Context Physicians are regularly confronted with research that is funded or presented by industry. Objective To assess whether physicians discount for conflicts of interest when weighing evidence for prescribing a new drug. Design and setting Participants were presented with an abstract from a single clinical trial finding positive results for a fictitious new drug. Physicians were randomly assigned one version of a hypothetical scenario, which varied on conflict of interest: ‘presenter conflict’, ‘researcher conflict’ and ‘no conflict’. Participants 515 randomly selected (...) Fellows in the American College of Obstetricians and Gynecologists' Collaborative Ambulatory Research Network; 253 surveys (49%) were returned. Main object measures The self-reported likelihood that physicians would prescribe the new drug as a first-line therapy. Results Physicians do not significantly discount for conflicts of interest in their self-reported likelihood of prescribing the new drug after reading the single abstract and scenario. However, when asked explicitly to compare conflict and no conflict, 69% report that they would discount for researcher conflict and 57% report that they would discount for presenter conflict. When asked to guess how favourable the results of this study were towards the new drug, compared with the other trials published so far, their perceptions were not significantly influenced by conflict of interest information. Conclusion While physicians believe that they should discount the value of information from conflicted sources, they did not do so in the absence of a direct comparison between two studies. This brings into question the effectiveness of merely disclosing the funding sources of published studies. (shrink)

Objective: To determine whether a moral reasoning exercise can improve response quality to surveys of healthcare priorities Methods: A randomised internet survey focussing on patient age in healthcare allocation was repeated twice. From 2574 internet panel members from the USA and Canada, 2020 (79%) completed the baseline survey and 1247 (62%) completed the follow-up. We elicited respondent preferences for age via five allocation scenarios. In each scenario, a hypothetical health planner made a decision to fund one of two programmes identical (...) except for average patient age (35 vs 65 years). Half of the respondents (intervention group) were randomly assigned to receive an additional moral reasoning exercise. Responses were elicited again 7 weeks later. Numerical scores ranging from –5 (strongest preference for younger patients) to +5 (strongest preference for older patients); 0 indicates no age preference. Response quality was assessed by propensity to choose extreme or neutral values, internal consistency, temporal stability and appeal to prejudicial factors. Results: With the exception of a scenario offering palliative care, respondents preferred offering scarce resources to younger patients in all clinical contexts. This preference for younger patients was weaker in the intervention group. Indicators of response quality favoured the intervention group. Conclusions: Although people generally prefer allocating scarce resources to young patients over older ones, these preferences are significantly reduced when participants are encouraged to reflect carefully on a wide range of moral principles. A moral reasoning exercise is a promising strategy to improve response quality to surveys of healthcare priorities. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 10.1 (2000) 103-108 [Access article in PDF] Letters "Small Sacrifices" in Stem Cell Research Madam: I agree with Professors McGee and Caplan (in their article "The Ethics and Politics of Small Sacrifices in Stem Cell Research," KIEJ, June 1999) that the question of the nature and status of the source of stem cells must be addressed. However, in their eagerness to convince us of (...) the smallness of the sacrifices, I think the authors use some unfortunate rhetorical devices and move much too quickly over some necessary distinctions.The rhetorical display is unfortunate if the article is intended to be a fair and rational development of an argument--e.g., those who hold a position in opposition to the authors do not argue they "inveigh." The section on the political area of the controversy seems particularly dismissive of other's positions.However, I will focus on just two areas where I think a more nuanced consideration would make the question of the moral legitimacy of the "small sacrifices" of embryos less obvious than the authors' rhetoric would suggest.First, they claim that opponents of such research assume some sort of "super status" for an embryo. The rights generally conceded to born human beings may not be as "weak" as they characterize. But even considering only the "negative right against unwarranted violence," I think the authors misdescribe the situation. Contrary to their assertion, I do not know when "adults and even children are... forced to give life... in the defense or at least interest of the community's highest ideals and most pressing interests" (p. 153). Could they be speaking of capital punishment, justified in the name of protecting the community? But then why mention children?It is true that not everyone can be guaranteed every means to preserving and enhancing life. But this limitation on positive rights is not a "forced giving." Adults may be compelled to risk life--e.g. in a draft for the sake of a war. But, again, the more or less justifiable imposition of a risk is not the same as selecting out one particular individual or class to be directly killed. Neither adults nor born children are compelled to be killed for the sake of organ "donation," even if a greater number might be saved. If one grants equivalent status to the embryo (as the authors seem to do here for the sake of argument), opponents do not have to claim a "super status" for embryos, just the ordinary human right not to be killed even for "compassionate" motives.A second area where I think the authors move too quickly is in their impoverished definition of the essential humanity of the early embryo as exhaustively represented by the physical structure of its DNA. The authors seem to recognize [End Page 103] that, ordinarily, there is more to personhood than sheer physical structure. For example, they mention memories and habits (p. 154). They could also speak of relationships, attitudes, and the like. Since an early embryo has no such components of personality as we experience it, the authors hold that its identity could only be contained in its DNA. Since this DNA is preserved, even spread far and wide, by the use of stem cells, it almost seems as if we are doing the early embryo a favor by breaking it up.However, just because the embryo does not have any conscious memories or other attributes of character or personality, that does not mean its identity is constituted only by its physical structure described statically. The early embryo is not just a bundle of discrete structures, and its DNA is not just an inert lump made up of certain smaller lumps. Both the embryo and its DNA are active. Thus the identity of even an early embryo includes both its current processes and the innate potential for further activity and development. Although lacking a conscious will, the early embryo is already in a sense an agent, already doing things--growing, changing, and heading toward something that... (shrink)