S. Van McCrary

A national survey of policies on disclosure of conflicts of interest in biomedical research

BACKGROUND Conflicts of interest pose a threat to the integrity of scientific research. The current regulations of the U.S. Public Health Service and the National Science Foundation require that medical schools and other research institutions report the existence of conflicts of interest to the funding agency but allow the institutions to manage conflicts internally. The regulations do not specify how to do so. METHODS We surveyed all medical schools (127) and other research institutions (170) that received more than

Physicians' legal defensiveness and knowledge of medical law : comparing Denmark and the USA

5 million in total grants annually from the National Institutes of Health or the National Science Foundation; 48 journals in basic science and clinical medicine; and 17 federal agencies in order to analyze their policies on conflicts of interest. RESULTS Of the 297 institutions, 250 (84 percent) responded by March 2000, as did 47 of the 48 journals and 16 of the 17 federal agencies. Fifteen of the 250 institutions (6 percent)--5 medical schools and 10 other research institutions--reported that they had no policy on conflicts of interest. Among the institutions that had policies, there was marked variation in the definition and management of conflicts. Ninety-one percent had policies that adhered to the federal threshold for disclosure (

Human contexts: Medicine in Society at Stony Brook University School of Medicine.

10,000 in annual income or equity in a relevant company or 5 percent ownership), and 9 percent had policies that exceeded the federal guidelines. Only 8 percent had policies requiring disclosure to funding agencies, only 7 percent had such policies regarding journals, and only 1 percent had policies requiring the disclosure of information to the relevant institutional review boards or to research subjects. Twenty journals (43 percent) reported that they had policies requiring disclosure of conflicts of interest. Only four federal agencies had policies that explicitly addressed conflicts of interest in extramural research, and all but one of the agencies relied primarily on institutional discretion. CONCLUSIONS There is substantial variation among policies on conflicts of interest at medical schools and other research institutions. This variation, combined with the fact that many scientific journals and funding agencies do not require disclosure of conflicts of interest, suggests that the current standards may not be adequate to maintain a high level of scientific integrity.

Neonatology and the specter of the law

The impact of legal factors on medical treatment decisions for dying patients has been studied in the USA for years. However, it is unknown how legal factors may affect similar medical decisions in other countries. This exploratory study compared responses between two populations of physicians, from Denmark (n=62) and the USA (n=301), who regularly treat terminally ill patients in tertiary care medical centers. We investigated whether Danish and US physicians differed significantly in their attitudes about the influence of law on treatment decisions for terminally ill patients. The Danish physicians demonstrated significantly better knowledge of medical law relevant to end-of-life treatment than did US physicians. The Danish sample also reported significantly lower levels of legal defensiveness than the US sample. These findings are consistent with our previous research showing that, among US physicians, legal defensiveness and knowledge of medical law are inversely related.

The Best Lack All Conviction: Biomedical Ethics, Professionalism, and Social Responsibility

Humanities teaching was introduced at Stony Brook University School of Medicine by Edmund Pellegrino, the first dean of the Medical School and founder of the Health Sciences Center. Since 1990, “Medicine in Society” has been a substantial presence throughout the curriculum, introducing students to the perspectives of a wide range of humanities disciplines as they apply to health care, and continuing as a sustained presence throughout the four years of training. Medicine in Society serves as a reminder that medicine is a human and communal endeavor, situated in sociocultural contexts, reliant on human values, and articulated most often through narratives. The authors describe the structure and function of the Medicine in Society curriculum and the Institute for Medicine in Contemporary Society, summarize their evaluation of the program, and outline their plans for meeting current and future challenges.

Superseding Psychiatric Advance Directives: Ethical and Legal Considerations

When I began my career with dual training in bioethics and law, my research and clinical interests were focused on the suffering of terminally ill adults due to unwanted treatment and how perceptions of law among health care providers contributed to this problem. A central goal of my work was to try to prevent situations where physicians would aggressively continue to treat patients in ways contrary to their expressed wishes and ignore the attempts of family members to implement the preferences of their loved ones. It was apparent that some physicians were so anxious about the impact of legal factors on their practice that they were willing to tolerate additional suffering of patients to protect themselves. Further, I suspected that many of these physicians were not well versed in the nuances of applicable laws and were making these judgments with inaccurate information. Hence my research was designed, in part, to dispel misperceptions by physicians of legal constraints on their practice and encourage them to educate themselves about law. I also hoped to suggest that some physicians modify their approach to cases of serious illness to evaluate all elements of the case proportionally, carefully considering the impact of suffering on both patients and families, rather than ascribing excessive importance to the impact of legal factors. Later in these pages, I will briefly describe some results of this research regarding cases of adult patients. As I became involved with ethical issues in neonatology, however,