Conflicts of interest in intensive care medicine
- PDF / 674,460 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 98 Downloads / 211 Views
EDITORIAL
Conflicts of interest in intensive care medicine Dustin C. Krutsinger1,2,3*, Scott D. Halpern1,2,3,4 and Erin S. DeMartino5,6 © 2018 Springer-Verlag GmbH Germany, part of Springer Nature and ESICM
Conflicts of interest in medicine are pervasive and are not isolated to certain practice settings or specialties. The Institute of Medicine defines a conflict of interest as “a set of circumstances that creates a risk that professional judgement or actions regarding a primary interest will be unduly influenced by a secondary interest” [1]. Medical professionals have a duty to minimize and disclose conflicts of interest in order to preserve the trust of patients and the public. In this editorial we focus on financial personal conflicts, non-financial personal conflicts, and conflicts that arise naturally in the role of ICU clinician, highlighting facets shared across medicine and challenges unique to the practice of intensive care medicine.
Financial personal conflicts ICU providers may have financial ties to investigational devices, proprietary assays or medications, or collect speakers’ fees. Yet advances in intensive care medicine have not traditionally been industry-driven to the same extent as in other fields, such as oncology or cardiology. With several notable exceptions such as drotrecogin alfa [2] and dexmedetomidine [3], most contemporary trials in critical care involve generic medications with other established uses (steroids, paralytics or resuscitative fluids) or non-pharmacologic interventions (prone positioning, ventilation strategies or early vs. late renal replacement therapy). To the extent any financial personal conflicts exist, intensivists should comply with reporting mechanisms such as the Centers for Medicare and Medicaid Service’s Open Payments system [4]. The reimbursement structure in the United States may impact treatment decisions in ICUs, though citing *Correspondence: [email protected] 1 Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA Full author information is available at the end of the article
fee-for-service as a primary determinant of decision making over-simplifies complex practice patterns [5].
Non‑financial personal conflicts Although financial conflicts of interest deservedly receive attention from professional societies and policymakers, non-financial personal conflicts may be even more prevalent in ICUs. Advancement of scientific knowledge, practice innovation and improvements in patient outcomes drive the majority of ICU investigators. However, secondary motivations such as career advancement and job security are predicated on research productivity, as measured by prolific publication and securing extramural funding. Pressure to enroll patients in clinical trials may lead to inadequate disclosure of risks, exaggeration of potential benefits of study participation, enrollment of subjects who do not meet eligibility criteria, failure to disclose adverse events to oversight committees, data manipulati
Data Loading...
