Inherent Conflict Of Interest Research Articles

Promotional Tools in Pharmaceutical Marketing

Medicine are a core part of health-care services and their use has grown enormously during the last century with the advent of effective Antibiotics, Anesthetics, Analgesics, Anti-retroviral and many other medicines, they can cure diseases, relieve symptoms and prevent future ill health. Appropriate medicine use means providing the right medicine at the right dose, when it is needed and avoiding medicine that are unnecessary or are unlikely to result in health benefits it means choosing the treatment with the best effectiveness and safety profile among available alternatives and the least costly of equivalent treatments. The international pharmaceutical industry plays an important role in the development, production and distribution of medicines. In many countries it has also become the major funder of continuing medical education (CME) and research. However, a tension exists between pressure to expand products sales within a competitive market and patient care. The World Health Organization (WHO) describe" an inherent conflict of interest between the legitimate business goals of manufacturers and the social, medical and economic needs of providers and the public to select and use drugs in the most rational way"( WHO Europe 1993)1 The Global Medicine Market: In 2007, global pharmaceutical sales amounted to US $ 712 billion (IMS 2008)2 The top product in term of sales, was the cholesterol lowering medicine, Lipitor (Atorvastatin), which had sales of US $ 13.6 billion (scrip.2007)3. This is more than the gross national income of over half of the world’s countries (World Bank, 2008)4. The effects of promotion in fueling sales of specific brands should not be underestimated e.g. sales of Lipitor (Atorvastatin) were higher than sales of simvastatin and Provaststin, two medicine in the same class that have similar effectiveness and are less costly (Preserire, 2006) 5. Newer Medicine are not necessarily better: To get a new medicine to market, a company must provide evidence of effectiveness, safety and manufacturing quality. Effectiveness and safety evidence includes laboratory animal and clinical studies. The largest are phase III randomized controlled trials in patient with the disease the medicine aims to treat. Most of these studies compare a new medicine to a placebo. Many people are unaware that manufacturers do not need to show that a new medicine is better than existing compound with placebo and be acceptably safe. To test the medicine 's efficacy, the manufacturers carried out the randomized, controlled trials involving patients with the condition to be treated by the new medicine. These are usually relatively short-term studies and many last a few weeks to a few months, even when the treatment for a chronic disease. For some serious disease for which placebo treatment would be unethical, a new medicine is compared with existing treatments. However, these studies aim to show that a new medicine is as effective as alternatives, or no less effective, it does not need to be better, when a new medicine comes to the market.it has only been tested on highly selected groups of clinical trials participants. e.g. the elderly and those with co-morbid, chronic conditions are usually excluded. To few people have been exposed to asses’ rare harmful effects, generally 3, 000 to 5, 000 peoples. Because of this inevitably incomplete safety assessment, there is a rational from a public health perspective and an individual patient Care perspective for a slow, cautious approach to the introduction of new medicines.

Developing relationships with patients, staff, and industry in dermatology.

Maintaining a thriving dermatology practice requires thoughtful and intentional investment in relationships with patients, staff, and industry. Growing the patient-physician relationship involves optimizing patient satisfaction and outcomes, which can provide improved ratings and reimbursement. Cultivating an environment of employee engagement is also essential for promotion of patient satisfaction, employee satisfaction, and practice productivity. Additionally, relationships with industry require careful navigation to maximize its great potential for medical advancement and benefit for all parties. There are inherent conflicts of interest between physician motivation for improved patient outcomes and industry goals of increased profits. Successful management of these relationships can be a difficult task, but it remains important.

International Research and Philanthropy

International Research and Philanthropy

The ethical dilemmas of risky decisions.

Even in a pandemic there seem to be inherent conflicts of interest between the individual and societal consequences of remedial actions and strategies. Actions taken in the sole interests of patients, as required by the Hippocratic oath, can have broadly inconvenient economic implications for the State. ("Average" benefits for a population can impose individual inconveniences for the vulnerable.). Understandably these decisions are not normally made explicitly and transparently by governments. This leads to seemingly illogical and inhumane strategies which are not understood and hence mistrusted and often ignored by the public. Vaccination sentiments on social media are often an unwanted symptom of this dilemma. This article outlines and discusses a number of examples of such situations with a focus on ethical aspects. It concludes that each case must be considered individually as to the issues that need to be weighed in these difficult decisions; and that there are no clear and universally acceptable ethical solutions. What can be learned from the COVID-19 crisis is that short term utilitarianism has consequences that in the eyes of the population are unacceptable. This lesson seems equally valid for cost benefit evaluations regarding other risks, such as from hazardous industries, flood defenses, and air transport. Decisionmakers and politicians can learn that persuasion only goes so far. In the end the people appear to prioritize in terms of deontology.

"Regulate the Regulator"

As the 2008 Financial Crisis caused global markets to contract, and people across the United States and the world suffered the costs, there has been a growing and significant body of literature investigating the relative culpability of different financial actors and institutions in perpetrating the 2008 crisis. “Regulate the Regulator” highlights the culpability of credit rating agencies (CRA) for the reason that their industry acted as a de-facto financial regulator in themselves, wielding a unique amount and type of power as the “gatekeepers” or “security guards” of capital markets. This article explores the role of CRAs in precipitating the events of the 2008 crisis by examining factors like inherent conflicts of interest, an opaque rating process that lacked substantive oversight, and the enforcement of a profit-oriented workplace culture. Taking its analysis a step, "Regulate the Regulator" then contextualizes the behaviour of CRAs within the post-1980s American financialization movement.

Regulatory Frameworks for Development and Evaluation of Artificial Intelligence-Based Diagnostic Imaging Algorithms: Summary and Recommendations.

Although artificial intelligence (AI)-based algorithms for diagnosis hold promise for improving care, their safety and effectiveness must be ensured to facilitate wide adoption. Several recently proposed regulatory frameworks provide a solid foundation but do not address a number of issues that may prevent algorithms from being fully trusted. In this article, we review the major regulatory frameworks for software as a medical device applications, identify major gaps, and propose additional strategies to improve the development and evaluation of diagnostic AI algorithms. We identify the following major shortcomings of the current regulatory frameworks: (1) conflation of the diagnostic task with the diagnostic algorithm, (2) superficial treatment of the diagnostic task definition, (3) no mechanism to directly compare similar algorithms, (4) insufficient characterization of safety and performance elements, (5) lack of resources to assess performance at each installed site, and (6) inherent conflicts of interest. We recommend the following additional measures: (1) separate the diagnostic task from the algorithm, (2) define performance elements beyond accuracy, (3) divide the evaluation process into discrete steps, (4) encourage assessment by a third-party evaluator, (5) incorporate these elements into the manufacturers’ development process. Specifically, we recommend four phases of development and evaluation, analogous to those that have been applied to pharmaceuticals and proposed for software applications, to help ensure world-class performance of all algorithms at all installed sites. In the coming years, we anticipate the emergence of a substantial body of research dedicated to ensuring the accuracy, reliability, and safety of the algorithms.

The Philosophy of Unfair Dismissal Law in Nigeria

In Nigeria, the past three decades have witnessed a steady growing private sector, but the relationship between employers and employees continues to be a turbulent one and a source of unending litigation. This situation is worsened by the dwindling state of the economy. Paid employment continues to constitute the major source of livelihood of many families and this has made it an important source of livelihood in majority of the households in Nigeria. However, with the employment relationship comes an inherent conflict of interest between the employer and the employee. How best to manage this conflict has been left to the different nations to determine. In Nigeria, the law governs the cessation of an employment relationship but the statute governing dismissal is seemingly still a relic of the received English law as at 1900. The failure to bring the provisions of the statute on dismissal in tandem with the current day realities has brought about a distortion of the balance of interest between the employer and employee. In a bid to ensure stability, the concept of fair dismissal evolved. The aim of this paper is to critically examine the fundamental nature, attitudes, realities, existence and theories that act as guiding principles for unfair dismissal law in Nigeria. This paper examines the evolution of the labour law jurisprudence on unfair dismissal, and its jurisprudential foundation in Nigeria. It seeks to reveal the historical, moral, and cultural basis of unfair dismissal law. The article focuses on finding the answers to such abstract questions as what is unfair dismissal law? and how do judges decide such cases?

The sixth estate: tech media corruption in the age of information

PurposeThe purpose of this paper is to demonstrate how some of the information and communication practices of the Tech Media and specifically of Facebook, constitute media corruption. The paper will examine what the professional role of Facebook is regarding its information/communication practices and then demonstrate that Facebook is essentially a media company and not merely a “platform,” therefore liable to the same normative responsibilities as other media companies.Design/methodology/approachApplying the dual obligation information theory (DOIT), a normative information and communication theory that applies generally to all media companies that disseminate and share information, the paper demonstrates that Facebook’s role of mediating and curating the information of its users places upon it a normative editing responsibility, to ensure both the preventive detection and corrective editing of fake news, as well as other forms of misinformation disseminated on its platform. Finally, applying a philosophical model of media corruption the paper will demonstrate that Facebook’s role in the Cambridge Analytica case was not only unethical but moreover, constituted media corruption.FindingsThe paper concludes that Facebook’s media corruption illustrated in the Cambridge Analytica case is not a one-off case but the result of a systemic and inherent conflict of interest between its business model of selling users’ information to advertisers and its normative media role rendering the conflict of interest between those two roles conducive to media corruption.Originality/valueThe paper's originality is twofold. It demonstrates that Facebook is a media company normatively accountable on the basis of an original theory the DOIT and moreover, on the basis of an original media corruption theory its actions in the Cambridge Analytica case constituted media corruption.

The Case for Assessing for Negative Response Bias, Not Malingering

ABSTRACT Assessment of response style is a vital component of forensic assessment. However, the focus on malingering in the literature and test offerings has predictable and negative consequences: Because the label of malingering is viewed as toxic, tests designed to assess for it are often long and sacrifice sensitivity to minimize false-positive errors. Rather than focusing on diagnosing or ruling out malingering, examiners and validity test authors can focus on detecting negative response bias that could invalidate other clinical and forensically relevant data. Doing so can avoid overstepping one’s data and stigmatization, allow shorter, more cost-efficient assessments, better inform the court, reduce inherent conflicts of interest, and lessen conflict surrounding the response style issue.

The Influence of Bondholder Concentration and Temporal Orientation on Investments in R&D

Although innovation can be a critical source of competitive advantage, research has found that debt can erode management’s willingness to invest in R&D. In this article, we employ a stakeholder bargaining power perspective to argue that this effect is most pronounced when the firm’s bonds are concentrated in the hands of bond blockholders. Furthermore, we contend that the temporal orientation of bondholders influences this relationship. Specifically, while it is commonly assumed that bondholders have a limited temporal orientation that induces them to focus on short-term value appropriation, we argue that some bond blockholders adopt a long-term temporal orientation. This orientation, in turn, makes them more inclined to support long-term value creation for the firm in the form of enhanced investments in R&D. Moreover, while agency theory suggests that there is an inherent conflict of interest between shareholders and bondholders, our results suggest that the temporal orientation of investors (i.e., both shareholders and bondholders) matters much more than whether they invested in the firm’s equity or its debt.

Utilizing relationships with pharmaceutical companies to maximize benefit to you and your clients

Ethics influence decisions we make every day. As health professionals, our decisions have consequences that can be far-reaching and are under high scrutiny. As entrepreneurs, it is our responsibility to our employees and our family to run a profitable enterprise. It is important to recognize any potential conflict of interest and manage it appropriately. We often are brought information by employees of pharmaceutical companies that have an inherent conflict of interest when they approach us. It is up to us to utilize this data to the best of our abilities to educate our clients. It is also our responsibility to maximize these relationships to maximize profit for our business and the businesses of our clients.

Robust science underpinning legislation can create better outcomes for threatened species impacted by infrastructure projects

Robust science underpinning legislation can create better outcomes for threatened species impacted by infrastructure projects

Testimony on the Regulation of Indian Gaming, Oversight Hearing on the [NIGC] Minimum Internal Control Standards, Before the United States House of Representatives, Committee on Resources, 109th Congress, 2nd Session (May 11, 2006)

State governments have an inherent conflict of interest in the regulation of Indian gaming. Strict regulation of Indian gaming can be good for the long term health of the industry, but may impact short term revenues. States have a strong short term interest in maximizing gaming revenue. Tribal governments should bear the primary responsibility for regulating Indian gaming. However, tribal regulators also have a weakness, namely, a myopia to the interests of other tribes and the national interests of the Indian gaming industry. Federal regulators can best protect the integrity of the industry nationally and ought to have a strong oversight role. Federal regulators must support the independence of tribal gaming commissions within tribal governments and must remain vigilant against regulatory capture of tribal commissions. Congress should shore up regulatory authority over Class III Indian gaming.

The vicious circle of patient-physician mistrust in China: health professionals' perspectives, institutional conflict of interest, and building trust through medical professionalism.

To investigate the phenomenon of patient-physician mistrust in China, a qualitative study involving 107 physicians, nurses and health officials in Guangdong Province, southern China, was conducted through semi-structured interviews and focus groups. In this paper we report the key findings of the empirical study and argue for the essential role of medical professionalism in rebuilding patient-physician trust. Health professionals are trapped in a vicious circle of mistrust. Mistrust (particularly physicians' distrust of patients and their relatives) leads to increased levels of fear and self-protection by doctors which exacerbate difficulties in communication; in turn, this increases physician workloads, adding to a strong sense of injustice and victimization. These factors produce poorer healthcare outcomes and increasingly discontented and angry patients, escalate conflicts and disputes, and result in negative media coverage, all these ultimately contributing to even greater levels of mistrust. The vicious circle indicates not only the crisis of patient-physician relationship but the crisis of medicine as a profession and institution. Underlying the circle is the inherent conflict of interest in the healthcare system by which health professionals and hospitals have become profit-driven. This institutional conflict of interest seriously compromises the fundamental principle of medical professionalism-the primacy of patient welfare-as well as the traditional Chinese ideal of "medicine as the art of humanity". Patient trust can be restored through rectifying this institutional conflict of interest and promoting medical professionalism via a series of recommended practical measures.

The Inherent Conflict of Interest in For-Profit Journals

An editor of Geochemistry, Geophysics, Geosystems reflects on the increase in for-profit journals and the implications for scholarly publishing and scientific integrity.

Gender blind? An analysis of global public-private partnerships for health

BackgroundThe Global Public Private Partnerships for Health (GPPPH) constitute an increasingly central part of the global health architecture and carry both financial and normative power. Gender is an important determinant of health status, influencing differences in exposure to health determinants, health behaviours, and the response of the health system.We identified 18 GPPPH - defined as global institutions with a formal governance mechanism which includes both public and private for-profit sector actors – and conducted a gender analysis of each.ResultsGender was poorly mainstreamed through the institutional functioning of the partnerships. Half of these partnerships had no mention of gender in their overall institutional strategy and only three partnerships had a specific gender strategy. Fifteen governing bodies had more men than women – up to a ratio of 5:1. Very few partnerships reported sex-disaggregated data in their annual reports or coverage/impact results. The majority of partnerships focused their work on maternal and child health and infectious and communicable diseases – none addressed non-communicable diseases (NCDs) directly, despite the strong role that gender plays in determining risk for the major NCD burdens.ConclusionsWe propose two areas of action in response to these findings. First, GPPPH need to become serious in how they “do” gender; it needs to be mainstreamed through the regular activities, deliverables and systems of accountability. Second, the entire global health community needs to pay greater attention to tackling the major burden of NCDs, including addressing the gendered nature of risk. Given the inherent conflicts of interest in tackling the determinants of many NCDs, it is debatable whether the emergent GPPPH model will be an appropriate one for addressing NCDs.

A Comparison of Execution Quality across U.S. Stock Exchanges

The complex and fragmented nature of the U.S. equities exchange landscape has given rise to structural inefficiencies that have created the potential for inherent conflicts of interest between market participants. The introduction of the Investors Exchange, or IEX, offers the unique opportunity to evaluate market quality across exchanges with varying design characteristics and fee structures. As execution quality on a stock exchange cannot be examined independently of equity market structure, we take a holistic approach: we study four dimensions of market quality — liquidity, execution costs, price discovery, and market stability — and within each category we examine structural mechanics responsible for observed disparities in execution quality. We observe a consistent trend in venue stratification by fee structure across a number of market quality metrics: maker-taker exchanges dominate the U.S. equities trading landscape in market share despite greater adverse selection, less stability around executions, significantly longer queues at the inside, and a lower probability of execution. This suggests that access fees and rebates perpetuate economic incentives misaligned with the tenets of best execution, and may promote activity detrimental to market quality. We employ a publicly available dataset (Daily TAQ) in an effort to facilitate replication of our metrics, via which market participants can independently evaluate venue performance.

The Income Effect of Minimum Wage for the Underclass: Is It Positive in China?

The ongoing debates on the impact of minimum wage have largely focused on the policy's employment effect for its theoretical implications, but the real question at stake here is its income effect, that is, whether or not it can increase the income of the underclass. Previous efforts have mostly relied on various forms of market imperfection to verify the theoretical integrity of this policy, whereas in this article we have raised another Marxian perspective, emphasizing the positive check of minimum wage on overtime work. Classical economists have long recognized the vulnerability of the working class when faced against capitalists, but only Marx has paid special attention to the complicated interaction between hourly/unit wage rates and the length of the working day, proposing that low wage rates would not only hurt workers by forcing them to work overtime, but that it would also hurt the capitalists as a class once large-scale labor degradation kicks in, endangering the very existence of a well-functioning working class for them to employ. Both the inherent conflict of interests between individual capitalists and capitalists as a class and workers' systematic disadvantage against capital serve to call for the intervention of a “visible hand” which is the establishment of a minimum wage. A theoretical model has been proposed to formalize this wage-hour mechanism for the underclass, emphasizing the special constraints they face when making labor supply decisions. We have discussed three different types of income effect, explaining how workers' income might increase with minimum wage and how firms might also benefit from such a process.

Improving the Medical Student Performance Evaluation to Facilitate Resident Selection.

The Medical Student Performance Evaluation (MSPE) was introduced as a refinement of the prior "dean's letter" to provide residency program directors with a standardized comprehensive assessment of a medical student's performance throughout medical school. The author argues that, although the MSPE was created with good intentions, many have questioned its efficacy in predicting performance during residency. The author asserts that, despite decades of use and some acknowledged improvement, the MSPE remains a suboptimal tool for informing program directors' decisions about which applicants to interview and rank. In the current approach to MSPEs, there may even be some inherent conflicts of interest that cannot be overcome. In January 2015, an MSPE Task Force was created to review the MSPE over three years and recommend changes to its next iteration. The author believes, however, that expanding this collaborative effort between undergraduate and graduate medical education and other stakeholders could optimize the MSPE's standardization and transparency. The author offers six recommendations for achieving this goal: developing a truly standardized MSPE template; improving faculty accountability in student assessment; enhancing transparency in the MSPE; reconsidering the authorship responsibility of the MSPE; including assessment of compliance with administrative tasks and peer assessments in student evaluations; and embracing milestones for evaluation of medical student performance.

Invited Commentary

Invited Commentary