Opinion Current Problems in the Media The burgeoning problems with the media have been documented in great detail by researchers, academicians and journalists themselves: High levels of inaccuracies Public confidence in the media, already low, continues to slip. According to an in-depth study by the American Society of Newspaper Editors in23 percent of the public find factual errors in the news stories of their daily paper at least once a week while more than a third of the public - 35 percent - see spelling or grammar mistakes in their newspaper more than once a week. The study also found that 73 percent of adults in America have become more skeptical about the accuracy of their news.
For example, gifts to endow named professorships or fund the construction of research facilities support the core teaching and research missions of academic medical centers.
The committee heard testimony that new kinds of institutional relationships between academia and industry—beyond relationships involving individual faculty members—could promote the translation of basic discoveries into new therapies and thereby benefit society Benz, ; Moses, The question for institutions as well as individuals is whether a relationship with industry can be maintained in a way that achieves the desired benefits but avoids the risks of undue influence on decision making and the loss of public trust.
Although several cases reported by the news media have called attention to institutional conflicts of interest in medicine, institutional conflicts of interest have generally received less attention than individual conflicts of interest. Institutional conflicts of interest often involve the financial interests of both the institution and its senior officials Box After the death of Jesse Gelsinger during a clinical trial involving a gene transfer intervention conducted by a University of Pennsylvania research institute, various investigations more The risks to core missions posed by institutional conflicts of interest can be as serious as those created by individual conflicts.
Moreover, if institutions do not prudently manage relationships with industry and are exposed to public criticism for inadequately or improperly managing conflicts, the work of many individual researchers, educators, and clinicians associated with the institution may unfairly be called into question, even though they were not involved in the conduct that was criticized.
This chapter begins by defining institutional conflicts of interest and describing what has been documented about the extent of such conflicts. The discussion then reviews responses to institutional conflicts of interest and examines some of the challenges in managing such conflicts.
The chapter concludes with recommendations, including a recommendation that the National Institutes of Health NIH require its grantees to adopt and apply policies on institutional conflicts of interest. Conflicts of interest may also arise when institutions seek and receive gifts or grants from companies, for example, a gift of an endowed university chair or a grant for a professional society to develop a clinical practice guideline.
In addition, institutional conflicts of interest exist when senior officials who act on behalf of the institution have personal financial interests that may be affected by their administrative decisions.
For instance, a department chair or dean who has a major equity holding in a medical device company could make decisions about faculty appointments and promotions or assignment of office or laboratory space in ways that favor the interests of the company but compromise the overall research, educational, or clinical mission of the institution.
As emphasized in Chapter 2conflicts of interest are defined in terms of the risk of undue influence and not actual bias or misconduct. Whether they are at the individual or the institutional level, conflict of interest policies seek to prevent compromised decision making rather than to try to remedy its consequences.
Institutional interests can be evaluated for the likelihood of undue influence and the seriousness of potential harms in ways analogous to those applicable to individual conflicts see Chapter 2. Thus, assessments would consider the nature of the primary interest, the value and scope of the secondary interest, the extent of institutional accountability and discretion involving decisions about the primary interest at stake, and the seriousness of potential harms in relation to potential benefits see also Emanuel and Steiner .
The committee found little comprehensive information about the scope and nature of the ties of academic medical centers, professional societies, patient advocacy groups, and other institutions to pharmaceutical, medical device, and biotechnology companies.
Most reports focus on prominent and usually egregious cases of misconduct, as illustrated in Box Chapter 4 reviewed the results of a survey of department chairs in medical schools and large independent teaching hospitals that found that 27 percent of preclinical departments and 16 percent of clinical departments received income from intellectual property licensing Campbell et al.
This income may be seen as a benefit of the provisions of the Bayh-Dole Act, which allow institutions to patent discoveries resulting from federally funded research and to grant exclusive licenses for others to develop those discoveries.
The survey also found that ties to industry were common among department chairs, who served as consultants 27 percentmembers of a scientific advisory board 27 percentpaid speakers 14 percentcompany officers 7 percentand company board members 11 percent.
The committee did not locate institution-level data on company funding of biomedical research, but Chapter 4 reported that the majority of such research in the United States is commercially funded. For institutions as well as individuals who provide health care, conflicts of interest also arise from provider reimbursement methods, whether these involve fee for service, prospective payment per case, pay for performance, or other arrangements.
As noted in Chapter 6however, consideration of payment methods and ownership interests in medical facilities are beyond the scope of this report. The report did not look specifically at biomedical research institutions.
The Association of University Technology Managers, which conducts an annual survey of technology transfer activities including the licensing of patents and the launching of start-up companiesdoes not report information by scientific field.
In connection with congressional inquiries about its relationships with pharmaceutical companies, the American Psychiatric Association APA reported that medical companies supplied about 28 percent of its annual income.
An informal APA survey of other medical specialty societies indicated that this figure was about in the middle of the range of the income that companies provide these groups from 2 to nearly 50 percent Stotland, An Associated Press story on pharmaceutical company spending to promote the awareness of fibromyalgia reported that companies contributed funds that amounted to 40 percent of the annual budget of the National Fibromyalgia Association Perrone, Many groups list corporate donors but do not report how much of their income is derived from these donors.
These data would assist with assessments of the risk of undue influence. In a report for its board of directors, the American Academy of Family Physicians AAFP analyzed its resources and activities and concluded that it was not financially possible to forgo industry funding for any of its activities without imposing unacceptable cuts in services to members or increases in member costs.
They also look at how media typically give voice to the most powerful, and how new media might offer tools to help those who are disenfranchised. Symbolic interactionists see the symbolic uses of technology as signs of everything from a sterile futuristic world to a successful professional r-bridal.com://r-bridal.com /chapter/chapter8-media-and-technology. Institutional conflicts of interest arise when an institution’s own financial interests or those of its senior officials pose risks of undue influence on decisions involving the institution’s primary r-bridal.com://r-bridal.com Any institution with a vested commercial interest in the outcome of an issue has a natural credibility barrier to overcome with the public, and often, with the media. (Rose ) Corporate front groups often portray themselves as environmentalists.
The report noted that the organization had sought to broaden its base of nondues funding beyond pharmaceutical companies by seeking grants from government and foundations for various activities and had also taken other steps to limit the influence of industry.
The data presented in Chapter 6 showed that physician membership organizations obtained 49 percent of their income for accredited continuing medical education from a combination of commercial funding for activities, advertising, and exhibits at meetings.
Medical school continuing medical education programs received about 62 percent of their income from these sources; for publishing and education companies, the figure was 73 percent. Public Health Service PHS regulations on conflict of interest, which were issued in and which are included in Appendix Bcover only individual conflicts of interest and relationships with industry.
Institutional conflicts of interest were deliberately not addressed NIH, The guidance on financial relationships in research with human participants published by the U. Department of Health and Human Services discusses the identification and management of institutional as well as individual financial interests HHS, The document suggests questions and procedures for institutional review boards IRBsinvestigators, and institutions to consider in evaluating institutional relationships.
Federal antikickback rules apply to illegal payments to institutions as well as individuals. The recommendation by the Medicare Policy Advisory Commission see Chapter 3 for industry reporting of consulting and other payments covers not only payments to physicians but also payments to medical schools, professional societies, and providers of continuing medical education MedPAC, A bill introduced in the U.
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Public and private sector interests in e-government: a look at the DOE’s PubSCIENCE. Author links open overlay panel Joseph A. Salem Jr. a. it was especially concerned with outlining commercial concerns over government competition online. In cases where the user was affiliated with an institution that subscribed to the journal, the r-bridal.com The Ombudsman shall inform the institution or body concerned as soon as a complaint is referred to him.
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