The Impact of Drug Trials With Financial Conflict of Interests on the Meta-Analyses: A Meta-Epidemiological Study

Background: Drug trials with potential financial conflict of interests (FCOIs) may influence trial design, drug dosage, comparators, and promising results are more likely to be reported. The objective of this study was to assess the impact of trials with FCOIs on evidence synthesis in meta-analyses (MAs). Methods: A total of 96 MAs from the Cochrane Library about drug trials were investigated. The primary outcomes examined the proportion of conclusions that would change with the exclusion of trials with potential FCOIs. If the proportion of changed conclusions was below the non-inferiority margin of 10%, we considered that it was not inferior to include the trials with potential FCOIs in the MAs. Results: Only 54.17% of MAs reported the funding sources of each included trial, and in 21.88% of MAs, the author-industry-related financial ties of each included trial were reported. When trials with FCOIs were excluded, the changed conclusions of effectiveness and major adverse events were 13.16% and 11.11%, respectively, and the I 2 decreased by 13.56% and 10.09%, respectively. For serious adverse events, the exclusion of FCOIs trials did not lead to any change in conclusions; however, the I 2 decreased by 24.24%. The impact of trials without reported FCOIs was also examined on evidence synthesis, and the results showed that the changed conclusions of effectiveness and major adverse events were 5.26% and 6.25%, respectively, indicating non-inferiority. However, the I 2 increased by 13.60% and 12.37%, respectively. Conclusion: In this meta-epidemiological study, we demonstrated that trials with FCOIs may not only influence the final outcome of MAs but may also increase the heterogeneity of results. It is suggested that all MAs fully report the FCOIs involved in evidence-based research and explore the impact of its FCOIs to better provide a more valuable reference for patients, clinicians, and policymakers.

Investigating the Lived Experiences of Working Couples about Marital Conflicts: A Phenomenological Study

Aim: The purpose of this study was to extract the lived experiences of working couples from marital conflicts. Methods: This study was conducted with a qualitative approach using interpretive phenomenology. In this study, researchers interviewed 12 working couples with marital conflicts using purposeful sampling. Interviews were analyzed using interpretive phenomenology. Findings: Analyzing the data from the interviews led to the identification of the 14 main themes: financial conflict, inappropriate interactions in social media, lack of participation in house chores, ineffective communication, inability in reciprocal empathy and expression, lack of time management, conflict of roles and responsibilities, cognition vulnerability, adherence to gender stereotypes, inability to manage tasks at job and work environment, work-family conflict, power struggles, ultra-personal destructive factors and belief and ethical problems, 55 primary and 12 secondary themes in the lived experiences of working couples from marital conflicts. Conclusion: A dual-career family is a place where couples are more likely to enter into marital conflicts if they do not realize fairness in various areas of family and work. The results of the present study showed that the families of career couples may be a high-risk group in terms of conflict, and this factor indicates the need for a negotiating role in the relationship between this type of couple. This highlights the need for special couple therapy for these couples. The results of the present study also showed that ineffective communication, cognitive vulnerability, work-family interaction, financial conflict and lack of participation in home affairs, were the most common causes of marital conflict; so it is recommended that preventive and educational programs for couples include the abovementioned factors.

The “throwaways”. Conflicts of interest in dermatology publications

ImportanceConflict of interest as it relates to medical education is a topic of concern. Dermatology journals, periodicals, editorials, and news magazines are influential resources that are not uniformly regulated and subject to influence from the pharmaceutical industry.ObjectiveThis study evaluates industry payments to physician editorial board members of common dermatology publications, including “throwaway” publications.DesignA list of editorial board members was compiled from a collection of clinical dermatology publications received over a 3-month period. To analyze the nature and extent of industry payments to this cohort, payments data from the Open Payments database from 2013 to 2019 were collected. Analysis of the total payments, number of transactions, categories of payments, payment sources, and physician specific characteristics was performed.ResultsTen publications were evaluated, and payments data for 466 physicians were analyzed. The total compensation across all years was $75,622,369.64. Services other than consulting, consulting, and travel/lodging payments comprised most of the payments. A faction of dermatologists received the majority of payments. The top payers were manufacturers of biologic medications. Payment amounts were higher for throwaway publications compared to peer-reviewed journals.ConclusionsEditorial board members of dermatology publications received substantial payments from the pharmaceutical industry. A minority of physicians receive the lion’s share of payments from industry. “Throwaway” publications have more financial conflict of interest than peer-reviewed journals. The impact of these conflicts of interest on patient care, physicians practice patterns, and patient perception of physicians is noteworthy.

Association Between Conflict of Interest and Published Position on Hypoglossal Nerve Stimulation for Sleep Apnea

Objective To determine if there is an association between authors’ financial conflict of interest and published position on clinical use of hypoglossal nerve stimulation for obstructive sleep apnea. Study Design Retrospective cross-sectional analysis. Setting International roster of authors and articles analyzed. Methods A Google Scholar search was performed for editorials and reviews citing the 2014 New England Journal of Medicine article on hypoglossal nerve stimulation for obstructive sleep apnea. Included articles were coded as favorable or neutral. Conflict of interest was recorded as declared by the authors in these articles and as independently searched in the Open Payments registry. Results Sixteen articles from 45 independent authors were analyzed. Nine articles by authors were coded as favorable. Among authors of articles with favorable views, 16 (59%) had a financial conflict of interest with the manufacturer of the hypoglossal nerve stimulator device, as opposed to only 1 of 21 (5%) authors of neutral/unfavorable articles. When we included only authors to whom payments could be identified or excluded on Open Payments, 16 of 20 (80%; 95% CI, 62%-98%) authors of favorable articles had a financial conflict, while 1 of 10 (10%; 95% CI, 0%-29.6%) of neutral/unfavorable articles did ( P = .004). Conclusion Our study demonstrates an association between published position on hypoglossal nerve stimulator use and financial conflict with the device manufacturer. Several undeclared conflicts were also found, suggesting a role for independent search for conflicts during the review process.

“Hear me!”

I am respectfully submitting a narrative essay to this journal. As a faculty member at a residency program, I got interested in contributing this essay after my experience caring for a disabled patient. I presumed we tend to imperfectly decipher what our patients’ needs are and my experience highlighted the need to be more sensitive and less dismissive to patients with disabilities. I started with the assumption that there were minimal teaching points to the house staff since this was an overt outpatient placement case. I was wrong and learnt much more than I expected. As faculty physicians, we tend to highlight pertinent clinical data to the learners and inadvertently gloss over vital nonclinical details that ultimately are as important. This patient was very succinct with her demands and understandably upset with our blatant conjectures with our daily mundane clinical rounds and consults. Taking time to listen to her, having a team meeting in her room and coordinating her care with nursing and medical colleagues was not only a learning experience but made me a better physician and teacher. She was the focus and her needs were met, not ours. I have no financial conflict of interest, and the patient was aware I intended to share my experience with my peers. I will appreciate any feedback and opportunity to learn and improve this narrative with expected revisions.

Prostate Cancer: People Transforming A Diagnosis, A Diagnosis Transforming People

Prostatic specific antigen (PSA) screening has been controversial since its inception. Controversy has persisted despite more and higher quality clinical evidence. Attention to lead and length time biases, overdiagnosis, overtreatment, medicalisation, iatrogenesis and financial conflict of interest has had limited impact. I undertook a social history of the prostate cancer diagnosis to reassess the causes of controversy and suggest different clinical and policy responses. For much of the twentieth century, clinicians were uninterested in early detection and radical treatment, believing that cancers revealed after obstruction-relieving surgery or autopsy could be ignored. In 1985, the FDA approved PSA diagnostic tests, which rapidly catalysed two self-reinforcing cycles of action and perception. One occurred when the increased diagnoses made the disease more prevalent and feared, and efforts at prevention and treatment seem more efficacious, leading to more screening, and so on. The other cycle occurred among men with screening detected cancer who initially eschewed radical treatments or imagined doing so, whose lives were often consumed with fear and surveillance, increasing demand for radical cures. This history underscores the need for novel clinical and policy responses to the looping effects—self-reinforcing cycles of action and perception—which can radically transform so much of what we believe and do about disease.

Editor and peer reviewer financial conflict of interest policies in public health journals

The influence of harmful commodity industries on health research has heightened concerns around author financial conflicts of interest (FCOIs) in public health journals (PHJs), with little discussion of potential editorial, i.e., editor and reviewer, FCOIs. In this analysis of 20 prominent PHJs, detailed disclosure requirements, the inclusion of timeframes, and policy accessibility were found lacking in editorial, compared with author, FCOI policies. Disclosure forms were employed in 32% of PHJs for authors but not for editors or reviewers. Recusal policies were similar for reviewers (68%) and editors (60%). Strengthening editorial FCOI policies will increase the integrity of PHJs’ editorial processes.