Financial Conflicts of Interest Among Oncologist Authors of Reports of Clinical Drug Trials

Abstract

reported only when respondents had already committed themselves deeply to patients' treatment (Q4) or when patients had arranged a second opinion without informing them (Q5). Specialists who provided second opinions struggled with feelings of helplessness toward patients if their opinion was in accordance with the first opinion and they thus took away the patient's hope (Q6). Moreover, respondents struggled with patients' unwillingness to be referred back to the first specialist after the second opinion. To reduce patients' reluctance, they actively tried to restore trust in the first specialist (Q7, Q8). Respondents were hesitant to communicate minor discrepancies with the first opinion to patients, fearing this would harm the patients' trust in the referring specialist, their own relationship with their colleague, or both (Q9, Q10). When differences in opinion were conveyed bluntly between the 2 specialists involved, this resulted in tension or anger (Q11, Q12). After back-referral, most referring specialists perceived that the physician-patient relationship had strengthened. Especially when both opinions aligned, patients gained acceptance, certainty, and trust (Q13). Discussion | The second-opinion process is complex and places great demands on the communication skills of medical specialists because of the emotions involved, especially when the attitudes they wish to convey conflict with their true beliefs and emotions. The physicians must balance objectivity with diplomacy to avoid harming their relationship with their patient or colleague. Interpersonal sensitivities between physicians and patients or colleagues may be managed by explicitly ascertaining patients' motivations and expectations, both when conducting and referring patients for second opinions. Although respondents in this study may not have been fully open about their personal experiences (a potential limitation of this study), the range of emotions identified suggests that acceptable candor was achieved. Addressing the identified challenges in medical training may improve the second-opinion process and enhance collaboration among medical specialists. Our research indicates that although some physicians believe they are often unnecessary, second opinions can strengthen the physicianpatient relationship after back-referral. Future research incorporating subjective and objective outcomes of second opinions should further establish their value.

Evaluation of Financial Conflicts of Interest Among Physician‐Authors of American College of Rheumatology Clinical Practice Guidelines

“…US‐based physician‐authors not found in the OPD were assumed to have not received industry payments. We excluded all food and beverage transactions, as this is consistent with the approach taken in previous studies . Payments were extracted in a parallel and blinded manner by 2 investigators (CW and ZZ) using the data download feature on the OPD.…”

“…Since August 2013, and updated annually, all payments to physicians or teaching hospitals have been posted on the OPD web site. Thus, the OPD has been used to track both the accuracy of physician FCOI disclosures and the magnitude of dollars received . A recent analysis of OPD data on payments received by authors of reports on randomized controlled trials of rheumatoid arthritis drugs concluded that FCOIs are common and are “temporally increasing” .…”

Financial relations between leaders of US medical societies and industry

“…This enactment resulted in the creation of the Open Payments database, which reports the financial benefits paid to physicians from April 2013 up to present time 2. These data have resulted in numerous studies evaluating financial ties of individual physicians,34 those of guideline authors,567 and those of doctors conducting randomized controlled trials89—ties that could unduly influence medical practice and research. Until now, however, we have lacked information on the extent of financial conflicts of interest among leaders of national medical associations and societies.…”

Leading US cancer researcher failed to disclose industry ties in dozens of articles

“…A study comparing the Open Payments database with the disclosures of 344 oncologist authors who reported trials of drugs approved by the US Food and Drug Administration found that 32% of authors did not fully disclose payments from the trial sponsor 3. The study was published on 30 August in JAMA Oncology —one of the journals in which Baselga omitted to mention industry payments.…”