Download - Industry Funding Of Medical Education
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Dr. Sami A. R. J. El Jundi, MD, MSc
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Key conceptsTRANSPARENCY: the quality or state of being transparent
Synonyms: clearness, limpidity, limpidness, lucency, translucence, translucency, clarity
TRANSPARENTa : free from pretense or deceit : frankb : easily detected or seen through : obviousc : readily understoodd : characterized by visibility or accessibility of information especially concerning business practices
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Psicology of decision makingBevan W. Subliminal Stimulation: A Pervasive Problem for Psychology. Psychological bulletin. 1964 Feb;61:81‐99. Zimbardo PG. On the ethics of intervention in human psychological research: with special reference to the Stanford Prison Experiment. Cognition. 1973;2(2):243‐56. Tversky A, Kahneman D. The framing of decisions and the psychology of choice. Science. 1981 Jan 30;211(4481):453‐8.
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Decision making coherence theorySimetry: coherence and incoherence are symmetric relaions. If F1 F2, then F2 F1.Facilitation: actions (A) that lead to goals/objectives (O)
Ai OA1 AnThe more A, the less coherence between An and O.A and O are “factors”, because they may change positions.
Thagard, P. Millgram, E. Inference to the best plan: a coherence theory of decision.In: Ram, A & Leake, DB (Eds), Goal-driven learning: Cambridge, MIT Press, 1995.
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Rules for coherenceIncompatibility:
If two factors cannot be achieved, they are strongly incoherentIf they are harder to achieve together, they are weakly incoherent
Objetives (goals) priorities: some goals are desirable due to intrinsic or non‐coherent reasons (AFECTIVE).Judgment: facilitation and competition relations can depend on admission judgments.Decisions: are taken based in a global coherence of actions and objectives evaluation.
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Mechanism of coherence“Affective manipulation”, via prefrontal cortex:
Heuristics of decisionPrioritaire factors (O e A) stablish the pathway
Process economyNo other areas intervention requiredReinforced by the speed it is done
Previous experienceHigh probability of success (reward)Operative conditioning, even in a more complex fashion
Complex interaction of cognitive factors and external influence (marketing, social networks, etc)Subconscious level of processing: 90%
Final objetive/goal: reaching the objetive (reward) through the most “efficient”, “shortest” and “fastest” path, keeping affective homeostasis.
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Decision making frame in individual levelLimits of decision autonomy: freedom a priori grade
Affective “anchor”
Effective freedom of decision
Morality (Kohlberg)
Culture
Rules and regulations
Economy
Inteligence
Information
Affection
Ideology
Prejudice
Conditioned reflex (Pavlov)
Operationl conditioning (Skinner)Social networks
PoliticsInstitucional policy
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Influence of information in decision‐making
Process: how does it interfere?Quality: which information?Quantity: how much information?Timely: when providing/requiring information?Source: whose information?
Power: effectiveness in redirecting (influencing) decision!
Affective “anchor”
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Positive feedback of influence
Highly rankedprofessional
$$$
CredibilityAffective bondInformation
Affective bondConfidencePrescription
Source
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... while there is conflict, it is not between desire and reason, but between a desire which wants a near‐by object and a desire which wants an object which is seen by thought to occur in consequence of an intervening series of
conditions, or in the “long run”.
Dewey, J. (1932) Ethics in The CollectedWork of John Dewey (1969‐1991). Boydston, JA (eds): Carbondale, Southern Illinois University Press.
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Final theoretical considerationsIf information creates a “threat” to goals/objectives achievement, it will be regarded to second plan, or even discarded as prejudicial
If information creates and emotional imbalanced state, it will be ignored as a factor in decision
Full disclosure of conflicts has a more than potential adverse effect – quite the opposite of desired – in medical decision making
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Decision‐making as a systemic process...
There are no simple solutions for complex problems
Transparency means providing information about ones interests – “full disclosure”Decision making as an individual process is strongly influenced by non‐rational issues – strongest biasTransparency does not solve the conflict. Instead, it creates a “frame of morality” and legitimates the process of influencing decision‐making
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... requires systemic solutions for conflicts
Public fundingPrivate anonymous fundingClear rules of engagementFull disclosure, including personal financesSubject to public screeningIndependent groups and publications
Transparency means nothing without INDEPENDENCY and even jeopardizes
it’s own purpose
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samieljundi@risk‐0.com