Research and Patient Care in Public Health Emergency

WHO Training Manual Ethics in epidemics, emergencies and disasters: Research, surveillance and patient care Learning Objective 7.3 Explain the potential conflicts of interest of health care workers participating in emergency research activities Outline 1. Key definitions and concepts 2. Problem solving tools and the model for the ethical management of conflicts 3. Case study 4. Discussion 5. Wrap up L.O. 7.3 Suggested

time 0-15 (15 min) 16-25 (10 min) 26-55 (30 min) 56-85 (30 min) 86-90 (5 min) Activity Introduction

Presentation problem-solving tools Case study and discussion, phase 1 Case study and discussion, phases 2 and 3 Summary and conclusion Definition: Conflict of Interest A situation in which a person has a private or personal interest sufficient to appear to influence the objective exercise of his or her official duties as, say, a public official, an employee, or a

professional. (MacDonald, McDonald and Norman 2002) Any factor that might tend to undermine a competent researchers ability to make scientifically reliable judgments concerning research strategy, evidence or conclusions. (Davis 1999) A set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest. (Institute of Medicine 2009) L.O. 7.3 Financial Interests Recruiting patients Research grants

Stock options L.O. 7.3 Non-financial Interests If theres no money, theres no conflict Tendency to focus on whats measurable ($$$) Non-financial interests often ignored completely Given much less attention in policies Not considered very harmful Less problematic than financial interests Recognizing these threatens professional identity Objectivity, neutrality, independence Non-financial interests can be especially problematic, because they are less recognized and less understood. L.O. 7.3

Case Study Determining the workforce costs of the AIDS epidemic L.O. 7.3 Managing COI in Practice Being in a COI is not unethical the issue is how to handle it. Guidance: 1. Identify COI, avoid when possible 2. Discuss with all concerned 3. Remove person from sensitive decisions Sometimes 1 and 3 are impossible. So 2 (transparency & dialogue) becomes crucial. L.O. 7.3 A Model for Ethical COI Management in Public Health

L.O. 7.3 Phase 1 Identifying the actors Where in the world are the COI? Theyre in the researcher and in the research setting Phase 2 The Context What is and What if? Phase 3 Take Home Messages What can we do better in the future? A Model for Ethical COI Management in Public Health

Educational PHASE Know what a COI is and appropriate policies Financial or non-financial? What policies are you subject to? Know yourself, the actors and evaluate the risk PHASE 1 PHASE 2 Where in the world are the COI? Theyre in the researcher and in the research setting Whos involved, what are their/your interests? Is there a problematic COI situation (actual/potential; financial/non-financial)? Know the context and how to manage it

What is? and What if? What are the benefits/risks of different resolution strategies? Take Home Messages PHASE 3 L.O. 7.3 What can we do better in the future: As a team - for future education and practice In terms of practice - to inform policy makers. Summary 1. Beyond a pejorative view of conflict of interest 2.

Attention to non-financial and institutional COI 3. Recognise some COI are endemic, unavoidable 4. Be proactive and systematic: Better prevent than cure 5. Use & limits of policies, procedures, guidelines 6.

Self-awareness, humility 7. Discuss integrity & ethical conduct L.O. 7.3 Sources MacDonald, C.; McDonald, M.; Norman, W. 2002. Charitable Conflicts of Interest Journal of Business Ethics 39(1): 67-74. Davis, M. 1999. Ethics and the University (London, UK: Routledge) Institute of Medicine. Conflict of Interest in Medical Research, Education, and Practice. Edited by B. Lo and M.J. Field, Washington, D.C.: Institute of Medicine Committee on Conflict of Interest in Medical Research, Education, and Practice, National Academies Press, 2009. http://www.nap.edu/catalog.php?record_id=12598

L.O. 7.3 Acknowledgements Chapter authors Potvin, Marie-Jose, Reproductive Ethics Research Group, School of Public Health, Universit de Montral, Montral, Qubec, Canada Williams-Jones, Bryn, Department of Social and Preventive Medicine, School of Public Health, Universit de Montral, Montral, Qubec, Canada L.O. 7.3

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