Medical Academia Conflict of Interest Policy and Potential Impact on Research Funding by Michael K. Maahs MPA, Troy University, 1993 BA, Ripon College, 1990 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Policy and Administration Walden University July 2015 The partnership between medical academia and the pharmaceutical industry has been scrutinized for issues associated with research bias. As a result of this scrutiny, the Institute of Medicine (IOM) issued policy recommendations in 2009 directing academia to adopt comprehensive conflict of interest (COI) policies. During the same time, a slowdown of funded research into academia occurred, and it is not clear whether the IOM recommendations contributed to this problem. The purpose of this case study was to determine the extent to which compliance with the IOM policy resulted in a reduction in funded research. The Advocacy Coalition Framework (ACF) was the theoretical lens used for study. COI policy statements (n = 15) were analyzed from American Association of Medical Colleges member schools that engage in medical research. In addition, in-depth interviews were conducted with 4 medical academic researchers. Data were inductively coded and organized around key themes. Key findings indicated that medical academia is compliant with IOM recommendations and COI policies did not appear to have a direct effect on research placement by industry. Interestingly, a possible explanation for reductions in industry funding relate to inefficient institutional review board processes. Additionally, the ACF construct was validated via an observed complex and slowly evolving COI policy process. The positive social change implications of this study include recommendations to academia to continue to monitor and report on COI and explore efficiency improvements related to IRB oversight in order to support important pharmaceutical research that ultimately improves the health and wellbeing of people.

<p>Bakgrund</p><p>Inom de investmentbanker som idag erbjuder heltäckande tjänster inom värdepappershandel och företagsrelaterade finanstjänster uppstår konflikter som grundar sig på vems intresse som kommer i första hand. I denna process har finansanalytikern en central roll där det finns en risk att hamna i en intressekonflikt med corporate finance avdelningen. Finansanalytikerns oberoende är viktigt då analyserna har påverkan på kursbildningen på värdepappersmarknaden.</p><p>Syfte</p><p>Syftet med denna kandidatuppsats är att beskriva hur ett antal svenska investmentbanker arbetar för att främja finansanalytikerns oberoende i sin yrkesroll. För att tydliggöra oberoendet kommer intressekonflikten mellan analysavdelningen och corporate finance avdelningen att beskrivas då problematiken kring finansanalytikerns oberoende här är som tydligast.</p><p>Metod</p><p>En kvalitativ ansats har valt för att uppfylla uppsatsens syfte. Tre personliga djupintervjuer genomfördes med investmentbanker och Finansinspektionen. Ytterligare en telefonintervju genomfördes med ett analyshus som marknadsför sig som oberoende. Detta gav sammanlagt tre olika perspektiv på problemet.</p><p>Slutsats</p><p>Investmentbankerna främjar finansanalytikerns oberoende genom att skapa förutsättningar för att denne ska kunna ha en hög integritet i sin yrkesroll. Dessa förutsättningar skapas genom att följa lagen och de rekommendationer som Finansinspektionen ger. Tillsammans med interna regler och incitament stärks finansanalytikerns oberoende gentemot corporate finance avdelningen.</p> / <p>Background</p><p>Within today’s full-service investment banks conflicts of interest related to who’s interest that comes first appears. Within this process the equity researcher has a fundamental profession and is exposed to conflicts of interest mainly towards the corporate finance department. The equity researcher’s independence is of importance since the analyses have impact on the determination of prices on the securities market.</p><p>Purpose</p><p>The purpose of this bachelor thesis is to describe how a number of Swedish investment banks operate to promote independence in the equity researcher’s profession. To describe the independence, conflicts of interest between the equity research department and the corporate finance department will be described. This situation chosen because of the problematic situation concerning the equity researcher’s independence that appears.</p><p>Method</p><p>A qualitative approach has been chosen to fulfil the purpose of the bachelor thesis. Three personal in-depth interviews have been conducted with investment banks as well as the Swedish Financial Supervisory Authority. One additional telephone interview was conducted with a company promoting itself as an independent equity researcher. This together gave us three different perspectives of the problem.</p><p>Conclusion</p><p>The investment banks promote the equity researcher’s independence by creating conditions to maintain a high integrity in their profession. These conditions are created by following the law and the recommendations given by the Swedish Financial Supervisory Authority. Together with internal rules and incentives, the equity researcher’s independence towards corporate finance will strengthen.</p>

1 Abstract: The diploma thesis applies sociological perspective on interrelationships of pharmaceutical industry, physicians and patients. Its main focus is on the role of pharmaceutical industry in context of relationships with the two other actors. The first part of the work summarizes available Czech and mainly foreign social science literature referring to the broad network of relations. The transformation of medical profession in current society and the development of international pharmaceutical industry in the Czech Republic are also discussed. The empirical part of the thesis reports the findings of a qualitative interview study undertaken with ambulatory physicians concerning their relationships with pharmaceutical companies. The goal of the research was to explore how and why Czech physicians interact with the pharmaceutical companies, gain insight into their ethical evaluation and assessment of consequences and detect the strategies and rationalizations they use to cope with these relationships. Keywords: pharmaceutical industry, physician, patient, conflict of interest, sociology of medicine

The aim of this thesis is to analyze conflict of interest which is connected to investment services as well as its current and upcoming regulation. The reason for that is quite obvious - there simply is a lot of going on within financial market and its regulation right now. This particular issue might seem to be theoretical and technical, though the consequences are crucial for practice in today's sophisticated, global and complex financial market that is under pressure from the public and politicians. The thesis is composed of six chapters, each of them dealing with different sorts of regulation of conflict of interest, except for Chapter One that is introductory, defines basic terminology used in the thesis and its purpose as well as points out basic questions that are answered in conclusion. First question is whether or not regulate conflict of interest. If so, what is the direction that should be followed by legislators - prevention, management of conflict of interest etc.? And is current regulation of conflict of interest sufficient and effective? And in that regard is it correct to differentiate more between retail and professional investors? I present answers based on my deep and precise research. Chapter Two describes conflicts of interest in general and then particularly in the area of...

Since the 1990s, academic physicians have been subjected to increased requirements for disclosure in their roles as educators and researchers and for conflict of interest (COI) resolution in their financial relationships with pharmaceutical, medical device, and biotech companies, collectively referred to as industry. The requirements are the result of the convergence of federal regulations, accreditation guidelines, professional and industry codes of ethics and conduct, and institutional policies. The disclosure and COI resolution requirements are managed and resolved by a review of forms and compliance with relevant guidance documents and policies. In the context of this environmental oversight, the purpose of the qualitative study was to explore physicians’ perspectives of how they manage and resolve conflicts of interest in their academic roles of teaching, research, and patient care. Minimal evidence-based research exists in the literature from the physician’s viewpoint. The grounded theory study examined the research question by using an issue-contingent, ethical decision-making theoretical framework from the management literature. The data were collected using a general interview guide that consisted of three sections – general questions regarding purpose and demographics, discussion of three case scenarios (teaching, research, and clinical practice), and finally, general concluding questions to assess the environment that is indicative of the context of the study. The theory emerged from the interview data as a refined theory representing a four-step ethical decision-making process with emphasis on the characteristics of physicians as moral agents. The study’s findings further indicated that bias is a significant concern. The study identified reasons physicians enter into financial relationships with industry, the risks and benefits associated with those relationships, methods for avoiding bias, and the need for healthy academic-industry collaborative research.

In this thesis, we study if credit rating agencies (CRAs) are capable, through their rating process, of discover information that it is valued by the market. Additionally, we investigate if CRAs are able to propagate their findings to the market. if Specifically, we study the differences between issuer-paid and investor-paid credit rating agencies, and how those differences shape the characteristics of their credit ratings and ultimately, if investors can profit from credit rating announcements. For our research we use a large dataset of rating announcements from 1997 to 2012, which includes information of four credit rating agencies (CRAs), Egan-Jones Ratings Company (EJR), Fitch, Moody's and Standard and Poor's, which representing investor-paid and issuer-paid CRAs. This allows us to compare these two kind of agencies and its ratings. In the first essay we study what variables explain the rating coverage of an investor-paid credit rating agency. We show that probability of being covered by EJR is positively related with the size of the firm, the level of institutional ownership of the firm, stock analysts and issuer-paid CRAs level of coverage, while it is negatively related to the firm's corporate governance. We found that the likelihood of being covered by EJR augments after regulatory changes and most interestingly, since EJR received the NRSRO certification. In the second essay we compare the timeliness of rating changes produced by EJR and the issuer-paid CRAs representatives. We found that the lead effect of investor-paid over issuer-paid CRAs has weakened in recent years, while Granger causality is bidirectional and therefore a lead-lag relationship cannot be established. Finally, stock prices manifest statistically significant abnormal reactions to downgrades of all agencies; however, abnormal negative returns are significantly higher for EJR. Our results support the hypothesis that issuer-paid agencies improve the quality and timeliness of their ratings when they see their market power threatened by tighter regulations. Nevertheless, event studies illustrate that markets still price stocks under the assumption that investor-paid rating actions carry superior information. Finally, our third essay found that purchasing (selling short) stocks with positive (negative) rating announcements generates portfolios with positive annual abnormal returns when investors react immediately to rating announcements. Returns are higher for stronger announcements (i.e. rating changes over rating outlooks) and for an investor-paid agency rather than an issuer-paid agency. When we introduced transaction costs, only the investor-paid agencies' announcements lead to positive abnormal returns. Additionally, when we included a delay in the reaction of investors to rating announcements, all positive abnormal returns net of transaction costs disappeared. Finally, our results suggests that the differences between investor-paid and issuer-paid agencies are based on their dissimilar business models rather than their regulatory status.

The partnership between medical academia and the pharmaceutical industry has been scrutinized for issues associated with research bias. As a result of this scrutiny, the Institute of Medicine (IOM) issued policy recommendations in 2009 directing academia to adopt comprehensive conflict of interest (COI) policies. During the same time, a slowdown of funded research into academia occurred, and it is not clear whether the IOM recommendations contributed to this problem. The purpose of this case study was to determine the extent to which compliance with the IOM policy resulted in a reduction in funded research. The Advocacy Coalition Framework (ACF) was the theoretical lens used for study. COI policy statements (n = 15) were analyzed from American Association of Medical Colleges member schools that engage in medical research. In addition, in-depth interviews were conducted with 4 medical academic researchers. Data were inductively coded and organized around key themes. Key findings indicated that medical academia is compliant with IOM recommendations and COI policies did not appear to have a direct effect on research placement by industry. Interestingly, a possible explanation for reductions in industry funding relate to inefficient institutional review board processes. Additionally, the ACF construct was validated via an observed complex and slowly evolving COI policy process. The positive social change implications of this study include recommendations to academia to continue to monitor and report on COI and explore efficiency improvements related to IRB oversight in order to support important pharmaceutical research that ultimately improves the health and wellbeing of people.

<p><strong></strong></p><p><strong></strong></p><p>Konflikt betyder sammanstötning eller krock och syftar då till exempel till krock mellan förväntningar, värderingar, mål eller behov. I Sverige är kommuner de som ger mest pengar åt idrottsföreningar, som också är den största verksamheten som bedrivs i samhället med över tre miljoner medlemmar. Trots att idrottsverksamheten är så stor i dagens samhällse blir inte bara vuxna utan även barn mer stillasittande. Stillasittandet påverkar framförallt den fysiska hälsan negativt. Syftet med uppsatsen är att undersöka om det finns en intressekonflikt mellan kommunen och idrottsföreningarnas syn på barn och ungdomars deltagande i idrottsföreningar. En representant från kommunen och representanter från tre idrottsföreningar tillhörande den valda kommunen valdes för intervju. Fyra stycken intervjuer genomfördes med representanter från de tre idrottsföreningarna och kommunen. Frågorna berörde det nuvarande samarbetet mellan aktörerna, mål för verksamheten och tankar kring barn och ungdomars deltagande. Resultatet visade att intressekonflikter förekommer men att de inte är så stora. I de fall de förekommer handlar det ofta om ekonomi. Både representanter från kommun och idrottsföreningar anser det är viktigt att alla ska få vara med och spela och känna sig välkomna i lagen. Det anses också att bredd- och elitidrotten lever i symbios med varandra. Representanterna från kommun och föreningar tycker att samarbetet som finns fungerar bra generellt sett men att förbättringar kan göras. Slutsatsen är att intressekonflikter mellan kommun och idrottsföreningar existerar i mindre grad och att samarbetet mellan dessa kan förbättras. </p>

Bakgrund Inom de investmentbanker som idag erbjuder heltäckande tjänster inom värdepappershandel och företagsrelaterade finanstjänster uppstår konflikter som grundar sig på vems intresse som kommer i första hand. I denna process har finansanalytikern en central roll där det finns en risk att hamna i en intressekonflikt med corporate finance avdelningen. Finansanalytikerns oberoende är viktigt då analyserna har påverkan på kursbildningen på värdepappersmarknaden. Syfte Syftet med denna kandidatuppsats är att beskriva hur ett antal svenska investmentbanker arbetar för att främja finansanalytikerns oberoende i sin yrkesroll. För att tydliggöra oberoendet kommer intressekonflikten mellan analysavdelningen och corporate finance avdelningen att beskrivas då problematiken kring finansanalytikerns oberoende här är som tydligast. Metod En kvalitativ ansats har valt för att uppfylla uppsatsens syfte. Tre personliga djupintervjuer genomfördes med investmentbanker och Finansinspektionen. Ytterligare en telefonintervju genomfördes med ett analyshus som marknadsför sig som oberoende. Detta gav sammanlagt tre olika perspektiv på problemet. Slutsats Investmentbankerna främjar finansanalytikerns oberoende genom att skapa förutsättningar för att denne ska kunna ha en hög integritet i sin yrkesroll. Dessa förutsättningar skapas genom att följa lagen och de rekommendationer som Finansinspektionen ger. Tillsammans med interna regler och incitament stärks finansanalytikerns oberoende gentemot corporate finance avdelningen. / Background Within today’s full-service investment banks conflicts of interest related to who’s interest that comes first appears. Within this process the equity researcher has a fundamental profession and is exposed to conflicts of interest mainly towards the corporate finance department. The equity researcher’s independence is of importance since the analyses have impact on the determination of prices on the securities market. Purpose The purpose of this bachelor thesis is to describe how a number of Swedish investment banks operate to promote independence in the equity researcher’s profession. To describe the independence, conflicts of interest between the equity research department and the corporate finance department will be described. This situation chosen because of the problematic situation concerning the equity researcher’s independence that appears. Method A qualitative approach has been chosen to fulfil the purpose of the bachelor thesis. Three personal in-depth interviews have been conducted with investment banks as well as the Swedish Financial Supervisory Authority. One additional telephone interview was conducted with a company promoting itself as an independent equity researcher. This together gave us three different perspectives of the problem. Conclusion The investment banks promote the equity researcher’s independence by creating conditions to maintain a high integrity in their profession. These conditions are created by following the law and the recommendations given by the Swedish Financial Supervisory Authority. Together with internal rules and incentives, the equity researcher’s independence towards corporate finance will strengthen.

Konflikt betyder sammanstötning eller krock och syftar då till exempel till krock mellan förväntningar, värderingar, mål eller behov. I Sverige är kommuner de som ger mest pengar åt idrottsföreningar, som också är den största verksamheten som bedrivs i samhället med över tre miljoner medlemmar. Trots att idrottsverksamheten är så stor i dagens samhällse blir inte bara vuxna utan även barn mer stillasittande. Stillasittandet påverkar framförallt den fysiska hälsan negativt. Syftet med uppsatsen är att undersöka om det finns en intressekonflikt mellan kommunen och idrottsföreningarnas syn på barn och ungdomars deltagande i idrottsföreningar. En representant från kommunen och representanter från tre idrottsföreningar tillhörande den valda kommunen valdes för intervju. Fyra stycken intervjuer genomfördes med representanter från de tre idrottsföreningarna och kommunen. Frågorna berörde det nuvarande samarbetet mellan aktörerna, mål för verksamheten och tankar kring barn och ungdomars deltagande. Resultatet visade att intressekonflikter förekommer men att de inte är så stora. I de fall de förekommer handlar det ofta om ekonomi. Både representanter från kommun och idrottsföreningar anser det är viktigt att alla ska få vara med och spela och känna sig välkomna i lagen. Det anses också att bredd- och elitidrotten lever i symbios med varandra. Representanterna från kommun och föreningar tycker att samarbetet som finns fungerar bra generellt sett men att förbättringar kan göras. Slutsatsen är att intressekonflikter mellan kommun och idrottsföreningar existerar i mindre grad och att samarbetet mellan dessa kan förbättras.