The drug industry and medical professionalism.
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Conflict of Interest↗
Biomedical subjects
Ian Kerridge
Publications and source records attributed to Ian Kerridge.
Ties that bind: multiple relationships between clinical researchers and the pharmaceutical industry.
BACKGROUND: It is believed that pharmaceutical industry sponsorship of clinical research leads to the development of multiple ties between clinicians and the pharmaceutical industry. To quantify this relationship we conducted a survey of medical specialists listed in the Medical Directory of Australia in 2002 and 2003. METHODS: A questionnaire was mailed that elicited information about all aspects of research relationships between clinicians and pharmaceutical companies. The odds of reporting multiple additional ties (financial and professional) with pharmaceutical companies by clinicians who had an active research relationship were compared with those who did not. All clinicians who returned a completed questionnaire about their research activities were included in the study. RESULTS: A questionnaire was mailed to 2120 medical specialists; 823 (39%) responded. Of these, 338 (41%) reported involvement in industry-sponsored research in the previous year. They were more likely than others to have been offered industry-sponsored items or activities valued at more than 500 AU dollars (>382 US dollars; odds ratio [OR], 3.5; 95% confidence interval [CI], 2.6-4.7) and support for attending international conferences (OR, 5.4; 95% CI, 3.9-7.4). The strongest associations were seen for acting as a paid consultant to industry (OR, 9.0; 95% CI, 3.9-20.4) and for membership on advisory boards (OR, 6.9; 95% CI, 5.1-9.6). There was a strong relationship between research collaboration and accumulation of industry ties. For 1 additional tie the OR was 2.2 (95% CI, 1.2-3.8) and rose to 6.3 (95% CI, 3.5-11.1) with 3 ties and 41.8 (95% CI, 14.5-143.4) with 6 or more ties. CONCLUSIONS: Medical specialists who have research relationships with the pharmaceutical industry are much more likely to have multiple additional ties than those who do not have research relationships. Institutional review should discourage clinical researchers from developing multiple ties.
Australia↗
Cancer patients' attitudes toward euthanasia and physician-assisted suicide: the influence of question wording and patients' own definitions on responses.
OBJECTIVES: The aims of this study were to: (1) investigate patients' views on euthanasia and physician-assisted suicide (PAS), and (2) examine the impact of question wording and patients' own definitions on their responses. DESIGN: Cross-sectional survey of consecutive patients with cancer. SETTING: Newcastle (Australia) Mater Hospital Outpatients Clinic. PARTICIPANTS: Patients over 18 years of age, attending the clinic for follow-up consultation or treatment by a medical oncologist, radiation oncologist or haematologist. MAIN OUTCOME MEASURES: Face-to-face patient interviews were conducted examining attitudes to euthanasia and PAS. RESULTS: 236 patients with cancer (24% participation rate; 87% consent rate) were interviewed. Though the majority of participants supported the idea of euthanasia, patient views varied significantly according to question wording and their own understanding of the definition of euthanasia. CONCLUSIONS: Researchers need to be circumspect about framing and interpreting questions about support of 'euthanasia', as the term can mean different things to different people, and response may depend upon the specifics of the question asked.
Adult↗
Selection of medical students according to their moral orientation.
INTRODUCTION: Consideration has been given to the use of tests of moral reasoning in the selection procedure for medical students. We argue that moral orientation, rather than moral reasoning, might be more efficacious in minimising the likelihood of inappropriate ethical behaviour in medicine. A conceptualisation and measure of moral orientation are presented, together with findings from 11 samples of medical school applicants and students. AIM: To provide empirical evidence for the reliability and validity of a measure of moral orientation and to explore gender, age, cultural and educational influences on moral orientation. METHODS: A questionnaire designed to measure a libertarian-dual-communitarian dimension of moral orientation was completed by 7864 medical school applicants and students in Australia, Israel, Fiji, New Zealand, Scotland and England and by 84 Australian psychology students between 1997 and 2001. RESULTS: Older respondents produced marginally higher (more communitarian) moral orientation scores, as did women compared to men. Minor but significant (P <0.05) cultural differences were found. The Israeli samples produced higher mean moral orientation scores, while the Australian psychology student sample produced a lower (more libertarian) mean score relative to all other samples. No significant change in moral orientation score was observed after 1 year in a sample of Australian medical school students (n=59), although some differences observed between 5 cohorts of Australian medical students (Years 1-5; n=234) did reach significance. Moral orientation scores were found to be significantly correlated with a number of personality measures, providing evidence of construct validity. In all samples moral orientation significantly predicted the moral decisions made in response to the hypothetical dilemmas embedded in the measurement instrument. Discussion The results provide support for the conceptualisation of a libertarian-dual-communitarian dimension of moral orientation and demonstrate the psychometric properties of the measurement instrument. A number of questions concerning the use of such tests in selection procedures are considered.
Education, Medical, Undergraduate↗
Making clinical decisions when the stakes are high and the evidence unclear.
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Anaphylaxis↗
Acute clinical ethics consultation: the practicalities.
In Australia there has been only limited experience with ethics consultation, and there are no reports of practical details. In 1999, the Institutional Clinical Ethics Committee at John Hunter Hospital, Newcastle, initiated an Acute Clinical Ethics Service (ACES) to formalise a perceived need within the hospital for ethics consultation. This need had previously been met by ad-hoc councils of "wise men". The ACES approach uses a team of people with different perspectives to provide an ethics consultation in a timely manner. Our initial experience of ACES has shown that a formal process of ethics consultation may be preferable to informal approaches in many circumstances; even when genuine consensus is not possible, an ethics consultation nevertheless provides an opportunity to share different points of view and helps to avoid practices that may be unacceptable. The specific implications of acute ethics consultations are not yet fully elucidated.
Abortion, Induced↗
On not taking objective risk assessments at face value.
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Ethics, Research↗
Xenobiotic gene polymorphisms and susceptibility to multiple myeloma.
Genetic variations in the activity of xenobiotic enzymes may predict susceptibility to multiple myeloma (MM). In a case-control study, 90 Australian Caucasians with MM had significantly higher incidences of GST T1 null, PON1 BB and NAT2 slow acetylation genotypes, but no difference in polymorphism frequencies for GST M1, NAT1, and CYP1A1 when compared to 205 controls.
Adult↗
Methionine synthase genetic polymorphism MS A2756G alters susceptibility to follicular but not diffuse large B-cell non-Hodgkin's lymphoma or multiple myeloma.
Lymphoproliferative diseases are characterized by chromosomal aberrations, and susceptibility may depend on inherited activity of enzymes required for DNA synthesis and methylation. We analysed genetic polymorphisms for methionine synthase (MS) A2756G, methylenetetrahydrofolate reductase (MTHFR) C677T and MTHFR A1298C in Caucasians with non-Hodgkin's lymphoma (NHL; n = 151), multiple myeloma (MM; n = 90) and 299 control subjects. The MS 2756 AG/GG genotypes were significantly under-represented in NHL (26.2%) vs control subjects (37.2%; P = 0.02), and conferred a 2.4-fold lower risk of follicular (odds ratio = 0.41, 95% confidence interval: 0.19-0.88, p = 0.02) but not diffuse large B-cell lymphoma. MM patients showed no significant difference in the polymorphisms compared with control subjects.
5-Methyltetrahydrofolate-Homocysteine S-Methyltran↗
Adverse events after imatinib mesylate therapy.
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Aged↗
Association between xenobiotic gene polymorphisms and non-Hodgkin's lymphoma risk.
The last four decades have seen a significant increase in the incidence of non-Hodgkin's lymphoma (NHL) as a possible result of increasing environmental carcinogen exposure, particularly pesticides and solvents. Based on the increasing evidence for an association between carcinogen exposure-related cancer risk and xenobiotic gene polymorphisms, we have undertaken a case-control study of xenobiotic gene polymorphisms in individuals with a diagnosis of NHL. Polymorphisms of six xenobiotic genes (CYP1A1, GSTT1, GSTM1, PON1, NAT1, NAT2) were characterized in 169 individuals with NHL and 205 normal controls using polymerase chain reaction-based methods. Polymorphic frequencies were compared using Fisher's exact tests, and odds ratios for NHL risk were calculated. Among the NHL group, the incidence of GSTT1 null and PON1 BB genotypes were significantly increased compared with controls, 34% vs 14%, and 24% vs 11% respectively. Adjusted odds ratios calculated from multivariate analyses demonstrated that GSTT1 null conferred a fourfold increase in NHL risk (OR = 4.27; 95% CI, 2.40-7.61, P < 0.001) and PON1 BB a 2.9-fold increase (OR = 2.92; 95% CI, 1.49-5.72, P = 0.002). Furthermore, GSTT1 null combined with PON1 BB or GSTM1 null conferred an additional risk of NHL. This is the first time that a PON1 gene polymorphism has been shown to be associated with cancer risk. We conclude that the two polymorphisms, GSTT1 null and PON1 BB, are common genetic traits that pose low individual risk but may be important determinants of overall population NHL risk, particularly among groups exposed to NHL-related carcinogens.
Arylamine N-Acetyltransferase↗
Interprofessionalism and ethics: consensus or clash of cultures?
The ethical arguments which underpin the call for interdisciplinary collaboration are analysed. In particular, the concept of 'teamwork' is considered as well as the organisational, professional, personal and cultural obstacles that constitute the barriers to the effective development of interdisciplinary relationships.
Australia↗
Hospital in the home (HITH) care following autologous stem cell transplantation for lymphoma and multiple myeloma.
BACKGROUND: Advances in outpatient and supportive care and increased pressure on hospital bed usage has led to the investigation of hospital in the home (HITH) management following autologous haematologous stem cell transplantation (AutoHSCT) for patients with multiple myeloma or lymphoma. DESIGN: The Newcastle Mater Hospital Haematology Unit together with the Mater Acute Care Community Service (MACCS) developed a protocol for HITH care following AutoHSCT. OUTCOMES: Clinical outcomes of the protocol were audited: 40% (13) of patients were suitable candidates for HITH care post transplantation. Of these 84.6% (11) were readmitted to the haematology unit within seven days of discharge from hospital. CONCLUSION: Our preliminary experience suggests that with adequate infrastructure support and rigorous patient selection this model of care is both safe and feasible.
Adult↗