Conflict of Interest

We read the article by Haut et al. with interest. 1 The authors report on the ability of some patients with epilepsy to predict the occurrence of their seizures. As suggested by the authors, this ability may rely on prodromes or warning and initial symptoms. Preictal dysphoria is a phenomenon well described by patients and their relatives, but the frequency, duration, and clinical features have been only occasionally investigated. The last systematic study specifically dedicated to this subject was published in 1986. 2 It is evident that mood changes preceding the occurrence of seizures represent a neglected area of research in epileptology and neuropsychiatry of epilepsy that, conversely, may have important clinical implications. Research concerning seizure-alerting dogs is also of interest. 3 It is possible that this phenomenon could be interlinked with preictal dysphoria-that dogs' behaviors are influenced by specific mood changes of the owner occurring in the preictal phase. It is now accepted that the end of the seizure is not the end of the problem, 4 but what precedes the seizure can be equally interesting.

his client pays nothing. 3 The current alternative at least theoretically available is the hourly fee. 4 Here the lawyer receives an ' The contingent fee receives grudging approval in ABA CODE OF PROFESSIONAL RESPONSIBILITY EC 2-20, 2-24, 5-7, & DR 2-106, 5-103, but must meet the restrictions of these and other provisions of the Code. For example, the fee must be reasonable in amount. See id. EC 2-17, 2-18, & DR 2-106(A) & (B). This general restriction may be enforced by self-restraint, contract, custom, bar associations, courts, and, to a lesser extent, legislatures and agencies. Also, this restriction sometimes spawns related rules, most of which simply require that the fee not be "excessive," "exorbitant," or "unconscionable." But in some places and for certain situations rules provide specific restrictions, such as maximum percentage fees.

The pharmaceutical industry has produced many drugs that have benefited man. Political frameworks designed to govern the industry must maintain these benefits. However, regulation needs to be sufficiently robust to protect public health from drugs that are unsafe, ineffective, or unnecessary. The extent of industry influence over drug regulation, at the expense of other interested parties, suggests that the current system could be more robust. The many ways in which the pharmaceutical industry can influence governments and regulatory agencies are discussed, and methods by which this influence can be curbed are suggested.

Mutualisms are of fundamental importance in all ecosystems but their very existence poses a series of challenging evolutionary questions. Recently, the application of molecular analyses combined with theoretical advances have transformed our understanding of many specific systems, thereby contributing to the possibility of a more general understanding of the factors that influence mutualisms.

High rates of addiction, overdose, and death make the opioid epidemic one of the most urgent public health issues in the United States, with more than 47,000 opioid related deaths in 2017. Evidence from the United States shows that opioid manufacturers' strategies to deceive the medical community about the safety and efficacy of opioids played a pivotal role in the American opioid epidemic. This paper investigates how pharmaceutical promotion practices in the United States influenced health professionals, the regulator and the public, and contributed to the opioid crisis. The study focuses on the approval of OxyContin (an opioid) in 1995 and the aggressive and misleading marketing campaign that followed its approval by its manufacturer, Purdue Pharma. This paper argues that drug companies' strategies to influence the medical community represent a significant public health concern. Identifying the influence of drug companies on the medical community can help prevent similar public health crises.

Thank you for the editorial (Edwards et al. 2005) concerning the appointment of Jean Coussins of The Portman Group to the Alcohol Education and Research Council (AERC). I was a member of the AERC for six years, my time in post ending in June 2004. The issue of Jean Coussins membership was raised at my final meeting as the retiring members of the AERC met with the new members to 'pass on the baton'. As an educationalist my response has always been that Jean's membership is important for the AERC as The Portman Group also funds education projects working with respected agencies such as TACADE. This element seems to have been forgotten amongst the concerns regarding research. AERC stands for Alcohol EDUCATION and Research Council and when I came to the council the balance was definitely towards research and not education. During my time on the AERC we were able to raise the profile of education projects and also recognize what could be called good education rather than just using 'shock/horror' techniques or one off events. Whilst I personally have issues and concerns about some of The Portman Group sponsored projects, the fact that two funders of education projects could come together and work in tandem is very exciting and perhaps the AERC influence will improve the quality of some of The Portman Group projects. When the AERC ran an event for providers of alcohol education on behalf of the Department for Education and Skills we recognized the importance of The Portman Group to this work and Jean came to this event. If the research community decides to withdraw applications to the AERC and will no longer act as referees then simply more funding will be available to education projects and for studentships. However I doubt that this will be the case as researchers chase a limited funding pot for their work. I would also remind you that the AERC has two sub groups, one for Research and one for People and Organisations, previously the Education committee. I was a member of People and Organisations, this is my area of expertise, and when funding proposals came before the full board I generally accepted the expert view of the Research group as they accepted my group's recommendations on educational matters. I do not know which of these groups Jean is on, but if it is not Research then her influence on such matters will be limited. It is now nearly a year since Jean was appointed to the AERC. The objections have been noted and surely it is now time to get on with the work despite any reservations you might have. Rather like voting Labour in the recent election.

An increasing number of countries show a trend towards a certain degree of consolidation of powers in financial supervision, which has resulted in the establishment of unified regulators, that are different from the national central banks. By contrast a high involvement of the central bank in supervision seems to be correlated with a multi -authorities regime (central bank fragmentation effect). This paper, using a simple application of a general common agency game, sheds light on which conditions the politicians prefer when implementing a unified sector supervision outside the central bank. From a theoretical point of view the quality of public sector governance plays a crucial role in determining the supervision unification. Focusing on the behaviour of the "good" policymaker (helping hand type), it will prefer a unified financial authority that is different from the central bank if the correspondent welfare gains -linked to at least one of the three effects: moral hazard, conflict of interest, bureaucracy -are considered higher respect to the information losses. The "bad" policymaker (grabbing hand type) will choose the single financial authority if the financial industry likes it, and the central bank is not a captured one. On the other hand, the paper tests the model, confirming the robustness of the institutional position of the central bank in explaining the recent trend in supervision consolidation, with an empirical analysis performed with ordered functions on an updated dataset.

This multicenter, randomized, investigator-blinded study compared the efficacy and tolerability of a combination of lymecycline 300 mg/day orally and adapalene topical gel 0.1% (n ϭ 118) to lymecycline 300 mg/day orally plus vehicle gel (n ϭ 124) in patients with moderate to moderately severe acne vulgaris with both inflammatory and noninflammatory lesions. The primary efficacy end point, total lesion count at end point (last observation carried forward), showed a statistically significant difference in favor of the lymecycline plus adapalene group (P ϭ .0011). The mean decrease in total, inflammatory and noninflammatory lesion counts was significantly greater at end point in the lymecycline plus adapalene group than in the lymecycline plus vehicle group (P Ͻ .01). In addition, a significant difference for inflammatory and total acne lesions was seen sooner in the adapalene plus lymecycline group. In total, 75.5% of patients in the lymecycline plus adapalene group were markedly improved, almost clear or clear of their lesions at week 12, compared with 51.8% of those in the lymecycline plus vehicle group (P Ͻ .001). Local cutaneous tolerance was generally good in both groups, although more patients receiving the lymecycline plus adapalene combination experienced cutaneous reactions than those receiving lymecycline plus vehicle. There are relatively few studies comparing the efficacy of combined oral and topical therapy with either individual therapy alone. This study clearly demonstrates that lymecycline plus adapalene combination treatment resulted in a significantly greater mean decrease in the number of inflammatory, noninflammatory and total lesions than lymecycline plus vehicle and was well tolerated.

The American Society of Clinical Oncology (ASCO) has embarked on an intensive campaign to integrate elimination of cancer health disparities into the Society's overall mission and activities. Key components of this commitment are enhancing awareness of disparities; improving access to care; and supporting research on health disparities. Major objectives are to advance the education of the oncology community in the care of patients from underserved and minority populations; increase the diversity of the clinical oncology workforce as a requisite to improving access to cancer care for the underserved; and support research in the area of health disparities. Racial and ethnic disparities in cancer care are an issue of critical importance to ASCO, the oncology community, and our society at large. The health disparities initiative outlined herein enunciates ASCO's dedication to eliminating disparities in cancer care and discusses our multipronged approach for addressing disparities within the clinical oncology community. ASCO is committed to collaborating with the diverse community of stakeholders to undertake the following: develop policies to guarantee equal access to quality health care, with special emphasis on reducing insurance and economic barriers to cancer care; develop a comprehensive plan to increase awareness of racial and ethnic disparities in cancer care; execute a strategy to enhance the supply of minority physicians and to improve the training of the oncology workforce to meet the needs of racially and ethnically diverse cancer patients; increase prioritization of public and private research on cancer care disparities; develop mechanisms to increase participation of racially and ethnically diverse populations in cancer clinical trials; and support initiatives to enhance patients' involvement in their cancer care.

Physicians are currently presented with very difficult ethical issues regarding who receives what level of medical care and for how long. A meaningful response to these perplexing issues necessitates a collaboration of doctors with others steeped in religious and ethical traditions. This paper addresses the complicated issue of the rationing of health care, and this issue is then addressed by responses from representatives of the religious community. This symposium took place at the New York Hospital--Cornell Medical Center in March 1991.

Conflicts of interest (COIs) cloud vaccine safety research. Sponsors of research have competing interests that may impede the objective study of vaccine side effects. Vaccine manufacturers, health officials, and medical journals may have financial and bureaucratic reasons for not wanting to acknowledge the risks of vaccines. Conversely, some advocacy groups may have legislative and financial reasons to sponsor research that

Basis of decision-making. Autonomy of the individual and informed consent have their roots in the writings of Hippocrates, Socrates, Plato, Aristotle, Erasmus, Descartes, Rousseau, and Thoreau. 4, 13-17 As a result, they have been incorporated into English common law, the Napoleonic Code, the US Constitution and Bill of Rights, and the Helsinki Declaration. 18 For these reasons, individual autonomy is accepted as a right by many developed countries and organizations such as the World Health Organization, Médecins sans Frontieres, and Amnesty International. Communal decision-making. In contrast, communal decisionmaking is frequent in developing countries. 6-9, 19, 20 It has been described in societies as different as Eskimos, South Sea Islanders, Native Americans, tribes in the Amazon, and diverse ethnic groups in sub-Saharan Africa. 4-9, 19-22 In those societies, health is just one area in which less emphasis is placed on individual autonomy. Other examples include the roles of chiefs, elders, and the community in allocating land and water rights and determining social roles, occupations, marriages, and the roles of children. DECISION-MAKING FROM THE PERSPECTIVE OF INFORMED CONSENT Autonomy of the individual. In developed countries, consent discussions typically involve the participants themselvesunless they are minors or legally incompetent (Figure 1). Thus, consent is an independent event for each participant. Except for studies that affect the entire population, representatives of the community are typically not involved in the consent process. Communal decision-making. Conversely, communal decision-making is common in many of the rural areas of sub-Saharan Africa where tropical diseases are prevalent. In these communities, the consent process typically begins with presentation of the study to the chief and village council (Figure 1). 6-9 , 19, 23 The proposal is then discussed with progressively broader audiences-councils of male and female elders, heads of household, other individuals, and parents. Meetings with potential research participants take place only after

The question of whether clinical ethics consultants may engage in patient advocacy in the course of consultation has not been addressed, but it highlights for the field that consultants' allegiances, and the boundaries of appropriate professional practice, must be better understood. I consider arguments for and against patient advocacy in clinical ethics consultation, which demonstrate that patient advocacy is permissible, but not central to the practice of consultation. I then offer four recommendations for consultants who engage in patient advocacy, and consider the implications of this issue for the field.

Background: Impact assessment (IA) of all major European Union (EU) policies is now mandatory. The form of IA used has been criticised for favouring corporate interests by overemphasising economic impacts and failing to adequately assess health impacts. Our study sought to assess how, why, and in what ways corporations, and particularly the tobacco industry, influenced the EU's approach to IA.

Family therapists are expected to engage in ethical and responsible research, while maintaining rigorous ethical standards and adhering to federal regulations that require protection for research participants. We present a short historical overview of the sign$icant events and ethical controversies leading to the formulation of current regulations in human subject research and review. Federal regulations and guidelines, including issues of informed consent, special populations, and conflict of interest are reviewed. A short list of recommendations to assist family therapists in staying abreast of contemporaPy research protocol is provided.

Evidence suggests that the pharmaceutical industry exerts a large influence on residents' education and practice. Yet existing guidelines by professional bodies do not cover the specifics of residents' interactions with the pharmaceutical industry. At the psychiatry residency program of the McGill University Health Center, the authors set out to systematically evaluate areas of concern for residents and to develop guidelines for use by residents during and outside their training. Areas of concern included educational activities, training, fundraising, and other specific resident-industry interactions. In 1998, a committee of residents and faculty systematically evaluated areas of concern and, based on a review of the literature and discussions with experts, in 2000 developed guidelines for Dr.

Intergroup conflicts generally involve conflicts of interests within the competing groups as well. This article outlines a taxonomy of games, called team games, which incorporates the intragroup and intergroup levels of conflict. Its aims are to provide a coherent framework for analyzing the prototypical problems of cooperation and competition that arise within and between groups, and to review an extensive research program that has used this framework to study individual and group behavior in the laboratory. Depending on the game's payoff structure, contradictions or conflicts are created among the rational choices at the individual, group, and collective levels-a generalization of the contradiction between individual and collective rationality occurring in the traditional mixed-motive games. These contradictions are studied so as to identify the theoretical and behavioral conditions that determine which level of rationality prevails.

The paper reviews current theories of the firm and its governance to apply the insights to the banking firm. The theory of the firm now acknowledges that there is a role for stakeholders in governance even if that obfuscates the objective function of management. Additional stakeholders add to the firm's complexity, thereby making performance remuneration schemes more difficult to implement. The banking firm is a typical example of a firm in which depositors are stakeholders that deserve an allocation of property rights. I argue that such property rights are suitably enforced by a regulatory agency, and that a bank will thus always be a firm that serves two masters. It therefore should be more cautious defining performance remuneration schemes.

Riassunto. Vi sono molti modi di pensare alle mète future della ricerca clinica. Lascian- do ad altri contributi il compito di occuparsi delle frontiere conoscitive della ricerca cli- nica, ci concentriamo in questo articolo su questioni di metodologia e di policy. Le finalità etico/scientifiche e la realtà della ricerca clinica sembrano infatti marciare in direzione opposta. Per i pazienti, una

In this case study from litigation, we show how ghostwriting of clinical trial results can contribute to the manipulation of data to favor the study medication. Study 329 for paroxetine pediatric use was negative for efficacy and positive for harm. Yet the ghostwritten publication from this study concluded that paroxetine provided evidence of efficacy and safety and continues to be influential. Despite the role of named authors in revisions of the manuscript, the sponsor company remained in control of the message.

Pyramidal groups, in Italy and elsewhere, represent a model of separation of ownership and control. Pyramids typically have blockholders which extract private benefits of control at the expenses of minority shareholder. This paper focuses on the Italian case where the number of pyramids is reducing but are still largely diffused. Groups are a form of entrenchment and may have negative effects on firm growth. They are characterized by conflicts of interest and self-dealing practices which reduced external financing opportunities. In this paper legal regulation of groups in Italy is discussed, which has positive aspects (art. 2497 ss. c.c.) but some weaknesses on self-dealing practices (artt. 2391 and 2391-bis c.c.). Future reforms should take into consideration the guidelines given at European level (for instance, by the High Level Group of Company Law Experts and the European Commission), which have been set aside from the political agendas of mostly European governments. Moreover, we suggest to strengthen the process of (not only formal) disclosure of relevant information to the company shareholders' as well, in order not to dismantle pyramids, but to make them "shorter" (when that is the case), more transparent and reciprocally competitive. Parole chiave: gruppi piramidali, corporate governance, conflitti di interesse, diritto societario, operazioni con parti correlate. JEL: G3; K22; 2 Il capitalismo italiano in evoluzione: i gruppi societari tra conflitti di interesse e sviluppo ‫٭‬ Giacomo Bosi Sandro Trento SOMMARIO: 1. Introduzione. -2. Cenni di analisi economica della disciplina dei gruppi di imprese piramidali. -3. Proprietà e controllo delle imprese in Italia tra continuità e cambiamento. -4. Gruppi di imprese e disciplina degli interessi degli amministratori societari. -5. Prospettive di regolazione dei gruppi di imprese piramidali. -6. (segue) Gruppi e operazioni con parti correlate. -7. Conclusione.

To explore a number of issues related to boundary violations in psychiatry, including the relationship between the individual physician and his or her patient and broader issues related to various dilemmas arising in academic departments of psychiatry. Several potentially troublesome scenarios are presented and discussed in the contexts of 1) the doctor-patient relationship, 2) sexual boundary violations, and 3) nonsexual forms of exploitation, such as finances, confidentiality, dual relationships, and relationships with industry. A number of examples of boundary problems involving psychiatrists have been explored, and although some of these behaviours are clearly forbidden and harmful, others are less clear and require careful consideration if the profession is to arrive at a thoughtful consensus.

Concerns about legal implications affect many decisions of the average radiologist, and physicians do not always appreciate the validity of these concerns. However, such concerns often influence radiologists' decisions more than is warranted. An improved understanding of the law and its ramifications may serve to prevent adverse legal effects found in the everyday practice of radiology. Legal issues influence radiology in many ways. Two important ways the law affects the practice of radiology relate to the business affairs of radiologists and to the radiologist's duty to perform to a standard of care. Legal issues relate to the business aspects of radiology through radiologists' relationship to their group practice and the radiology group's relation to the outside world. Radiology groups use legal services for issues such as employment contracts, hospital privileges, group relations, and bylaws. They make decisions with major legal implications when they establish th...

This paper integrates elements from the theory of agency, the theory of property rights and the theory of finance to develop a theory of the ownership structure of the firm. We define the concept of agency costs, show its relationship to the 'separation and control' issue, investigate the ...

Academic entrepreneurship arose from internal as well as external impetuses. The entrepreneurial university is a result of the working out of an "inner logic" of academic development that previously expanded the academic enterprise from a focus on teaching to research. The internal organization of the Research University consists of a series of research groups that have firm-like qualities, especially under conditions in which research funding is awarded on a competitive basis. Thus, the Research University shares homologous qualities with a start-up firm even before it directly engages in entrepreneurial activities.