.010; RRR = 3.6; 95 % CI = 1.36-9.52). Both groups of doctors are convinced that other doctors are more influenced by the pharmaceutical industry than they are themselves (51 % with and 37 % without guidelines, p = 0.207). 70 % and 90 %, respectively of all participants considered hospital guidelines setting standards of conduct toward the pharmaceutical industry and those not sponsored by industry to have a positive effect. Every other doctor additionally stated the advice by the pharmaceutical industry was not helpful for his work. CONCLUSIONS: Hospital guidelines on relations with the pharmaceutical industry appear to further a critical attitude by physicians regarding the pharmaceutical industry.
  • From Actors to Authors: A First Account About the Involvement of Patients in the Informed Consent Governance of a Major Italian Translational Research Hospital

    CASATI, SARA; MONTI, PAOLO; BONINO, FERRUCCIO (Nucleo Permanente per la Valutazione e il Miglioramento del Consenso Informato, 2016-01-09)
    From 2007 to 2009 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, one of the major public research hospitals in Italy, has invested on a participatory action to promote a good practice of informed consent. The project focused on the improvement and innovation of informed consent considered as a participated act through the involvement of all the actors at stake. The main purpose was to improve the informative practices through the participatory innovation of institutional and organizational elements as conditions of possibility. Therefore the project has pursued the involvement of managers, healthcare professionals, patients and their associations in the institutional governance of informed consent. The involvement of citizens and patients within the whole process meant to put them in charge not just as actors or final evaluators of a good practice, but as co-authors in defining standards, tools and conditions for a good practice. Several actions were taken, including a phase of analysis which involved 20 patients from 8 Associations, a phase of innovation and education where 113 patients and citizens worked together with clinicians from 53 Units in deliberative laboratories, the institution of a multidisciplinary committee inclusive of representatives from 6 associations of patients. The project has produced different outcomes: new institutional guidelines adopted by the hospital; the renewal of consent forms and procedures as part of an explicit shared informative process; an increased implementation of institutional standards of good informative practice; the measure and communication of the outcomes of care and their bench-marking; bottom-up building of paths of validation; the creation of participatory electronic tools; an innovative education on the field for patients and clinicians.
  • Camel No. 9 Cigarette-Marketing Campaign Targeted Young Teenage Girls

    Pierce, John P.; Messer, Karen; James, Lisa E.; White, Martha M.; Kealey, Sheila; Vallone, Donna M.; Healton, Cheryl G. (2016-01-09)
    CONTEXT: The 1998 Master Settlement Agreement (MSA) restricted tobacco industry advertising practices that targeted teens. OBJECTIVE: To assess whether cigarette-advertising campaigns conducted after the MSA continue to influence smoking among adolescents. DESIGN, SETTING, AND PARTICIPANTS: Participants were a national longitudinal cohort of 1036 adolescents (baseline age: 10-13 years) enrolled in a parenting study. Between 2003 and 2008, 5 sequential telephone interviews were conducted, including the participant's report of brand of "favorite" cigarette advertisement. The fifth interview was conducted after the start of RJ Reynolds' innovative "Camel No. 9" advertising campaign in 2007. Smoking outcome reported from the fifth survey. RESULTS: The response rate through the fifth survey was 71.8%. Teenagers who reported any favorite cigarette ad at baseline (mean age: 11.7 years) were 50% more likely to have smoked by the fifth interview (adjusted odds ratio: 1.5 [95% confidence interval: 1.0-2.3]). For boys, the proportion with a favorite ad was stable across all 5 surveys, as it was for girls across the first 4 surveys. However, after the start of the Camel No. 9 advertising campaign, the proportion of girls who reported a favorite ad increased by 10 percentage points, to 44%. The Camel brand accounted almost entirely for this increase, and the proportion of each gender that nominated the Marlboro brand remained relatively stable. CONCLUSIONS: After the MSA, adolescents continued to be responsive to cigarette advertising, and those who were responsive were more likely to start smoking. Recent RJ Reynolds advertising may be effectively targeting adolescent girls.
  • Corporatization of Pain Medicine: Implications for Widening Pain Care Disparities

    Meghani, Salimah H (2016-01-09)
    The current health care system in the United States is structured in a way that ensures that more opportunity and resources flow to the wealthy and socially advantaged. The values intrinsic to the current profit-oriented culture are directly antithetical to the idea of equitable access. A large body of literature points to disparities in pain treatment and pain outcomes among vulnerable groups. These disparities range from the presence of disproportionately higher numbers and magnitude of risk factors for developing disabling pain, lack of access to primary care providers, analgesics and interventions, lack of referral to pain specialists, longer wait times to receive care, receipt of poor quality of pain care, and lack of geographical access to pharmacies that carry opioids. This article examines the manner in which the profit-oriented culture in medicine has directly and indirectly structured access to pain care, thereby widening pain treatment disparities among vulnerable groups. Specifically, the author argues that the corporatization of pain medicine amplifies disparities in pain outcomes in two ways: 1) directly through driving up the cost of pain care, rendering it inaccessible to the financially vulnerable; and 2) indirectly through an interface with corporate loss-aversion/risk management culture that draws upon irrelevant social characteristics, thus worsening disparities for certain populations. Thus, while financial vulnerability is the core reason for lack of access, it does not fully explain the implications of corporate microculture regarding access. The effect of corporatization on pain medicine must be conceptualized in terms of overt access to facilities, providers, pharmaceuticals, specialty services, and interventions, but also in terms of the indirect or covert effect of corporate culture in shaping clinical interactions and outcomes.
  • Association Between Industry Affiliation and Position on Cardiovascular Risk With Rosiglitazone: Cross Sectional Systematic Review

    Wang, Amy T.; McCoy, Christopher P.; Murad, Mohammad Hassan; Montori, Victor M. (2016-01-09)
    OBJECTIVE: To explore a possible link between authors' financial conflicts of interest and their position on the association of rosiglitazone with increased risk of myocardial infarction in patients with diabetes. DATA SOURCES: On 10 April 2009, we searched Web of Science and Scopus for articles citing and commenting on either of two index publications that contributed key data to the controversy (a meta-analysis of small trials and a subsequent large trial). Data selection Articles had to comment on rosiglitazone and the risk of myocardial infarction. Guidelines, meta-analyses, reviews, clinical trials, letters, commentaries, and editorials were included. DATA EXTRACTION: For each article, we sought information about the authors' financial conflicts of interest in the report itself and elsewhere (that is, in all publications within two years of the original publication and online). Two reviewers blinded to the authors' financial relationships independently classified each article as presenting a favourable (that is, rosiglitazone does not increase the risk of myocardial infarction), neutral, or unfavourable view on the risk of myocardial infarction with rosiglitazone and on recommendations on the use of the drug. RESULTS: Of the 202 included articles, 108 (53%) had a conflict of interest statement. Ninety authors (45%) had financial conflicts of interest. Authors who had a favourable view of the risk of myocardial infarction with rosiglitazone were more likely to have financial conflicts of interest with manufacturers of antihyperglycaemic agents in general, and with rosiglitazone manufacturers in particular, than authors who had an unfavourable view (rate ratio 3.38, 95% CI 2.26 to 5.06 and 4.29, 2.63 to 7.02, respectively). There was likewise a strong association between favourable recommendations on the use of rosiglitazone and financial conflicts of interest (3.36, 1.94 to 5.83). These links persisted when articles rather than authors were used as the unit of analysis (4.69, 2.84 to 7.72), when the analysis was restricted to opinion articles (6.29, 2.15 to 18.38) or to articles in which the rosiglitazone controversy was the main focus (6.50, 2.56 to 16.53), and both in articles published before and after the Food and Drug Administration issued a safety warning for rosiglitazone (3.43, 0.99 to 11.82 and 4.95, 2.87 to 8.53, respectively). CONCLUSIONS: Disclosure rates for financial conflicts of interest were unexpectedly low, and there was a clear and strong link between the orientation of authors' expressed views on the rosiglitazone controversy and their financial conflicts of interest with pharmaceutical companies. Although these findings do not necessarily indicate a causal link between the position taken on the cardiac risk of rosiglitazone in patients with diabetes and the authors' financial conflicts of interest, they underscore the need for further changes in disclosure procedures in order for the scientific record to be trusted.
  • Financial Ties and Conflicts of Interest Between Pharmaceutical and Tobacco Companies

    Shamasunder, Bhavna; Bero, Lisa (2016-01-09)
    Corporate diversification allows for well-hidden financial ties between pharmaceutical and tobacco companies, which can cause a conflict of interest in the development and marketing of pharmaceutical products. In our investigation of tobacco company documents released and posted on the Internet as a result of the Master Settlement Agreement, we have found that these financial ties have fostered both competition and collaboration between the tobacco and pharmaceutical industries. We present 3 case studies. One shows how tobacco companies pressured pharmaceutical companies to scale back their smoking cessation educational materials that accompanied Nicorette. The second shows how they restricted to whom the pharmaceutical company could market its transdermal nicotine patch. In the third case, we show how subsidiary tobacco and pharmaceutical companies of a parent company collaborated in the production of a nicotine-release gum. Thus, because tobacco cessation product marketing has been altered as a result of these financial conflicts, disclosure would serve the interest of public health.
  • Imaging: The Self-Referral Boom and the Ongoing Search for Effective Policies to Contain It

    Hillman, Bruce J; Goldsmith, Jeff (2016-01-09)
    When a physician who isn't a radiologist holds an ownership interest in an advanced imaging machine and refers patients for diagnostic procedures on that machine, this act of self-referral presents a conflict of interest. Numerous studies demonstrate greater use of high-tech imaging when physicians can financially benefit from such referrals. This overview summarizes the issues surrounding imaging self-referral and reviews the history of attempts to control it, as well as options for limiting its impact on spending. Recent payment reductions by Medicare limited the rewards for imaging self-referral, and the Affordable Care Act mandated disclosure of physicians' ownership interests. However, the rewards for imaging self-referral remain strong. Policy makers continue to search for the right mechanisms for containing the practice and for assuring that Medicare beneficiaries receive only medically necessary imaging studies, regardless of who owns or operates the equipment.

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