Joint issues – conflicts of interest, the ASR hip and suggestions for managing surgical conflicts of interest
نویسندگان
چکیده
BACKGROUND Financial and nonfinancial conflicts of interest in medicine and surgery are troubling because they have the capacity to skew decision making in ways that might be detrimental to patient care and well-being. The recent case of the Articular Surface Replacement (ASR) hip provides a vivid illustration of the harmful effects of conflicts of interest in surgery. DISCUSSION We identify financial and nonfinancial conflicts of interest experienced by surgeons, hospitals and regulators in the ASR case. These conflicts may have impacted surgical advice, decision-making and evidence gathering with respect to the ASR prosthesis, and contributed to the significant harms experienced by patients in whom the hip was implanted. Drawing on this case we explore shortcomings in the standard responses to conflicts of interest--disclosure and recusal. We argue disclosure is necessary but by no means sufficient to address conflicts of interest. Using the concept of recusal we develop remedies including second opinions and third party consent which may be effective in mitigating conflicts, but their implementation introduces new challenges. SUMMARY Deployment of the ASR hip is a case of surgical innovation gone wrong. As we show, there were multiple conflicts of interest involved in the introduction of the ASR hip into practice and subsequent attempts to gloss over the mounting body of evidence about its lack of safety and effectiveness. Conflicts of interest in surgery are often not well managed. We suggest strategies in this paper which can minimise the conflicts of interest associated with surgical innovation.
منابع مشابه
The Role of Transparency in Reducing Corruption, Global Experiences Lessons for Iran
Abstract: According to the International Organization for Transparency International, in 2017, Iran's ranking on the "Corruption Perceptions (CPI) Index" among the 180 countries surveyed was 130, and the country's score was 30 out of 100. Also, our country's score in 2016 was 29 in the index and 131 in the ranking, which is calculated from 176 countries. According to information from recent yea...
متن کامل“Big” Food, Tobacco, and Alcohol: Reducing Industry Influence on Noncommunicable Disease Prevention Laws and Policies; Comment on “Addressing NCDs: Challenges From Industry Market Promotion and Interferences”
The food, tobacco and alcohol industries have penetrated markets in low- and middle-income countries (LMICs), with a significant impact on these countries’ burden of noncommunicable diseases (NCDs). Tangcharoensathien and colleagues describe the aggressive marketing of unhealthy food, alcohol and tobacco in LMICs, as well as key tactics used by these industries to resis...
متن کاملTowards Patient-Centered Conflicts of Interest Policy
Financial conflicts of interest exist between industry and physicians, and these relationships have the power to influence physicians’ medical practice. Transparency about conflicts matters for ensuring adequate informed consent, controlling healthcare expenditure, and encouraging physicians’ reflection on professionalism. The US Centers for Medicare & Medicaid Services (CMS) launched the Open ...
متن کاملThe Effectiveness of Group Therapy Based On Acceptance and Commitment to Increase the Life Expectancy, Marital Intimacy and Reducing the Marital Conflicts of Women
Introduction: Marriage is one of the most important issues of interest to the human community. Therefore, the present study was conducted to determine the effect of group therapy based on the acceptance and commitment on life expectancy, marital intimacy and marital conflicts. Methods: The research design was pre-test, post-test and the statistical population of this study was women referring t...
متن کاملFinancial Conflicts and Compatibility in Dual-Career Couples: A Phenomenological Study
Extended Abstract Introduction: The notion of the traditional family (the man working outside the home and the housewife working indoors) is fading away, so that there are families where both men and women are working as full-time employees (Musavi, Samavatyan, & Nouri, 2018). The lifestyle of a dual-career couple refers to a situation in which the couple plays different roles, with the couple...
متن کامل