Sports medicine clinicians face conflicts of interest in providing medical care to athletes. Using a survey of college football players, this study evaluates whether athletes are aware of these conflicts of interest, whether these conflicts affect athlete trust in their health care providers, or whether conflicts or athletes' trust in stakeholders are associated with athletes' injury reporting behaviors.

Drug Safety Communications are used by the Food and Drug Administration to inform health care providers, patients, caregivers, and the general public about safety issues related to FDA-approved drugs. To assess patient knowledge of the messaging contained in DSCs related to the sleep aids zolpidem and eszopiclone, we conducted a large, cross-sectional patient survey of 1,982 commercially insured patients selected by stratified random sampling from the Optum Research Database who had filled at least two prescriptions for either zolpidem or eszopiclone (...) between July 1, 2012 and June 30, 2013. Among the 594 respondents, two-thirds reported hearing generally about drug safety information prior to starting a new drug, with the remaining one-third “rarely” or “never” hearing such information. Providers and pharmacists were primary sources of drug safety information. Two-thirds of zolpidem users and half of eszopiclone users reported having heard about the related DSC messages, ability to accurately identify the major factual messages was limited. Respondents reacted to new drug safety information about their sleep aids by reporting that they would want to learn about alternative ways to help them sleep and seek out more information about the safety of their specific sleeping pill. Opportunities may exist for the FDA to work with providers and pharmacies to help ensure the DSC information is more widely received and is more fully understood by those taking the affected medications. (shrink)

Medical aid in dying (MAiD), despite being legal in many jurisdictions, remains controversial ethically. Existing surveys of physicians’ perceptions of MAiD tend to focus on the legal or moral permissibility of MAiD in general. Using a novel sampling strategy, we surveyed physicians likely to have engaged in MAiD-related activities in Colorado to assess their attitudes toward contemporary ethical issues in MAiD.

The conflicts of interest that may arise in relationships between academic researchers and industry continue to prompt controversy. The bulk of attention has focused on financial aspects of these relationships, but conflicts may also arise in the legal obligations that faculty acquire through consulting contracts. However, oversight of faculty members' consulting agreements is far less vigorous than for financial conflicts, creating the potential for faculty to knowingly or unwittingly contract away important rights and freedoms. Increased regulation could prevent this, but (...) it is unclear what forms of oversight universities view as feasible and effective. In this article, we report on a Delphi study to evaluate several approaches for oversight of consulting agreements by medical schools. The panel was comprised of 11 senior administrators with responsibility for oversight of faculty consulting relationships. We found broad agreement among panelists regarding the importance of institutional oversight to protect universities' interests. There was strong support for two specific approaches: providing educational resources to faculty and submitting consulting agreements for institutional review. Notwithstanding the complexities of asserting authority to regulate private consulting agreements between faculty members and companies, medical school administrators reached consensus that several approaches to improving institutional oversight are feasible and useful. (shrink)

Public disclosure of industry payments to physicians is one way to address financial conflicts of interest in medicine. As part of the Patient Protection and Affordable Care Act, the Physician Payment Sunshine Act requires pharmaceutical, medical device, and biologics manufacturers who have at least one product reimbursed by Medicare or Medicaid to disclose payments to physicians and teaching hospitals on a public website starting in 2014. The physician payment data will contain individual physician names, monetary values, and specific products connected (...) to payments.According to the Final Regulations issued by the Centers for Medicare and Medicaid Services in February 2013, the law will make transparent the extent and nature of relationships between physicians, teaching hospitals, and manufacturers. (shrink)

BackgroundRandomized controlled trials (RCTs) are often complex and expensive to perform. Less than one third achieve planned recruitment targets, follow-up can be labor-intensive, and many have limited real-world generalizability. Designs for RCTs conducted using cohorts and routinely collected health data, including registries, electronic health records, and administrative databases, have been proposed to address these challenges and are being rapidly adopted. These designs, however, are relatively recent innovations, and published RCT reports often do not describe important aspects of their methodology in (...) a standardized way. Our objective is to extend the Consolidated Standards of Reporting Trials (CONSORT) statement with a consensus-driven reporting guideline for RCTs using cohorts and routinely collected health data.MethodsThe development of this CONSORT extension will consist of five phases. Phase 1 (completed) consisted of the project launch, including fundraising, the establishment of a research team, and development of a conceptual framework. In phase 2, a systematic review will be performed to identify publications (1) that describe methods or reporting considerations for RCTs conducted using cohorts and routinely collected health data or (2) that are protocols or report results from such RCTs. An initial “long list” of possible modifications to CONSORT checklist items and possible new items for the reporting guideline will be generated based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) and The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statements. Additional possible modifications and new items will be identified based on the results of the systematic review. Phase 3 will consist of a three-round Delphi exercise with methods and content experts to evaluate the “long list” and generate a “short list” of key items. In phase 4, these items will serve as the basis for an in-person consensus meeting to finalize a core set of items to be included in the reporting guideline and checklist. Phase 5 will involve drafting the checklist and elaboration-explanation documents, and dissemination and implementation of the guideline.DiscussionDevelopment of this CONSORT extension will contribute to more transparent reporting of RCTs conducted using cohorts and routinely collected health data. (shrink)

Children and individuals with developmental disabilities compared to typical participants are disadvantaged not only by virtue of being vulnerable to risks inherent in research participation but also by the higher likelihood of exclusion from research altogether. Current regulatory and ethical guidelines although necessary for their protection do not sufficiently ensure fair distributive justice. Yet, in view of disproportionately higher burdens of co-occurring physical and mental disorders in individuals with DD, they are better positioned to benefit from research by equitable participation. (...) Greater elucidation of this ethical dilemma is called for by researchers, institutional review boards, and funding agencies to urgently redress the imbalance. This article discusses many of the regulatory principles to ensure better research participation of children and individuals with DD: human rights, validity, distributive justice, beneficence/nonmaleficence, and autonomy. (shrink)

In a recent no-go theorem [Bong et al., Nature Physics (2020)], we proved that the predictions of unitary quantum mechanics for an extended Wigner’s friend scenario are incompatible with any theory satisfying three metaphysical assumptions, the conjunction of which we call “Local Friendliness”: Absoluteness of Observed Events, Locality and No-Superdeterminism. In this paper (based on an invited talk for the QBism jubilee at the 2019 Växjö conference) I discuss the implications of this theorem for QBism, as seen from the point (...) of view of experimental metaphysics. I argue that the key distinction between QBism and realist interpretations of quantum mechanics is best understood in terms of their adherence to different theories of truth: the pragmatist versus the correspondence theories. I argue that a productive pathway to resolve the measurement problem within a pragmatist view involves taking seriously the perspective of quantum betting agents, even those in what I call a “Wigner bubble”. The notion of reality afforded by QBism, I propose, will correspond to the invariant elements of any theory that has pragmatic value to all rational agents—that is, the elements that are invariant upon changes of agent perspectives. The classical notion of ‘event’ is not among those invariants, even when those events are observed by some agent. Neither are quantum states. Nevertheless, I argue that far from solipsism, a personalist view of quantum states is an expression of its precise opposite: Copernicanism. (shrink)

Lawrence et al. have presented an argument purporting to show that “relative facts do not exist” and, consequently, “Relational Quantum Mechanics is incompatible with quantum mechanics”. The argument is based on a GHZ-like contradiction between constraints satisfied by measurement outcomes in an extended Wigner’s friend scenario. Here we present a strengthened version of the argument, and show why, contrary to the claim by Lawrence et al., these arguments do not contradict the consistency of a theory of relative facts. Rather, considering (...) this argument helps clarify how one should not think about a theory of relative facts, like RQM. (shrink)

Bellʼs 1964 theorem causes a severe problem for the notion that correlations require explanation, encapsulated in Reichenbachʼs principle of common cause. Despite being a hallmark of scientific thought, dropping the principle has been widely regarded as much less bitter medicine than the perceived alternative—dropping relativistic causality. Recently, however, some authors have proposed that modified forms of Reichenbachʼs principle could be maintained even with relativistic causality. Here we break down Reichenbachʼs principle into two independent assumptions—the principle of common cause proper and (...) factorization of probabilities. We show how Bellʼs theorem can be derived from these two assumptions plus relativistic causality and the law of total probability for actual events, and we review proposals to drop each of these assumptions in light of the theorem. In particular, we show that the non-commutative common causes of Hofer-Szabó and Vecsernyés fail to have an analogue of the notion that the common causes can explain the observed correlations. Moreover, we show that their definition can be satisfied trivially by any quantum product state for any quantum correlations. We also discuss how the conditional states approach of Leifer and Spekkens fares in this regard. (shrink)

The 1964 theorem of John Bell shows that no model that reproduces the predictions of quantum mechanics can simultaneously satisfy the assumptions of locality and determinism. On the other hand, the assumptions of signal locality plus predictability are also sufficient to derive Bell inequalities. This simple theorem, previously noted but published only relatively recently by Masanes, Acin and Gisin, has fundamental implications not entirely appreciated. Firstly, nothing can be concluded about the ontological assumptions of locality or determinism independently of each (...) other—it is possible to reproduce quantum mechanics with deterministic models that violate locality as well as indeterministic models that satisfy locality. On the other hand, the operational assumption of signal locality is an empirically testable (and well-tested) consequence of relativity. Thus Bell inequality violations imply that we can trust that some events are fundamentally unpredictable, even if we cannot trust that they are indeterministic. This result grounds the quantum-mechanical prohibition of arbitrarily accurate predictions on the assumption of no superluminal signalling, regardless of any postulates of quantum mechanics. It also sheds a new light on an early stage of the historical debate between Einstein and Bohr. (shrink)

I apply some of the lessons from quantum theory, in particular from Bell’s theorem, to a debate on the foundations of decision theory and causation. By tracing a formal analogy between the basic assumptions of causal decision theory (CDT)—which was developed partly in response to Newcomb’s problem— and those of a local hidden variable theory in the context of quantum mechanics, I show that an agent who acts according to CDT and gives any nonzero credence to some possible causal interpretations (...) underlying quantum phenomena should bet against quantum mechanics in some feasible game scenarios involving entangled systems, no matter what evidence they acquire. As a consequence, either the most accepted version of decision theory is wrong, or it provides a practical distinction, in terms of the prescribed behaviour of rational agents, between some metaphysical hypotheses regarding the causal structure underlying quantum mechanics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Matter and Spirit in the Age of Animal MagnetismEric G. WilsonDuring the Romantic period, writers on both sides of the Atlantic explored the sleepwalker as a merger of holiness and horror. Emerging when scientific thinkers for the first time were connecting spirit to electricity and magnetism, the somnambulist became to certain Romantics a disclosure of the difficulty of harmonizing unseen and seen, agency and necessity. This problem prominently arose (...) in Anton Mesmer's late eighteenth-century experiments in animal magnetism, in which the sleepwalker proved a paradox: an opaque revelation of transparent currents and an unconscious vehicle of sophisticated thought. Romantics such as Coleridge embraced the somnambulist as an embodiment of these troubles involved in relating motion and meaning. Coleridge and those who responded to him saw in the hypnotized human this sobering possibility: the invisible requires the visible to make itself manifest while the visible needs the invisible to become significant. 1 This is sublime and sinister: to elevate a material form to spiritual power is transcendence; to sink the boundless into a body is grotesque.Here I explore the philosophical implications of animal magnetism, the place of the sleepwalker in the history of ideas, and the role of the hypnotized human in Romantic writers, especially Coleridge. I also meditate on relationships between matter and spirit, machine and human, word and thing. Along the way, I place the history of ideas and the works of Romantic writers in mutually illuminating dialogues. The literary texts shed fresh light on philosophical problems while the ideas reveal hidden literary elements.The somnambulistic trance had been around long before Mesmer's magnetic sleeps. For centuries, shamans had used auto-hypnosis to sound [End Page 329] their souls and other-hypnosis to cure their tribe-members' ailments. However, somnambulism could not become a scientific phenomenon until Europeans in laboratories began to study electricity and magnetism. In the early modern period, Paracelsus argued that a vital fluid courses through the cosmos. The human being draws this flow like a magnet attracts force. When the body pulls to itself evil effluvia, it falls ill. To return patients to health, Paracelsus placed magnets on painful areas. He hoped to extract the unwanted current and return it to the cosmic swirl. 2 In "magnetizing" spirit, Paracelsus opened a door for empirical inquiry into the invisible world. In 1600, William Gilbert claimed that magnets correspond to the earth: both are animated by universal attraction and repulsion. 3 By the end of the seventeenth-century, Newton proposed that things are impelled by a force that draws and repels. Newton's theory of gravity inspired natural philosophers of the next centuries to search for a principle of which the magnet and the spark are manifestations. 4During the second half of the eighteenth century and the early part of the nineteenth, natural philosophers explored electricity and magnetism with unprecedented precision. In 1752, Benjamin Franklin revealed the mystery of lightning and perhaps the spark of life. 5 Inspired by Franklin, F. C. Oetinger, J. L. Fricker, and Prokop Divisch developed a theology of electricity, based on the belief that God is the electrical current. 6 Later in the century, Luigi Galvani and Alessandro Volta debated over whether the galvanic flow might be the origin and principle of life itself. 7 A few years before Franklin harvested lightning, John Michell argued that the magnetic force is not constrained to lodestones but is possibly pervasive. Some years later, Franz Aepinus suggested that magnetism and electricity manifest a deep energy. Soon after, C. A. de Coulomb discovered the mathematical law by which electrical and magnetic forces operate (Whittaker, pp. 50–59).These findings led to the breakthroughs of the nineteenth century. 8 In 1807, Humphry Davy hypothesized that chemical elements interact through electromagnetic affinity or repulsion. 9 In 1820, H. C. Oersted demonstrated the correspondence between electricity and magnetism. The same year, A. M. Ampere formulated the laws by which electrical and magnetic currents interact (Whittaker, pp. 81–86). Michael Faraday in 1831 revealed electromagnetic induction and thus inaugurated a second Copernican revolution: he showed that matter is not solid and discrete but a field of electromagnetic energy. 10 The dreams of [End... (shrink)

This experiment investigated the effect of format (line vs. bar), viewers’ familiarity with variables, and viewers’ graphicacy (graphical literacy) skills on the comprehension of multivariate (three variable) data presented in graphs. Fifty-five undergraduates provided written descriptions of data for a set of 14 line or bar graphs, half of which depicted variables familiar to the population and half of which depicted variables unfamiliar to the population. Participants then took a test of graphicacy skills. As predicted, the format influenced viewers’ interpretations (...) of data. Specifically, viewers were more likely to describe x–y interactions when viewing line graphs than when viewing bar graphs, and they were more likely to describe main effects and “z–y” (the variable in the legend) interactions when viewing bar graphs than when viewing line graphs. Familiarity of data presented and individuals’ graphicacy skills interacted with the influence of graph format. Specifically, viewers were most likely to generate inferences only when they had high graphicacy skills, the data were familiar and thus the information inferred was expected, and the format supported those inferences. Implications for multivariate data display are discussed. (shrink)