Financial Conflicts Of Interest Research Articles

The pharmaceutical company-healthcare relationship: much ado about something.

The relationship between the pharmaceutical companies and the healthcare profession, especially doctors, has always been fraught with conflicts of interest (COI). The publication of the influential The Diagnostic and Statistical Manual for Mental Disorders, Fifth edition, Text Revision (DSM-5-TR), by the American Psychiatric Society (APA) raised concerns that the financial relationships between pharma and members responsible for DSM could result in bias. This resulted in calls for stricter enforcement of controls on financial conflict of interest (FCOI) [1, 2], which could influence the formulation of diagnostic criteria (resulting in more people being "diagnosable as mentally ill"), creating a larger pool of "patients" who "need" pharmaceutical drugs. Knowingly or unknowingly, they would end up serving the pharmaceutical companies' agenda to sell more drugs and drive up profits [2] .

Conflicts of Interest Among Cardiology Clinical Practice Guideline Authors in Japan.

Clinical practice guidelines (CPGs) offer disease management recommendations based on scientific evidence. However, financial conflicts of interest between CPG developers and the pharmaceutical industry could bias these recommendations, potentially affecting patient care. Proper management of these conflicts of interest is particularly crucial for maintaining the integrity of CPGs. The study aimed to evaluate the extent of financial relationships between the pharmaceutical industry and authors of CPGs for cardiovascular diseases in Japan. The study analyzed personal payments from the pharmaceutical industry to authors of cardiovascular disease CPGs published by the Japanese Circulation Society from January 2015 to December 2022. Payment data, including speaking, consultancy, and writing fees from 2016 to 2020, were extracted from a publicly available database containing personal payments disclosed by all major pharmaceutical companies. A total of 929 unique authors from 37 eligible Japanese Circulation Society CPGs were identified. Notably, 94.4% of these authors received personal payments from pharmaceutical companies, totaling >US $70.8 million. The mean±SD payment per author was US $76 314±138 663) and the median payment per author was US $20 792 (interquartile range: US $4262-US $76 998) over the 5-year period. Chairs of CPGs received significantly higher payments than other authors. More than 80% of authors in each CPG received personal payments. The study elucidated that there were considerable financial relationships between pharmaceutical companies and cardiology CPG authors in Japan. This finding deviates from international conflict of interest management policies, suggesting the need for more stringent conflict of interest management strategies by the Japanese Circulation Society to ensure the development of trustworthy and evidence-based CPGs.

The Prevalence of Financial Conflict of Interest Disclosures by Endovascular Specialists on X (Twitter)

PurposeTo evaluate conflicts of interest (COIs) among interventional radiologists and related specialties who mention specific devices or companies on the social media (SoMe) platform X, formerly Twitter. Materials and MethodsIn total, 13,809 posts between October 7, 2021, and December 31, 2021, on X were evaluated. Posts by U.S. interventional radiologists and related specialties who mentioned a specific device or company were identified. A positive COI was defined as receiving a payment from the device manufacturer or company within 36 months prior to posting. The Center for Medicare & Medicaid Services Open Payment database was used to identify financial payments. The prevalence and value of COIs were assessed and compared between posts mentioning a device or company and a paired control group using descriptive statistics and chi-squared tests and independent t tests. ResultsEighty posts containing the mention of 100 specific devices or companies were evaluated. COIs were present in 53% (53/100). When mentioning a specific device or product, 40% interventional radiologists had a COI, compared with 62% neurosurgeons. Physicians who mentioned a specific device or company were 3.7 times more likely to have a positive COI relative to the paired control group (53/100 vs 14/100; P < .001). Of the 31 physicians with a COI, the median physician received $2,270. None of the positive COIs were disclosed. ConclusionsPhysicians posting on SoMe about a specific device or company are more likely to have a financial COI than authors of posts not mentioning a specific device or company. No disclosure of any COI was present in the posts, limiting followers’ ability to weigh potential bias.

Financial Conflicts of Interest Among Physician Authors of ACR Appropriateness Criteria

BackgroundThe accuracy and completeness of self-disclosures by authors of imaging guidelines are not well known. ObjectiveThe aim of this study was to assess the accuracy of financial disclosures by US authors of ACR appropriateness criteria. MethodsWe reviewed financial disclosures provided by US-based authors of all ACR-AC published in 2019, 2021 and 2023. For each US- based author, payment reports were extracted from the Open Payments Database (OPD) in the previous 36 months related to general category and research payments categories. We analyzed each author individually to determine if the reported disclosures matched results from OPD. ResultsA total of 633 authorships, including 333 unique authors were included from 38 ACR AC articles in 2019, with 606 authorships (387 unique authors) from 35 ACR-AC articles published in 2021, and 540 authorships (367 unique authors) from 32 ACR AC articles published in 2023. Among authors who received industry payments, failure to disclose any financial relationship was seen in 125/147 unique authors in 2019, 142/148 authors in 2021 and 95/125 unique authors in 2023. The proportion of nondisclosed total value of payments was 86.1% in 2019, 88.6% in 2021 and 56.7% in 2023. General category payments were nondisclosed in 94.1% in 2019, 89.7% in 2021 and 94.4% in 2023 by payment value. ConclusionIndustry payments to authors of radiology guidelines are common and frequently undisclosed.

Conflicts of Interest in Radiology Publishing

Lack of disclosure of Conflicts of Interest (COI) in radiology research can undermine trust in medical recommendations and patient care. A recent study found significant discrepancies between disclosed COIs and those listed in the Open Payments Database (OPD). This commentary discusses the importance of transparency in financial and nonfinancial COIs, the implications of undisclosed COIs on research integrity and clinical decision-making, and the challenges and controversies surrounding current disclosure practices. The field of radiology should discuss and update COI management and ethical standards, for more practical accountability in radiology publishing.

Financial conflicts of interest among presenters, panellists and moderators at haematology and oncology FDA workshops.

To assess the characteristics and financial conflicts of interest of presenters, panellists and moderators at haematology and oncology workshops held jointly with or hosted by the US FDA. We included information on all publicly available haematology or oncology FDA workshop agendas held between 1 January 2018 and 31 December 2022. General and research payments reported on Open Payments, industry funding to patient advocacy organizations reported on their webpages or 990 tax forms and employment in both pharmaceutical and regulatory settings. Among physicians eligible for payments, 78% received at least one payment from the industry between 2017 and 2021. The mean general payment amount was $82,170 for all years ($16,434 per year) and the median was $14,906 for all years ($2981 per year). Sixty-nine per cent of patient advocacy speakers were representing organizations that received financial support from the pharmaceutical industry. Among those representing regulatory agencies or pharmaceutical companies, 16% had worked in both settings during their careers. Our findings in this cross-sectional study show a majority of US-based physician presenters at haematology and oncology workshops held jointly with members of the US FDA have some financial conflict of interest with the pharmaceutical industry. These findings support the need for clear disclosures and suggest that a more balanced selection of presenters with fewer conflicts may help to limit bias in discussions between multiple stakeholders.

Pharmaceutical Industry Payments to Medical Oncologists in the Netherlands: Trends and Patterns Provided by an Open-Access Transparency Data Set.

Health care expenditure related to oncologic treatments is skyrocketing although many treatments offer marginal, if any, clinical benefit. Financial conflicts of interest (fCOI) resulting from pharmaceutical industry (pharma) payments to physicians is increasingly recognized as a predictive factor for regulatory board approval and guideline incorporation of low-value treatments. We sought to study the extent to which pharma payments to medical oncologists occur in the Netherlands, the amount of money involved, and whether these occur more frequently and are higher for key opinion leaders (KOLs). In our cross-sectional retrospective database study, we used several Dutch open-access databases and extracted data registered between 2019 and 2021. A cumulative amount of €899,863 was paid to 48.8% of the 408 registered medical oncologists. Over time, there was a marked decline in both the proportion of medical oncologists receiving payments (from 40.4% in 2019 to 19.1% in 2021) and the mean annual value of payments (from €2,962 in 2019 to €2,188 in 2021) with the latter mainly resulting from a decline in hospitality-related transactions. KOLs were more likely to receive industry payments and received a higher median payment value. Our findings should contribute to the increasing awareness in the Netherlands of the potential effects of fCOI.

Financial Conflicts of Interest and Industry Funding are Associated With Conclusions Favorable to New Technologies: A Review of Published Economic Analyses in Hip and Knee Arthroplasty

BackgroundNew technologies in hip and knee arthroplasty are commonly evaluated using cost-effectiveness analyses and similar economic assessments. There is a wide variation in the methodology of these studies, introducing the potential for bias. The purpose of this study was to evaluate associations between potential financial conflicts of interest (COI) and the outcomes of economic analyses. We hypothesized that authors’ COI and industry funding would be associated with conclusions favorable to a new technology. MethodsEconomic analyses making cost-effectiveness or economic implementation claims on patient-specific instrumentation, robotics, and implants used in hip and knee arthroplasty published from 2010 to 2022 were identified. Papers were evaluated to determine if conclusions were favorable to the new technology being studied. Fisher’s exact test was utilized to determine the relationship between the presence of COI and an article’s conclusions. ResultsOf 43 eligible articles, 76.7% were cost-effectiveness analyses, 23.2% were cost analyses, and 67.4% of articles had conclusions favorable to a technology. Of the 29 articles with favorable conclusions, 26 had an author with a financial COI (89.7%), and 14 had industry funding (48.3%). Of the 33 articles with a financial COI, 26 (78.8%) had favorable conclusions, and of the 16 articles with industry funding, 14 (87.5%) had favorable conclusions. Fisher’s exact test revealed a statistically significant association between an article having favorable conclusions and the presence of an author’s COI or industry funding (odds ratio, 13.5; 95% CI [confidence interval], 2.3 to 79.9; P = .003). ConclusionsFinancial COIs were present in 79.1% of lower extremity arthroplasty economic analyses on technologies and were associated with an article having conclusions favorable to the new technology. Surgeons and decision-makers should be aware of the variability and assumptions in these studies and the potential bias of the conclusions.

Different cellular barriers to RNA therapeutics and strategies to overcome

Dear Editor, It has been about 8 months since Russia invaded Ukraine, and the war does not appear to be ending anytime soon. As of October 2022, the United Nations (UN) had reported 6221 deaths, 972 of which were children1. There has also been a massive displacement of civilians with seven million Ukrainian refugees across Europe1. The devastation caused by this brutal war cannot be overstated; from constant terror attacks resulting in massive civilian deaths, war crimes of violence and rape cases, food shortages, infrastructure damages, and many others1,2. However, one major sector in Ukraine has been at the heart of the entire situation, and that is healthcare. As of October 17, the WHO has authenticated 623 attacks on healthcare since the start of the war1. Health infrastructures have been brutally targeted, causing catastrophic impact to healthcare delivery2. Before the Russian invasion, Ukraine’s healthcare system, particularly the surgical sector, was facing significant gaps and challenges3. Also, there was a significant burden of surgical cases in Ukraine before the war, which was made worse because of the COVID-19 pandemic that accumulated elective surgeries backlog across the globe. This brutal war has clearly exacerbated the situation, putting the country’s healthcare system on a knife-edge. With all of the destruction and limited resources, it is clear that emergency and surgery departments in hospitals must deal with overburdened cases of traumatic injuries during these hard times4. Ukraine’s surgical capacity currently lacks the necessary resources to deal with these outrageous burdens. With damaged hospital infrastructure, insufficient health professionals in the emergency and surgical departments, and inadequate surgical equipment, the country’s surgical capacity clearly requires massive assistance. Ukrainian healthcare workers’ brevity, commitment, and professionalism have been highly visible and acknowledged4. Furthermore, the incredible efforts and response of the world since the beginning of this war cannot be overstated. Massive humanitarian aid, as well as good deliveries of healthcare equipment and various financial aids for healthcare support, have been delivered. Most importantly, health officials from around the world have made sacrifices and risked their lives to be in Ukraine and along its borders to support Ukrainian healthcare workers, even during these threatening circumstances1. With Russia’s current brutal attacks on major cities, the duration of this war is clearly unpredictable, necessitating a long-term support plan for Ukrainian healthcare, particularly surgical capacity. The surgical capacity is a highly complex and costly field that necessitates enormous efforts and resources to maintain. We urge international communities, governments, and organizations to assist Ukraine in strengthening its surgical sector by assisting in the establishment of new surgical clinics in nonaffected or least-affected western regions. The new facilities could be built underground to avoid damage from shelling and explosions. These facilities could also incorporate telesurgery into their services, allowing surgeons to operate remotely without putting their lives in danger. In war-torn areas, temporary hospitals should also be established underground to prevent disruption of care during shelling and explosions, with the goal of providing first aid care to patients who require immediate assistance. Furthermore, specialized trauma units should be established to provide trauma care to injured civilians. Continuous supplies of surgical equipment and assistance in transporting affected patients to war-free regions of the country and neighboring countries for ongoing care are still required. Securing a safe passage for delivery of life-saving supplies and humanitarian aids is crucial. The Ukrainian government should maintain its efforts to support healthcare workers and ensure equitable resource distribution across all sectors. Neighboring countries should continue to extend humanitarian aid to Ukraine by reducing the surgical caseload by performing surgeries on Ukrainian refugees during wartime. They can also begin planning to assist in reducing the post-war surgical backlog, particularly for emergency or oncological surgeries. Furthermore, surgical education and training should be maintained to ensure that post-war surgical capacity is adequate to meet demand. Telementoring or remote training should be considered between Ukrainian surgeons or trainees and other global experts. Above all, the international community should vehemently condemn acts of violence and intentional attacks on healthcare facilities and personnel around the world. Ethical approval Not applicable. Sources of funding None. Author’s contribution A.A.W. and J.C.N. conceptualized the ideas. A.A.W., J.C.N., and L.D. reviewed and edited the manuscript. All authors were involved in data curation and writing of initial draft. Conflicts of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantor Andrew A. Wireko.

Understanding PCOS-Related Content across Social Media Platforms—A Cross-Sectional Analysis

IntroductionPCOS is commonly diagnosed in adolescence and information about the condition is often shared online. We aim to assess the extent, content, and engagement of PCOS related information across social media platforms. MethodsWe performed a cross-sectional content analysis of PCOS related posts on TikTok, Instagram, and Reddit. Top PCOS posts were collected from TikTok and Instagram (N=100). Two researchers independently coded all posts using a codebook including symptoms, interventions, and qualities. Logistic regression assessed the relationship between user engagement and creator conflict of interest. On Reddit, posts from 2020 - 2022 (N=34,208) were collected. Topic modeling using Latent Dirichlet Allocation (LDA) and Non-Negative Matrix Factorization (NMF) was applied to discover topics in the textual data. ResultsPCOS content received high engagement across all platforms, with an average of 1.8 million views on TikTok. “Weight” and “Diet” were the most frequently mentioned topics on TikTok and Instagram, while interactions with medical providers were discussed in 30% of posts. A financial conflict of interest was present in 45% of TikTok posts and 89% of Instagram posts. NMF identified 15 coherent topics, including symptoms, interventions, interactions with the medical system, and information-seeking. Reddit posts under “Symptom Management” received the most comments. DiscussionPCOS content is present and pervasive across social media platforms, suggesting the ability of information from non-clinician sources to reach and engage with a large population using novel modes of health information sharing. Further studies of this content will allow for a deeper understanding of patient perceptions, misconceptions, and knowledge of PCOS, with the potential to inform patient-centered counseling.

Sponsorship bias in published pharmacoeconomic evaluations of national reimbursement negotiation drugs in China: a systematic review

BackgroundChina’s National Reimbursement Drug List (NRDL) has become the primary route for drug reimbursement in China. More recently, the authority has made pharmacoeconomic evaluation an integral part of the application...

Characteristics of clinician input in Canadian funding decisions for cancer drugs: a cross-sectional study based on CADTH reimbursement recommendations

ObjectiveTo examine characteristics of clinician input to the pan-Canadian Oncology Drug Review (pCODR) for cancer drug funding recommendations from 2016 to 2020.Design, setting and participantsDescriptive, cross-sectional study including 62 reimbursement...

Financial Conflicts of Interest Among the Authors of the Clinical Practice Guidelines for Rheumatoid Arthritis in Japan.

Objective To assess the financial relationships between pharmaceutical companies and authors of the 2020 Japan College of Rheumatology Clinical Practice Guidelines (CPG) for the Management of Rheumatoid Arthritis and to evaluate the quality of evidence supporting the guideline recommendations. Methods This retrospective study evaluated financial relationships between all 27 authors of the CPGand pharmaceutical companies in Japan. Personal payments from pharmaceutical companies to these authors between 2016 and 2020 were extracted from publicly disclosed databases for each pharmaceutical company. The quality of the evidence supporting the CPG recommendations was also assessed. Results All 27 authors received personal payments from pharmaceutical companies, totaling $3,683,048 over five years. The median and mean payments per author were $101,624 and $136,409, respectively. Speaking compensations accounted for more than 80% of all personal payments. More than 77.8% (21 authors), 66.7% (18 authors), and 51.9% (14 authors) received more than $10,000, $50,000, and $100,000 in total payments over the five years, respectively. Nevertheless, these financial relationships between the CPG authors and pharmaceutical companies were not disclosed. More than 81.8% of the CPG recommendations were supported by low- or very-low-quality evidence. Of the strong recommendations, 66.7% were supported by low- or very-low-quality evidence. Conclusion Even though all CPG authors received substantial amounts of personal payments from pharmaceutical companies, these conflictsof interest(COIs) were not disclosed in the CPG. These findings underscore the urgent need for policy interventions to enhance transparency, integrity, and reliability in the development of CPGs in Japan.

High throughput system for preparing samples for genomic, epigenetic, transcriptomic, proteomic and metabolomic analysis

Multi-omics considers the analysis of complex biological “omes” (genome, epigenome, transcriptome, proteome, metabolome, and others). This exponentially growing systems biology approach aims to better understand phenotypes in health and disease and as such identify biomarkers of disease and drug targets. The basic workflow is divided into an upstream sample preparation step, and corresponding downstream assays. To prepare samples for these assays biospecimen are treated to extract analytes such as chromatin, DNA, RNA, protein and metabolites. Often these sample preparation steps are done using cavitation. Current tools such as ultrasonic horns, and even many commercial sample preparation instruments, can be highly inconsistent, leading to unreliable assays. In order to overcome the problems of inconsistency, an instrument was designed and built with a transducer array (free field pressures P + = 30 MPa, P– = 12 MPa) capable of processing samples directly in standard 96-well microplates. An array of transducers is mounted below a microplate, coupled to a lens array that focuses acoustic energy into each well of a microplate. Intense cavitation is generated in each well. This process results in consistent analytes extraction that leads to consistently reproducible results. The authors have a financial conflict of interest. [Funded by NIH R33CA191135, R21GM111439, R01DK103849, R42HG010855, U01CA246503, and R44GM122097.]

Financial Conflicts of Interest in Public Comments on Medicare National Coverage Determinations of Medical Devices

This study reviewed public comments for all Medicare National Coverage Determinations between June 2019 and 2022 on select pulmonary and cardiac devices to determine whether financial conflicts of interest were disclosed.

Financial conflicts of interest of physicians followed by oncology journals on Twitter.

Physicians have increasingly adopted Twitter as a discussion and distribution platform for oncology research. While the influence of financial conflicts of interests (FCOI) on medical research is well documented, their role in the dissemination of research on social media platforms is not well known. In this study, we sought to evaluate the FCOIs of physicians followed by the top three oncology journalson Twitter. We used the Open Payments Search Tool ( https://openpaymentsdata.cms.gov ) to assess FCOIs between 2016 and 2021 of United States (US) physicians followed by three oncology journals (Journal of Clinical Oncology, The Lancet Oncology, and Annals of Oncology) on Twitter. Of 1914 Twitter accounts followed by the top three oncology journals on Twitter, 547 (28.6%) belonged to US physicians. Of these, 463 (84.6%) received general payments between 2016 and 2021. After excluding 30 US physicians currently in residency or fellowship, this percentage increased to 88.2% (n = 456/517). Combined, the median (interquartile range) general payment amount was $8100 ($200-90,000). Additionally, over $42 million in general payments were made between 2016 and 2021. Our findings offer insight on FCOIs between oncology journals and US physicians on Twitter. These findings may serve as the foundation for future research regarding optimal medical journal conduct on social media platforms.

Observational studies of antidepressant use and suicide risk are selectively published in psychiatric journals

ObjectivesTo investigate if observational studies showing favorable results for antidepressants on suicidal behavior (reduced risk) are preferably and more easily published in psychiatric journals and cited more often compared to studies with unfavorable results (increased risk). Study Design and SettingPrespecified secondary analysis, including 27 original studies selected through a systematic review of observational studies reporting associations between the use of newer antidepressant drugs and suicide risk. ResultsIndependent of study quality, studies reporting favorable results were more frequently published in psychiatric than nonpsychiatric journals and were more often conducted by lead authors with financial conflicts of interest (fCOI). Within psychiatric journals, lead authors with fCOI published in journals with a higher impact factor (IF) and ranking. Within psychiatric journals, favorability of results also correlated with citation frequency, IF, and journal ranking, but these associations became weaker and inconclusive after adjusting for study quality. Results for ease of publishing were inconclusive. ConclusionStudies reporting unfavorable results (increased suicide risk with antidepressant exposure) are less likely to be published in psychiatric journals. Lead authors with fCOI report more favorable results, and their studies are published in the most prestigious psychiatric journals. This may create a biased evidence base and an unbalanced dissemination and appraisal of findings within psychiatry.

Intellectual conflicts of interest among cardiology and pulmonology clinical practice guidelines.

Intellectual conflicts of interest (COI), like financial COI, may threaten the validity and trustworthiness of clinical practice guidelines (CPGs). However, comparatively little is known about intellectual COI in CPGs. This study sought to estimate the prevalence of intellectual COI and corresponding management strategies among cardiology and pulmonology CPGs. We conducted a retrospective document review of CPGs published by cardiology or pulmonology professional societies from the United States, Canada, or Europe from 2018 to 2019 available via the Emergency Care Research Institute, Guidelines International Network, or Medscape databases. We assessed the percentage of authors with an intellectual COI, defined as i) authorship on a study reviewed by the CPG, ii) authorship of a prior editorial related to a CPG recommendation, or iii) authorship of a prior related CPG. Management strategies assessed included use of GRADE methodology, inclusion of a methodologist, and recusals due to intellectual COI. Outcomes were assessed overall and compared between cardiology and pulmonology CPGs. Among the 39 CPGs identified (14 cardiology, 25 pulmonology), there were a total of 737 authors, of whom 473 (64%) had at least one intellectual COI. Among all CPGs, a median of 67% (Interquartile Range 50%-76%) of authors had at least one intellectual COI, and COI was more prevalent among cardiology compared with pulmonology CPGs (84% vs 57%, p<0.001). There was variable use of management strategies among the CPGs, including use of GRADE methodology (64% of CPGs), inclusion of a methodologist (49%), and recusals due to intellectual COI (0%). Intellectual conflicts of interest appear to be highly prevalent and under-reported among cardiology and pulmonology CPGs, which may threaten their validity. Greater attention to and improved management of intellectual COI by CPG-producing organizations is needed.

Misuse of antibiotics in COVID-19: a neglected threat in Pakistan

Antibiotics are a range of powerful medications utilized for the treatment of bacterial infections. Although, misuse can result in a mass epidemic of antibiotic-resistant infections across the world. Antibiotic resistance is a ubiquitous phenomenon owing to the poor management of dosage, overuse due to a lack of public awareness, and increased negligence of physicians in prescribing antibiotics. Furthermore, the World Health Organization (WHO) has declared anti-microbial resistance to be among the top 10 threats to the global public1, making it an indisputable issue of global health. In Pakistan, a study declared that ~88% of COVID-19 patients were using multiple antibiotics for treatment with no culture tests indicative of the need for antibiotic therapy2. Moreover, in a study of hospitalized COVID-19 patients, it was concluded that ~8% of all COVID-19 patients suffered from concurrent bacterial infections, however, up to 90% of the patients received antibiotic therapy3. These alarming figures demonstrate the dire need of intervention at a national level, to prevent the rapid emergence of an endemic of antibiotic-resistant infections. Furthermore, the incidence of antibiotic-resistant infections has seen a sharp rise within the past decade4, largely due to the imprudent use of antibiotics. The unregulated misuse of antibiotics can result in a new strain of fatal infection, triggering a relentless endemic in the face of a pandemic. Statistical models predict approximately 5 million deaths in a year (mostly caused by Escherichia coli) due to rising antibiotic-resistant infections worldwide, creating an overwhelming global burden of infections5. This burden is unaffordable for developing countries like Pakistan, which cannot pay the price of catastrophic socio-economic constraints created by the warfare of 2 active outbreaks. With the looming threat of nationwide antibiotic-resistant infections, it is exceedingly important to initiate early intervention. National health authorities should impose strict regulations on pharmacies, clinics, and hospitals, wherein COVID-19 patients are not encouraged for antibiotic therapy unless evidently indicated. Moreover, physicians should comprehensively counsel their patients regarding the grave consequences of antibiotic misuse, especially during COVID-19 infections, where use has not been indicated. Local awareness programs must also be utilized, encouraging the general population to decrease their misuse of antibiotics. With persistent intervention, we hope to reduce the rise of new menacing endemics nationwide. Ethical approval Not Applicable. Sources of funding None. Author contribution Conceptualization: Muhammad Omar Larik; Literature Search: Muhammad Omar Larik; Creation of First Draft: Muhammad Omar Larik, Muhammad Ashhal Iftekhar, Daniyal Muhammad Alam, Omema Ansari, Mozaena Ansari; Creation and Review of Final Draft: Muhammad Omar Larik. All authors have approved the final mauscript. Conflict of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) Not Applicable. Guarantor Muhammad Omar Larik. Assistance with the study None. Provenance and peer review Not commissioned, externally peer-reviewed.

Outbreak of measles: threatening India’s goal to achieve elimination

Outbreak of measles: threatening India’s goal to achieve elimination