Susannah Rose

Susannah Rose

Associate Chief Experience Officer, Cleveland Clinic
Professional Staff, Department of Bioethics, Cleveland Clinic
Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University

Dissertation Title:"Conflicts of Interest among Oncology Clinical Trial Investigators and among Patient Advocacy Organizations, and Patient Preferences and Health Care Disparities"

The first paper is entitled "Relationships Between Authorship Contributions and Authors' Industry Financial Ties Among Oncology Clinical Trials." This paper tests the hypothesis that authors who play key scientific roles in oncology clinical trials are more likely than those who do not play such roles to have financial ties to industry. Data were abstracted from all trials (n=235 with 2,927 authors) published in the Journal of Clinical Oncology, between 1/1/2006 and 6/30/2007. The findings confirm that authors who perform key roles are more likely than authors who do not perform such roles to have financial ties to industry.

The second paper is entitled "Patient Preferences and Health Care Disparities." The Institute of Medicine's (1OM) proposes that any differences that exist between ethnic or racial groups in the utilization of health care that are due to patient preferences should be removed when calculating health care disparities. However, one objection to this proposal stems from the adaptive preferences problem, which asserts that disadvantaged minority groups might not prefer the best treatments because they have historically been denied full access to high-quality care. Therefore, giving adaptive preferences full weight in such calculations re-victimizes these disadvantaged minorities. I argue that we should respect all autonomous preferences, even if they are adaptive, because this treats minorities as if they have the same capacity to form autonomous preferences as do non-minorities.

The third paper is entitled "Patient Advocacy Organizations (PAOs): Institutional Conflicts of Interest (COI) Policies, Trust and Trustworthiness." PAOs shape health policy and provide education to patients with medical illnesses. Many PAOs have financial ties to industry, which might increase bias which could cause harm to patients. The 10M proposes policies that seek to reduce the risk of harm associated with COI and proposes that maintaining trust in organizations should be primary goal of COI policies. I expand upon the IOM's proposal to focus on trust by arguing that promoting trustworthiness and appropriately-placed trust are preferred goals of COI policies in order to minimize the risk of harm and maximize benefits to society. Additionally, I propose specific policies to help PAOs better manage COI.


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